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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Bancroft J. Human sexuality and its problems. 3rd ed. London: Churchill Livingstone/Elsevier; 2009, pp. 5–19, 381–407.
Meston CM, Frohlich PF. The neurobiology of sexual function. Arch Gen Psychiatry. 2000;57:1012–30.
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.
Arciniegas DB. Psychosis. Continuum (Minneap Minn). 2015;21(3 Behavioral Neurology and Neuropsychiatry):715–36.
World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992. Print.
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.
ICD-11—Mortality and Morbidity Statistics. Schizophrenia or other primary psychotic disorders. https://icd.who.int/browse11/l-m/en.
Castle DJ, Buckley PF. Schizophrenia. Oxford: Oxford University Press; 2012. p. 3–115.
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.
Agarkov ST. Endogeniji psikozi. In: Vasilcenko GS, Agarkova TE, Agarkov ST, editors. Seksopatologia: spravocnik. Medicina: Moskva; 1990. p. 450–8.
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.
Gittleson NL, Dawson-Butterworth K. Subjective ideas of sexual change in female schizophrenics. Br J Psychiatry. 1967;113:491–4.
Gittleson NL, Levin S. Subjective ideas of sexual change in male schizophrenics. Br J Psychiatry. 1966;112:779–82.
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.
Stusinski J, Lew-Starowicz M. Sexuality of people with schizophrenia and related problems in clinical perspective. Przegl Seks. 2015;4(44):3–13.
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.
Stusinski J, Lew-Starowicz M. Gender identity in schizophrenia. Psychiatr Pol. 2018;52(6):1041–52.
LaTorre R. The psychological assessment of gender identity and gender role in schizophrenia. Schizophr Bull. 1976;2(2):266–85.
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/.
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.
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.
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.
Ong KY, Muhd Ramli ER, Che IH. Remitted male schizophrenia patients with sexual dysfunction. J Sex Med. 2014;11:956–65.
Aizenberg D, Zemishlany Z, Dorfman-Etrog P, et al. Sexual dysfunction in male schizophrenic patients. J Clin Psychiatry. 1995;56:137–41.
Kelly DL, Conley RR. Sexuality and schizophrenia: a review. Schizophr Bull. 2004;30(4):767–79.
Davis KL, Kahn RS, Ko G, et al. Dopamine in schizophrenia: a review and reconceptualization. Am J Psychiatry. 1991;148(11):1474–86.
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.
Segraves RT. Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry. 1989;46(3):275–84.
Carani C, Granata AR, Fustini MF, et al. Prolactin and testosterone: their role in male sexual function. Int J Androl. 1996;19:48–54.
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.
Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics: differential risk and clinical implications. CNS Drugs. 2007;21(11):911–36.
Gitlin MJ. Psychotropic medications and their effects on sexual function: diagnosis, biology, and treatment approaches. J Clin Psychiatry. 1994;55(9):406–13.
Hagen R, Gråwe RW, Grotmol KS, et al. Depresjon ved psykose: forståelse og kliniske implikasjoner. Tidsskr Nor Psykol Foren. 2006;43(2):99–104.
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.
Buckley PF, Miller BJ, Lehrer DS, et al. Psychiatric comorbidities and schizophrenia. Schizophr Bull. 2009;35(2):383–402.
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.
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.
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.
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.
Kozumplik O, Uzun S, Jakovljevic M. Psychotic disorders and comorbidity: somatic illness vs. side effect. Psychiatr Danub. 2009;21(3):361–7.
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.
Baggaley M. Sexual dysfunction in schizophrenia: focus on recent evidence. Hum Psychopharmacol. 2008;23:201–9.
Basson R, Rees P, Wang R, et al. Sexual function in chronic illness. J Sex Med. 2010;7:374–88.
Serretti A, Chiesa A. A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics. Int Clin Psychopharmacol. 2011;26:130–40.
Sood S, James W, Bailon MJ. Priapism associated with atypical antipsychotic medications: a review. Int Clin Psychopharmacol. 2008;23:9–17.
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.
Berger SH. Trifluoperazine and haloperidol: sources of ejaculatory pain? Am J Psychiatry. 1979;136:350.
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.
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.
Skopec HM, Rosenberg SD, Tucker GJ. Sexual behavior in schizophrenia. Med Aspects Hum Sex. 1976;10:32.
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.
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.
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.
Kamenskov M. Disorders of sexual preference and schizophrenia (P03-72). Psychotic disorders/Schizophrenia. Eur Psychiat. 2010;25(1):1194.
Lesandrić V, Orlović I, Peitl V, et al. Zoophilia as an early sign of psychosis. Alcohol Psychiat Res. 2017;53:27–32.
Langstrom N, Sjostedt G, Grann M. Psychiatric disorders and recidivism in sexual offenders. Sex Abus. 2004;16(2):139–50.
Drake CR, Pathe M. Understanding sexual offending in schizophrenia. Crim Behav Ment Health. 2004;14(2):108–20.
Bogerts B. Delusional jealousy and obsessive love--causes and forms. MMW Fortschr Med. 2005;147(6):26,28–9.
De BM. Clérambault’s syndrome (erotomania) in an evolutionary perspective. Evol Hum Behav. 2001;22(6):409–15.
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.
Jordan HW, Howe G. De Clerambault syndrome (Erotomania): a review and case presentation. J Natl Med Assoc. 1980;72(10):979–85.
Kingham M, Gordon H. Aspects of morbid jealousy. Adv Psychiatr Treat. 2004;10:207–15.
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.
Terentev EI. Problem of sexual pathology in alcoholic delusions of jealousy. Zh Nevropatol Psikhiatr Im S S Korsakova. 1978;78(11):1705–9.
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.
Chowdhury AN. Dysmorphic penis image perception: the root of Koro vulnerability. A longitudinal study. Acta Psychiatr Scand. 1989;80(5):518–20.
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.
Schiørring E. Psychopathology induced by “speed drugs”. Pharmacol Biochem Behav. 1981;14(1):109–22.
Resnick RB, Resnick EB. Cocaine abuse and its treatment. Psychiatr Clin North Am. 1984;7(4):713–28.
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.
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.
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.
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.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
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
Download citation
DOI: https://doi.org/10.1007/978-3-030-52298-8_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-52297-1
Online ISBN: 978-3-030-52298-8
eBook Packages: MedicineMedicine (R0)