A Comparative Study of Sexual Dysfunction Involving Risperidone, Quetiapine, and Olanzapine

Article excerpt

Byline: Anil Kumar. Nagaraj, Nagesh. Pai, Satheesh. Rao

Background: With the advent of newer antipsychotic drugs, side effects such as sexual dysfunction have been a major contributor toward treatment compliance. There are only a few studies that have compared different atypical antipsychotic agents regarding sexual dysfunction. We have not come across any data in this area on Indian population. Aims: To determine and compare the frequency of sexual dysfunction associated with risperidone, olanzapine, and quetiapine, among patients with clinically stable schizophrenia. Settings and Design: It is a cross-sectional hospital-based study. The subjects were recruited for the study by the purposive sampling technique. Materials and Methods: The total sample size was 102, consisting of 25 each in the quetiapine and risperidone groups, 22 in the olanzapine group, and 30 healthy volunteers. A Brief Psychiatric Rating Scale and Sexual Functioning Questionnaire (SFQ) were administered. The Kruskal Wallis test was used to compare the variables in the demographic data and the mean chlorpromazine equivalent doses of the study groups. To analyze the sexual dysfunction, the mean scores on all the domains of sexual functioning in SFQ were compared across the study groups using the Chi square test, for proportions. Results and Conclusion: Twenty-three percent of the healthy volunteers had some impairment in one or more domains of sexual functioning. For the medication groups this was 96, 88, and 90%, respectively for risperidone, quetiapine, and olanzapine. However, there was statistically no significant difference across the study groups although it was relatively less with quetiapine.

Introduction

Sexual function is the physiological capacity to experience desire, arousal, and orgasm. Sexual dysfunction can result from a wide variety of psychological and physical causes. Among drugs, antihypertensives, diuretics, antihistamines, antidepressants, benzodiazepines, and antipsychotics are the common agents associated with sexual dysfunction. [sup][1] Schizophrenic patients can develop sexual dysfunction that may not be related to drugs. Studies have shown that a majority of untreated schizophrenic patients have a reduced desire for sex, more in females as compared to males, although arousal and ejaculatory functions remain relatively intact. The schizophrenic men often limit their sexual activity to masturbation, as the negative symptoms limit their ability to maintain relationships.[sup] [2] However, while on treatment, they may experience erectile dysfunction and orgasmic difficulties as adverse effects of the medicines, that is, antipsychotics, unless they have no primary organic pathology or comorbid medical conditions contributing to the sexual dysfunction.[sup] [3],[4] Thus, the major impact on sexual functioning in schizophrenic patients is by antipsychotics. There are sufficient studies that have looked into sexual dysfunction due to typical antipsychotics as well as studies that have compared typical and atypical antipsychotic agents. [sup][5],[6],[7],[8],[9] However, there are only a few studies that have compared different atypical antipsychotic agents for sexual dysfunction.[sup] [10],[11] The authors have not come across such studies among the Indian population.

Materials and Methods

The study sample was taken from the Psychiatry Outpatient Department and it consisted of 72 patients with clinically stable schizophrenia meeting the ICD-10 criteria; as well as 30 healthy volunteers from among the staff of the hospital and caregivers of patients who were willing to participate in the study. This is a cross-sectional, hospital-based study. After obtaining the local ethical committee clearance, the subjects were recruited for the study by the purposive sampling technique during August 2005-April 2006. The sample (N = 102) was divided into four groups [Table 1]. Group one (G[sub] 1 ) consisted of 25 patients on risperidone, group two (G[sub] 2 ) had 25 patients on quetiapine, group three (G[sub] 3 ) was made up of 22 patients on olanzapine, and group four (G[sub] 4 ) had 30 healthy volunteers. …