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Der Nervenarzt

, Volume 81, Issue 9, pp 1129–1139 | Cite as

Beeinträchtigung der Sexualfunktion durch Psychopharmaka und psychotrope Substanzen

  • S. Cohen
  • K.U. Kühn
  • B. Sträter
  • N. Scherbaum
  • W.  Weig
CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Ungestörte Sexualität spielt für die Lebensqualität, auch psychisch kranker Menschen, eine erhebliche Rolle. Erkenntnisse über die komplexe neuronale und endokrine Steuerung der Sexualfunktion legen Störmöglichkeiten durch Substanzen nahe, die diese Regelkreise beeinflussen, also insbesondere auch durch Psychopharmaka und abhängigkeitserzeugende Substanzen. Die Abgrenzung von unmittelbaren oder mittelbar durch die Krankheit selbst hervorgerufenen Funktionsdefiziten ist allerdings in der Praxis schwierig. Sowohl klassische trizyklische Antidepressiva als auch Serotoninwiederaufnahmehemmer verursachen häufig Beeinträchtigungen in mehreren Aspekten der sexuellen Funktions- und Erlebnisfähigkeit. Dies gilt ebenso für Neuroleptika, wobei auch hier nicht der Pharmakotherapie zuzuordnende Auswirkungen der Erkrankung Schizophrenie die Beurteilung schwierig machen. Bei den zur Behandlung substanzbezogener Störungen eingesetzten medikamentösen Strategien führt insbesondere das Substitut Methadon in vielen Fällen zu sexuellen Funktionsstörungen. Die Beachtung medikamenteninduzierter sexueller Funktionsstörungen hat für die Compliance hohe Bedeutung, Abhilfemöglichkeiten bestehen insbesondere in Anpassung der Medikation, zusätzlicher Medikamentengabe, z. B. von Partialantagonisten und Erektiva, sowie in einer störungsspezifischen Psychotherapie und Psychoedukation.

Schlüsselwörter

Sexuelle Funktionsstörungen Medikamentennebenwirkungen Antidepressiva Neuroleptika Substitutionsbehandlung 

Adverse side-effect on sexual function caused by psychotropic drugs and psychotropic substances

Summary

Unhindered sexuality plays an important role in the quality of life and this also holds true for patients with psychiatric illnesses. Knowledge concerning the complex neuronal and endocrine control mechanisms of sexual function reveals areas of possible dysfunction caused by the interactions between the control system, psychiatric drugs and addictive psychoactive substances. The differentiation of the cause of the dysfunction between being caused by the underlying illness and caused by other factors is difficult in practice. Both classical tri-cyclic antidepressants and selective serotonin uptake inhibitors can frequently cause adverse effects in multiple dimensions of sexual function. This same is true for neuroleptics, whereby the differentiation between symptoms of schizophrenia and side-effects from the medication can make an evaluation difficult. The medication-based strategy used to treat opiate dependency by administration of methadone causes sexual dysfunction in many cases. The consideration of medication-induced sexual dysfunction has a great importance with regard to compliance. Possible solutions can be modification of the medication regime, additional medication, e.g. partial antagonists and PD5 inhibitors, as well as dysfunction-specific psychotherapy and psychoeducation.

Keywords

Sexual dysfunction Medication side-effects Anti-depressants Neuroleptics Maintenance treatment 

Notes

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Referententätigkeit für Janssen-Cilag.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • S. Cohen
    • 1
  • K.U. Kühn
    • 2
  • B. Sträter
    • 2
  • N. Scherbaum
    • 3
  • W.  Weig
    • 4
  1. 1.LVR-KlinikumKliniken der Heinrich-Heine-Universität DüsseldorfDüsseldorfDeutschland
  2. 2.Universitätsklinik BonnBonnDeutschland
  3. 3.LVR-KlinikumKliniken der Universität Duisburg-EssenDuisburg-EssenDeutschland
  4. 4.Magdalenen-Klinik, GeorgsmarienhütteOsnabrückDeutschland

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