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Schizophrenia and Other Psychotic Disorders

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Psychiatry and Sexual Medicine
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Abstract

This chapter reviews how sexuality, sexual function, and behaviour manifest in patients with psychotic disorders such as schizophrenia spectrum disorders, delusional disorder, and psychotic disorders secondary to other mental or medical conditions. The chapter also presents an overview about polymorphic sexual content in psychopathology such as a hallucinatory-delusional condition with content theme about love, jealousy, sexual acts, genitals, sexual identity, as well as hypersexual behaviour, paraphilic behaviour, and sexual dysfunctions. In addition, the main principles of diagnostic and management strategies such as the stabilisation of the psychotic condition, the assessment of sexual function, psychosexual counselling, and the adjustment of disorder-specific treatment are analysed here.

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References

  1. Bancroft J. Human sexuality and its problems. 3rd ed. London: Churchill Livingstone/Elsevier; 2009, pp. 5–19, 381–407.

    Google Scholar 

  2. Meston CM, Frohlich PF. The neurobiology of sexual function. Arch Gen Psychiatry. 2000;57:1012–30.

    Article  CAS  PubMed  Google Scholar 

  3. Lauren E, Gibson LE, Lauren B, et al. Trauma and the psychosis spectrum: a review of symptom specificity and explanatory mechanisms. Clin Psychol Rev. 2016;49:92–105.

    Article  Google Scholar 

  4. Arciniegas DB. Psychosis. Continuum (Minneap Minn). 2015;21(3 Behavioral Neurology and Neuropsychiatry):715–36.

    Google Scholar 

  5. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992. Print.

    Google Scholar 

  6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

    Book  Google Scholar 

  7. ICD-11—Mortality and Morbidity Statistics. Schizophrenia or other primary psychotic disorders. https://icd.who.int/browse11/l-m/en.

  8. Castle DJ, Buckley PF. Schizophrenia. Oxford: Oxford University Press; 2012. p. 3–115.

    Google Scholar 

  9. Briken P, Hill A, Berner W. Hypersexuality: clinical aspects. In: Aboujaoude E, Koran LM, editors. Impulse control disorders. Cambridge: Cambridge University Press; 2010. p. 197–212.

    Chapter  Google Scholar 

  10. Agarkov ST. Endogeniji psikozi. In: Vasilcenko GS, Agarkova TE, Agarkov ST, editors. Seksopatologia: spravocnik. Medicina: Moskva; 1990. p. 450–8.

    Google Scholar 

  11. Zemishlany Z, Weizman A. The impact of mental illness on sexual dysfunction. In: Balon R, ed. Sexual dysfunction. The brain-body connection. Adv Psychosom Med. Karger: Basel. 2008;29:89–106.

    Article  Google Scholar 

  12. Gittleson NL, Dawson-Butterworth K. Subjective ideas of sexual change in female schizophrenics. Br J Psychiatry. 1967;113:491–4.

    Article  CAS  PubMed  Google Scholar 

  13. Gittleson NL, Levin S. Subjective ideas of sexual change in male schizophrenics. Br J Psychiatry. 1966;112:779–82.

    Article  CAS  PubMed  Google Scholar 

  14. Wan-Yuk Harley E, Boardman J, Craig T. Sexual problems in schizophrenia: prevalence and characteristics. A cross sectional survey. Soc Psychiatry Psychiatr Epidemiol. 2010;45:759–66.

    Article  PubMed  Google Scholar 

  15. Stusinski J, Lew-Starowicz M. Sexuality of people with schizophrenia and related problems in clinical perspective. Przegl Seks. 2015;4(44):3–13.

    Google Scholar 

  16. De Boer MK, Castelein S, Wiersma D, et al. The facts about sexual (dys)function in schizophrenia: an overview of clinically relevant findings. Schizophr Bull. 2015;41(3):674–86.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stusinski J, Lew-Starowicz M. Gender identity in schizophrenia. Psychiatr Pol. 2018;52(6):1041–52.

    Article  PubMed  Google Scholar 

  18. LaTorre R. The psychological assessment of gender identity and gender role in schizophrenia. Schizophr Bull. 1976;2(2):266–85.

    Article  CAS  PubMed  Google Scholar 

  19. Rajkumar RP. Gender identity disorder and schizophrenia: neurodevelopmental disorders with common causal mechanisms? Schizophr Res Treatment. 2014;2014:463757. https://www.hindawi.com/journals/schizort/2014/463757/.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Malik P, Kemmler G, Hummer M, et al. EUFEST Study Group. Sexual dysfunction in first-episode schizophrenia patients: results from European first episode schizophrenia trial. J Clin Psychopharmacol. 2011;31:274–80.

    Article  PubMed  Google Scholar 

  21. Montejo AL, Majadas S, Rico-Villademoros F, et al. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. Frequency of sexual dysfunction in patients with a psychotic disorder receiving antipsychotics. J Sex Med. 2010;7(10):3404–13.

    Article  PubMed  Google Scholar 

  22. Bobes J, Garc A-Portilla MP, Rejas J, et al. Frequency of sexual dysfunction and other reproductive side-effects in patients with schizophrenia treated with risperidone, olanzapine, quetiapine, or haloperidol: the results of the EIRE study. J Sex Marital Ther. 2003;29:125–47.

    Article  CAS  PubMed  Google Scholar 

  23. Ong KY, Muhd Ramli ER, Che IH. Remitted male schizophrenia patients with sexual dysfunction. J Sex Med. 2014;11:956–65.

    Article  Google Scholar 

  24. Aizenberg D, Zemishlany Z, Dorfman-Etrog P, et al. Sexual dysfunction in male schizophrenic patients. J Clin Psychiatry. 1995;56:137–41.

    CAS  PubMed  Google Scholar 

  25. Kelly DL, Conley RR. Sexuality and schizophrenia: a review. Schizophr Bull. 2004;30(4):767–79.

    Article  PubMed  Google Scholar 

  26. Davis KL, Kahn RS, Ko G, et al. Dopamine in schizophrenia: a review and reconceptualization. Am J Psychiatry. 1991;148(11):1474–86.

    Article  CAS  PubMed  Google Scholar 

  27. Knegtering H, van den Bosch R, Castelein S, et al. Are sexual side effects of prolactin-raising antipsychotics reducible to serum prolactin? Psychoneuroendocrinology. 2008;33:711–7.

    Article  CAS  PubMed  Google Scholar 

  28. Segraves RT. Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry. 1989;46(3):275–84.

    Article  CAS  PubMed  Google Scholar 

  29. Carani C, Granata AR, Fustini MF, et al. Prolactin and testosterone: their role in male sexual function. Int J Androl. 1996;19:48–54.

    Article  CAS  PubMed  Google Scholar 

  30. Knegtering H, van der Moolen AE, Castelein S, et al. What are the effects of antipsychotics on sexual dysfunctions and endocrine functioning? Psychoneuroendocrinology. 2003;28(Suppl 2):109–23.

    Article  CAS  PubMed  Google Scholar 

  31. Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics: differential risk and clinical implications. CNS Drugs. 2007;21(11):911–36.

    Article  CAS  PubMed  Google Scholar 

  32. Gitlin MJ. Psychotropic medications and their effects on sexual function: diagnosis, biology, and treatment approaches. J Clin Psychiatry. 1994;55(9):406–13.

    CAS  PubMed  Google Scholar 

  33. Hagen R, Gråwe RW, Grotmol KS, et al. Depresjon ved psykose: forståelse og kliniske implikasjoner. Tidsskr Nor Psykol Foren. 2006;43(2):99–104.

    Google Scholar 

  34. Green AI, Canuso CM, Brenner MJ, et al. Detection and management of comorbidity in patients with schizophrenia. Psychiatr Clin North Am. 2003;26(1):115–39.

    Article  PubMed  Google Scholar 

  35. Buckley PF, Miller BJ, Lehrer DS, et al. Psychiatric comorbidities and schizophrenia. Schizophr Bull. 2009;35(2):383–402.

    Article  PubMed  Google Scholar 

  36. Newton-Howes G, Tyrer P, North B, et al. The prevalence of personality disorder in schizophrenia and psychotic disorders: systematic review of rates and explanatory modelling. Psychol Med. 2008;38(8):1075–82.

    Article  CAS  PubMed  Google Scholar 

  37. Margolese HC, Malchy L, Negrete JC, et al. Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences. Schizophr Res. 2004;67(2–3):157–66.

    Article  PubMed  Google Scholar 

  38. Kavanagh DJ, Waghorn G, Jenner L, et al. Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophr Res. 2004;66(2–3):115–24.

    Article  PubMed  Google Scholar 

  39. Nesvåg R, Knudsen GP, Bakken IJ, et al. Substance use disorders in schizophrenia, bipolar disorder, and depressive illness: a registry-based study. Soc Psychiatry Psychiatr Epidemiol. 2015;50(8):1267–76.

    Article  PubMed  Google Scholar 

  40. Kozumplik O, Uzun S, Jakovljevic M. Psychotic disorders and comorbidity: somatic illness vs. side effect. Psychiatr Danub. 2009;21(3):361–7.

    PubMed  Google Scholar 

  41. Barnett AH, Mackin P, Chaudhry I, et al. Minimising metabolic and cardiovascular risk in schizophrenia: diabetes, obesity and dyslipidaemia. J Psychopharmacol. 2007;21(4):357–73.

    Article  CAS  PubMed  Google Scholar 

  42. Baggaley M. Sexual dysfunction in schizophrenia: focus on recent evidence. Hum Psychopharmacol. 2008;23:201–9.

    Article  CAS  PubMed  Google Scholar 

  43. Basson R, Rees P, Wang R, et al. Sexual function in chronic illness. J Sex Med. 2010;7:374–88.

    Article  PubMed  Google Scholar 

  44. Serretti A, Chiesa A. A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics. Int Clin Psychopharmacol. 2011;26:130–40.

    Article  PubMed  Google Scholar 

  45. Sood S, James W, Bailon MJ. Priapism associated with atypical antipsychotic medications: a review. Int Clin Psychopharmacol. 2008;23:9–17.

    Article  PubMed  Google Scholar 

  46. Ghadirian AM, Chouinard G, Annable L. Sexual dysfunction and plasma prolactin levels in neuroleptic-treated schizophrenic outpatients. J Nerv Ment Dis. 1982;170:463–7.

    Article  CAS  PubMed  Google Scholar 

  47. Berger SH. Trifluoperazine and haloperidol: sources of ejaculatory pain? Am J Psychiatry. 1979;136:350.

    Article  CAS  PubMed  Google Scholar 

  48. Dossenbach M, Hodge A, Anders M, et al. Prevalence of sexual dysfunction in patients with schizophrenia: international variation and underestimation. Int J Neuropsychopharmacol. 2005;8:195–201.

    Article  PubMed  Google Scholar 

  49. Dickson RA, Glaser W. Development of a scale to asses sexual functioning. In: Antipsychotic medication and sexuality: program and abstracts from the 153rd Annual Meeting of the American Psychiatry Association, Chicago. Abstract S35; 2000.

    Google Scholar 

  50. Skopec HM, Rosenberg SD, Tucker GJ. Sexual behavior in schizophrenia. Med Aspects Hum Sex. 1976;10:32.

    CAS  PubMed  Google Scholar 

  51. Rettenbacher MA, Hofer A, Ebenbichler C, et al. Prolactin levels and sexual adverse effects in patients with schizophrenia during antipsychotic treatment. J Clin Psychopharmacol. 2010;30(6):711–5.

    Article  CAS  PubMed  Google Scholar 

  52. Marshall WL. Diagnostic problems with sexual offenders. In: Marshall WL, Fernandez YM, Marshall LE, Serran GA, editors. Sexual offender treatment: controversial issues. Chichester: Wiley; 2006. p. 33–43.

    Google Scholar 

  53. Novak B, McDermott BE, Scott CL, et al. Sex offenders and insanity: an examination of 42 individuals found not guilty by reason of insanity. J Am Acad Psychiatry Law. 2007;35:444–50.

    PubMed  Google Scholar 

  54. Kamenskov M. Disorders of sexual preference and schizophrenia (P03-72). Psychotic disorders/Schizophrenia. Eur Psychiat. 2010;25(1):1194.

    Google Scholar 

  55. Lesandrić V, Orlović I, Peitl V, et al. Zoophilia as an early sign of psychosis. Alcohol Psychiat Res. 2017;53:27–32.

    Article  Google Scholar 

  56. Langstrom N, Sjostedt G, Grann M. Psychiatric disorders and recidivism in sexual offenders. Sex Abus. 2004;16(2):139–50.

    Article  Google Scholar 

  57. Drake CR, Pathe M. Understanding sexual offending in schizophrenia. Crim Behav Ment Health. 2004;14(2):108–20.

    Article  PubMed  Google Scholar 

  58. Bogerts B. Delusional jealousy and obsessive love--causes and forms. MMW Fortschr Med. 2005;147(6):26,28–9.

    Google Scholar 

  59. De BM. Clérambault’s syndrome (erotomania) in an evolutionary perspective. Evol Hum Behav. 2001;22(6):409–15.

    Article  Google Scholar 

  60. Soyka M, Naber G, Völcker A. Prevalence of delusional jealousy in different psychiatric disorders. An analysis of 93 cases. Br J Psychiatry. 1991;158:549–53.

    Article  CAS  PubMed  Google Scholar 

  61. Jordan HW, Howe G. De Clerambault syndrome (Erotomania): a review and case presentation. J Natl Med Assoc. 1980;72(10):979–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Kingham M, Gordon H. Aspects of morbid jealousy. Adv Psychiatr Treat. 2004;10:207–15.

    Article  Google Scholar 

  63. Todd J, Mackie JRM, Dewhurst K. Real or imagined hypophallism: a cause of inferiority feelings and morbid sexual jealousy. Br J Psychiatry. 1971;119:315–8.

    Article  CAS  PubMed  Google Scholar 

  64. Terentev EI. Problem of sexual pathology in alcoholic delusions of jealousy. Zh Nevropatol Psikhiatr Im S S Korsakova. 1978;78(11):1705–9.

    CAS  Google Scholar 

  65. Behere PB, Natraj GS. Dhat syndrome: the phenomenology of a culture bound sex neurosis of the orient. Indian J Psychiatry. 1984;26(1):76–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Chowdhury AN. Dysmorphic penis image perception: the root of Koro vulnerability. A longitudinal study. Acta Psychiatr Scand. 1989;80(5):518–20.

    Article  CAS  PubMed  Google Scholar 

  67. Howard R, Rabins PV, Seeman MV, Jeste DV, the International Late-Onset Schizophrenia Group. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international concensus. Am J Psychiatry. 2000;157:172–8.

    Article  CAS  PubMed  Google Scholar 

  68. Schiørring E. Psychopathology induced by “speed drugs”. Pharmacol Biochem Behav. 1981;14(1):109–22.

    Article  PubMed  Google Scholar 

  69. Resnick RB, Resnick EB. Cocaine abuse and its treatment. Psychiatr Clin North Am. 1984;7(4):713–28.

    Article  CAS  PubMed  Google Scholar 

  70. Poletti M, Lucetti C, Baldacci F, et al. Concomitant development of hypersexuality and delusional jealousy in patients with Parkinson’s disease: a case series. Parkinsonism Relat Disord. 2014;20(11):1290–2.

    Article  PubMed  Google Scholar 

  71. Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.

    Article  CAS  PubMed  Google Scholar 

  72. Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–30.

    Article  CAS  PubMed  Google Scholar 

  73. De Boer MK, Castelein S, Bous J, et al. The antipsychotics and sexual functioning questionnaire (ASFQ): preliminary evidence for reliability and validity. Schizophr Res. 2013;150(2–3):410–5.

    Article  PubMed  Google Scholar 

  74. Stevenson R, Elliott S. Sexual disorders with comorbid psychiatric or physical illness. In: Balon R, Segraves RT, editors. Clinical manual of sexual disorders. 1st ed. Washington, DC: American Psychiatric Publishing Inc; 2009. p. 59–90.

    Google Scholar 

  75. Kirana E. Psychosexual treatment methods in sexual medicine. In: Porst H, Reisman Y, editors. The ESSM syllabus of sexual medicine. Medix Publishers: Amsterdam; 2012. p. 313–23.

    Google Scholar 

  76. Shim JC, Shin JG, Kelly DL, et al. Adjunctive treatment with a dopamine partial agonist, aripiprazole, for antipsychoticinduced hyperprolactinemia: a placebo-controlled trial. Am J Psychiatry. 2007;164:1404–10.

    Article  PubMed  Google Scholar 

  77. De Boer MK, Oolders JM, van den Heuvel ER, et al. Efficacy of tadalafil on erectile dysfunction in male patients using antipsychotics: a double- blind, placebo-controlled, crossover pilot study. J Clin Psychopharmacol. 2014;34(3):380–2.

    Article  PubMed  Google Scholar 

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Jonusiene, G. (2021). Schizophrenia and Other Psychotic Disorders. In: Lew-Starowicz, M., Giraldi, A., Krüger, T. (eds) Psychiatry and Sexual Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-52298-8_15

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  • DOI: https://doi.org/10.1007/978-3-030-52298-8_15

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