quetiapine-fumarate and Sexual-Dysfunctions--Psychological

Adverse effects of antipsychotics often lead to noncompliance. Thus, clinicians should address patients' concerns about adverse effects and attempt to choose medications that will improve their patients' quality of life as well as overall health. The side effect profiles of the atypical antipsychotics are more advantageous than those of the conventional neuroleptics. Conventional agents are associated with unwanted central nervous system effects, including extrapyramidal symptoms (EPS), tardive dyskinesia, sedation, and possible impairment of some cognitive measures, as well as cardiac effects, orthostatic hypotension, hepatic changes, anticholinergic side effects, sexual dysfunction, and weight gain. The newer atypical agents have a lower risk of EPS, but are associated in varying degrees with sedation, cardiovascular effects, anticholinergic effects, weight gain, sexual dysfunction, hepatic effects, lowered seizure threshold (primarily clozapine), and agranulocytosis (clozapine only). Since the incidence and severity of specific adverse effects differ among the various atypicals, the clinician should carefully consider which side effects are most likely to lead to the individual's dissatisfaction and noncompliance before choosing an antipsychotic for a particular patient.

Topics: Agranulocytosis; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Central Nervous System Diseases; Clozapine; Dibenzothiazepines; Drug Interactions; Dyskinesia, Drug-Induced; Health Status; Humans; Hypotension, Orthostatic; Olanzapine; Pirenzepine; Quality of Life; Quetiapine Fumarate; Receptors, Cholinergic; Risperidone; Schizophrenia; Sexual Dysfunctions, Psychological; Sleep Wake Disorders; Treatment Refusal; Weight Gain

This study evaluated the effect of switching to quetiapine vs. risperidone continuation on sexual functioning in outpatients with risperidone-associated sexual dysfunction. Outpatients (n=42, age>or=18 years) with schizophrenia or schizoaffective disorder who experienced risperidone-associated sexual dysfunction were randomized to 6 weeks of double-blind risperidone continuation (mean dose=4.1 mg/day, S.D.=1.2) or quetiapine switch (mean dose=290.0 mg/day, S.D.=55.2) treatment. The five-item Arizona Sexual Experience Scale (ASEX) assessed sexual functioning at baseline and subsequently at weeks 2, 4 and 6. A mixed-model analysis of repeated measures included gender and baseline ASEX and PANSS scores as covariates. There was no significant Treatment Group effect for ASEX total scores and ASEX sub-items, and no significant Treatment GroupxPeriod interaction for ASEX total scores and ASEX sub-items. Treatment Group effects were not significantly different in any of the prospective weeks for ASEX total scores and ASEX sub-items. Adjusted mean ASEX total scores were slightly lower in the quetiapine switch group than in the risperidone continuation group at weeks 2 and 6 (21.27 vs. 22.18 and 18.51 vs. 20.53, respectively), but were nearly identical at week 4 (20.01 vs. 20.15). In this pilot trial, sexual functioning did not differ significantly between outpatients receiving quetiapine switch vs. risperidone continuation, although the quetiapine switch group had slightly lower adjusted mean ASEX total scores at weeks 2 and 6.

Topics: Adult; Ambulatory Care; Antipsychotic Agents; Dibenzothiazepines; Double-Blind Method; Female; Humans; Male; Middle Aged; Pilot Projects; Psychiatric Status Rating Scales; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia; Schizophrenic Psychology; Sexual Behavior; Sexual Dysfunctions, Psychological

The aim of this study was to assess the long-term impact of quetiapine on sexual functioning of patients with schizophrenia treated in a real practice setting.. This was a multicenter, noncomparative, open-label, and naturalistic study conducted in outpatients with a diagnosis of schizophrenia or schizophreniform disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Patients were evaluated at baseline, day 15, and at the end of months 1, 3, and 6 using the Brief Psychiatry Rating Scale, the Clinical Global Impression Severity and Improvement Scales, and the Psychotropic-Related Sexual Dysfunction Questionnaire. All primary effectiveness analyses were based on the intent-to-treat sample and consisted primarily of last-observation-carried-forward analysis of Psychotropic-Related Sexual Dysfunction Questionnaire, Brief Psychiatry Rating Scale, and Clinical Global Impression Improvement of Illness Scale.. Eighty-six patients were recruited by 19 investigators, and 82 patients were included in the intent-to-treat sample. Psychotropic-Related Sexual Dysfunction Questionnaire total scores for the patients decreased progressively and significantly from baseline to the study end point. When only patients who initiated quetiapine treatment without being switched from another antipsychotic (n = 28) were included in the intent-to-treat analysis, Psychotropic-Related Sexual Dysfunction Questionnaire scores remained almost unchanged throughout the study. Sexual dysfunction rates, defined as a change in the score of any item greater than 0, were 3.7%, 2.4%, 2.4%, and 4.9% for decreased libido, delayed ejaculation/orgasm, lack of ejaculation/orgasm, and difficulties with erection/lubrication, respectively. Overall, quetiapine was efficacious and well tolerated.. Despite the limitations of the design, our results suggest that quetiapine shows a low frequency of sexual dysfunction during long-term treatment of patients with schizophrenia or schizophreniform disorder in the clinical practice setting.

Topics: Adult; Antipsychotic Agents; Brief Psychiatric Rating Scale; Dibenzothiazepines; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Quetiapine Fumarate; Schizophrenia; Severity of Illness Index; Sexual Dysfunctions, Psychological; Time Factors

To compare sexual functioning in patients treated with quetiapine or risperidone.. This open-label study included patients with schizophrenia or a related psychotic illness who were randomized to quetiapine (200-1200 mg/d) or risperidone (1-6 mg/d) for 6 weeks. Sexual dysfunction was assessed by a semistructured interview, the Antipsychotics and Sexual Functioning Questionnaire (ASFQ), based upon the Utvalg for Kliniske Undersogelser (UKU).. Four of 25 quetiapine-treated patients (16%) and 12 of 24 risperidone-treated patients (50%) reported sexual dysfunction (chi 2 = 6.4; df = 1; P = 0.006) on the ASFQ. Six patients (11.7%; 4 on risperidone, 2 on quetiapine) spontaneously reported sexual dysfunction. The mean+/-SD dose was 580+/-224 mg/d for quetiapine and 3.2 +/- 1.3 mg/d for risperidone. Mean +/- SD prolactin levels in quetiapine- and risperidone-treated patients were 13.8 +/- 17.9 and 57.7 +/- 39.7 ng/mL, respectively.. Sexual dysfunction was less common in patients treated with quetiapine than with risperidone. Direct questioning about sexual functioning is necessary to avoid underestimating the frequency of sexual side effects in patients with schizophrenia and related psychotic disorders.

Topics: Adolescent; Adult; Dibenzothiazepines; Drug Administration Schedule; Female; Humans; Male; Prolactin; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia; Sexual Dysfunctions, Psychological; Surveys and Questionnaires; Testosterone; Treatment Outcome

We present the case of an acute steroid-induced psychosis in a 17-year-old boy who presented with inappropriate sexual behaviour. Quetiapine treatment was initiated at an initial dosage of 300 mg/day. The dosage was increased to 900 mg/day on the fourth day of the treatment. The patient's symptoms began to improve in the second week and were resolved by the fourth week of quetiapine treatment. Steroid use may result in a psychosis, including inappropriate sexual behaviour. Clinicians should be very cautious while administering these drugs and should consider and monitor side effects carefully.

Topics: Adolescent; Antipsychotic Agents; Dibenzothiazepines; Humans; Male; Prednisolone; Psychoses, Substance-Induced; Quetiapine Fumarate; Sexual Dysfunctions, Psychological

Sixty male patients with schizophrenia and schizophrenia spectrum disorders were studied in the first five years of disease. Characteristics of psychosexual development and sexual behavior were reviewed. Sexual disorders (mostly the decreased libido) developed in patients during the worsening of mental state and were aggravated during the treatment with neuroleptics. The disturbances of ejaculation appeared during the treatment with risperidone and olanzapine but not with quetiapine. Peculiarities of structure and dynamics of sexual disorders in patients were revealed.

Topics: Antipsychotic Agents; Benzodiazepines; Dibenzothiazepines; Humans; Male; Olanzapine; Quetiapine Fumarate; Risperidone; Schizophrenia; Sexual Dysfunctions, Psychological; Young Adult

Topics: Adult; Antimanic Agents; Antipsychotic Agents; Clonazepam; Dibenzothiazepines; Female; GABA Modulators; Gonadal Steroid Hormones; Humans; Masturbation; Quetiapine Fumarate; Risperidone; Schizophrenia; Schizophrenic Psychology; Sexual Behavior; Sexual Dysfunctions, Psychological; Valproic Acid