Title:The Role of Atypical Antipsychotics in Sexuality: Road to Recovery in Schizophrenia
Volume: 19
Issue: 12
关键词:
非典型抗精神病药，性，康复，精神分裂症，心理教育，心理治疗。
摘要: Sexuality is an important dimension in human beings as a form of expression of individuality.
For many decades, sexual functioning has been a neglected area among patients suffering from
schizophrenia. It was a presumption that patients with schizophrenia could be asexual and this could
be secondary to overwhelming situations of delusion, hallucination, hostility and negative symptoms
among others. The deficient in sexual functioning are due to innate factors, i.e. negative symptoms
(apathy, avolition and amotivation) and also as a result of prefrontal dysfunction, i.e. inability to plan
and execute meaningful relationship. Adverse effects of the psychopharmacological agents, especially
the typical antipsychotics, e.g. dystonia, excessive sedation and hyperprolactinemia may interfere with
patients’ sexual activity. In this review, we highlight the neurobiology of schizophrenia in the context
of understanding sexual functioning and to integrate the knowledge of dopamine-serotonin neurotransmitter's
interaction and the receptors’ target. Interventional approaches consist of psychopharmacological
and psychosocial interventions. In the perspective of sexuality, we recommend atypical antipsychotic
should be placed as the first line treatment for both drug naïve patients and also to patients
who are already receiving psychopharmacological agents in consideration for a drug-switch from typical
to atypical antipsychotics. Aripiprazole, clozapine, olanzapine and quetiapine exert benefits in
terms of sexual functioning recovery due to their atypical mechanism of action. However, the potential
adverse effect like metabolic syndrome should be adequately managed to prevent negative consequences.
Psychosocial interventions, i.e. psychoeducation, destigmatization, supportive psychotherapy
and psychiatric rehabilitation also play a crucial role in the management. In conclusion, restoration of
sexual function is an achievable recovery target in patients with schizophrenia through these biopsycho-
social interventions.
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