■在精神分裂症患者中,抗精神病药物引起的功能障碍是常见的,但在临床实践中往往开发不足。
■综合观察性研究数据,探索精神分裂症谱系障碍患者性功能障碍的患病率以及相关因素。
■在Google中进行了没有语言或时间限制的系统文献检索,谷歌学者,PubMed/MEDLINE,科学直接,和巴黎索邦大学的研究发表于2022年6月8日。
■纳入所有报告精神分裂症谱系障碍患者性功能障碍患病率的观察性研究。
■使用了由2名观察者独立提取的MOOSE指南和随机效应模型。
■性功能障碍的患病率和每种特定的功能障碍。
■从开始到2022年6月,共有来自6大洲33个国家的1119项研究中的72项被纳入,共有21,076名精神分裂症参与者。性功能障碍的汇总全球患病率为56.4%(95%CI,50.5-62.2),男性患病率为55.7%(95%CI,48.1-63.1),女性患病率为60.0%(95%CI,48.0-70.8)。男性最常见的性功能障碍是勃起功能障碍(44%;95%CI,33.5-55.2),其次是男性性欲丧失(41%;95%CI,30.7-51.4),男性射精功能障碍(39%;95%CI,26.8-51.8),女性性高潮功能障碍(28%;95%CI,18.4-40.2),女性闭经(25%;95%CI,17.3-35.0)。与异质性相关的因素是研究设计,时间和地点,社会人口统计数据,酒精使用障碍,精神病诊断,疾病严重程度,以及抗抑郁药和抗焦虑药的使用。性功能障碍在精神分裂症和分裂情感障碍中更常见,在病程较长的个体中,勃起障碍的发生率较低。抗抑郁药和情绪稳定剂处方与较低的勃起障碍发生率相关(β,-6.30;95%CI,-10.82至-1.78);P=.006和-13.21;95%CI,分别为-17.59至-8.83;P<.001)和射精障碍(β,-6.10;95%CI,-10.68至-1.53;P=0.009和β,-11.57;95%CI,分别为-16.34至-6.80;P<.001)。其他时间性功能障碍的发生率没有明显改善,关于抗精神病药类别的结果相互矛盾。
■这项系统评价和荟萃分析发现,精神分裂症患者的性功能障碍患病率很高,相关因素具有相当大的异质性。研究结果还表明,某些功能障碍可能是由精神分裂症解释的。较低的功能障碍发生率与抗抑郁药使用之间的关联表明,治疗共病抑郁症可能是改善性健康的有效策略。还注意到缺乏有关代谢参数和身体健康的数据,而这些问题在精神分裂症的治疗中很常见。
In individuals with schizophrenia, antipsychotic-induced dysfunctions are frequent but often underexplored in clinical practice.
To synthetize the data of observational studies exploring the prevalence of sexual dysfunction in individuals with schizophrenia-spectrum disorders as well as associated factors.
A systematic literature search without language or time restrictions was conducted in Google, Google Scholar, PubMed/MEDLINE, Science Direct, and Université Sorbonne Paris Cité for studies published up to June 8, 2022.
All observational studies reporting a prevalence of sexual dysfunction in schizophrenia-spectrum disorder were included.
The MOOSE guidelines with independent extraction by 2 observers and random-effects models were used.
The prevalence of sexual dysfunction and each specific dysfunction.
A total of 72 of 1119 studies from 33 countries on 6 continents published from inception to June 2022 were included with a total of 21 076 participants with schizophrenia. The pooled global prevalence of sexual dysfunctions was 56.4% (95% CI, 50.5-62.2), with a prevalence of 55.7% (95% CI, 48.1-63.1) for men and 60.0% (95% CI, 48.0-70.8) for women. The most frequent sexual dysfunction was erectile dysfunction in men (44%; 95% CI, 33.5-55.2), followed by loss of libido in men (41%; 95% CI, 30.7-51.4), ejaculation dysfunction in men (39%; 95% CI, 26.8-51.8), orgasm dysfunction in women (28%; 95% CI, 18.4-40.2), and amenorrhea in women (25%; 95% CI, 17.3-35.0). Factors associated with heterogeneity were study design, time and location, sociodemographic data, alcohol use disorder, psychiatric diagnosis, illness severity, and the use of antidepressants and anxiolytics. Sexual dysfunctions were more frequent in schizophrenia vs schizoaffective disorders, and erectile disorders were less frequent in individuals with longer illness duration. Antidepressant and mood stabilizer prescriptions were associated with lower rates of erection disorders (β, -6.30; 95% CI, -10.82 to -1.78); P = .006 and -13.21; 95% CI, -17.59 to -8.83; P < .001, respectively) and ejaculation disorders (β, -6.10; 95% CI, -10.68 to -1.53; P = .009 and β, -11.57; 95% CI, -16.34 to -6.80; P < .001, respectively). No obvious improvements in the rates of sexual dysfunction at other times were found, and there were conflicting results regarding antipsychotic classes.
This systematic
review and meta-analysis found a high prevalence of sexual dysfunction among individuals with schizophrenia, with considerable heterogeneity in associated factors. The findings also suggest that some dysfunctions may be explained by schizophrenia. The association between lower rates of dysfunction and antidepressant use suggests that treating comorbid depression could be an effective strategy to improve sexual health. A lack of data on metabolic parameters and physical health in general was also noted, while these issues are frequent in the care of schizophrenia.