Sexual and Reproductive Health in Adolescents and Young Adults With Psychotic Disorders: A Scoping Review

Abstract

Background and Hypothesis The sexual and reproductive health (SRH) of young people with psychosis has been largely overlooked. We hypothesised that there are key deficiencies in the existing literature on the SRH of adolescents and young adults with psychotic disorders. Study Design We conducted a systematic scoping review using Pubmed, Web of Science, Embase, PsycINFO, and CINAHL. We included empirical studies and case reports focused on SRH issues in young people (aged 14–24 years) with psychotic disorders. A qualitative synthesis was completed. Joanna Briggs Institute Critical Appraisal Tools were utilized to assess study quality. Study Results Seventeen empirical studies and 52 case reports met inclusion criteria. Most focused on sexual dysfunction which was identified as common among this cohort and associated with both psychotic disorders and antipsychotics. The study population was more likely to engage in sexual risk-taking behavior and was at higher risk of sexually transmissible infections than those without psychosis. SRH topics of clinical relevance in older patients with psychosis such as pregnancy, abortion, sexual violence, coercion, sexual identity, and gender were poorly addressed in this younger group. We found empirical studies generally lacked identification and controlling of confounders whilst case reports provided limited description of mental health and SRH outcomes following clinical intervention. Conclusion Research and clinical practice addressing sexual and reproductive health is needed for young people living with psychosis. To address research gaps future studies should focus on women’s health, sexual violence, gender, and sexuality in young people with psychosis.

Monitoring the Effectiveness of Treatment in Women with Schizophrenia: New Specialized Cooperative Approaches

“…Women with schizophrenia who are on contraceptive medication, those who show premenstrual symptom exacerbation or are pregnant, those who are postpartum or lactating, and those undergoing menopause all require antipsychotic drug adjustments due to changed hormonal milieu [ 81 , 82 ]. At the time of menopause, the use of long-acting injectable antipsychotics eludes first-pass liver metabolism and, thus, overcomes the effect of estrogen loss on the action of estrogen-dependent liver enzymes, subsequently preventing raised doses and concomitant adverse effects [ 11 ].…”

Improving treatment of women with schizophrenia: a review of the recent literature

“…Careful history taking and early intervention [26] Early phases of disorder Negative influence of hyperprolactinemia on cognition Screening, prevention, and monitoring of hyperprolactinemia [27,28] Sexual dysfunction Sexual health interventions [29] Abortion and sexual violence Psychoeducation, family planning [30][31][32][33][34][35] Sexual and reproductive health…”

“…High prolactin levels reduce fertility. Yu and collaborators [29] asked about reproductive concerns in 15 women with schizophrenia (age [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. The women's main concerns were psychological barriers to reproduction such as discouragement by their partners and by medical/psychiatric staff.…”

“…The issue of parenting needs to be raised with women with schizophrenia, and thoroughly discussed. If children are not wanted or motherhood is unrealistic at the time, it is important to ensure that contraceptive measures are in place [31]. A systematic scoping review by Vickers and collaborators [32] investigated sexual and reproductive health in adolescents and young adults with psychotic disorders.…”

Experiences of Sexual and Reproductive Health Care Access for Women and Nonbinary People With Early Psychosis: Towards an Integrated Perspective of Service Users and Clinicians

“…Youth with psychosis face significant risks during this time including elevated rates of sexually transmitted infections, higher-risk sexual behaviour, and sexual and relationship dysfunction. [12][13][14][15][16][17] However, most research on SRH and psychosis has focused on older populations and most psychosis-specific SRH interventions have not been youth-focused. [18][19][20] Ensuring that young people with psychosis have access to tailored, high-quality SRH care is crucial to improve health trajectories, yet little research has explored SRH care experiences in this population.…”