Effects of medications on sexual functioning in patients treated in a day hospital setting

Introduction
Sexual problems are present in roughly one third of women and one quarter of men, at least once in their lifetime. Sexual problems are more prevalent in people with mental disorders, especially in people with posttraumatic stress disorder (PTSD), depression, schizophrenia, dependence. Also, psychotropic drugs have a negative influence on sexual functioning. It is well known that antipsychotics can affect sexual desire and sexual excitement, while antidepressants can affect desire and achieving orgasm. Day hospital is an organizational method of treatment in which people spend several hours in a therapeutic setting, while the rest of the day they live in their usual home setting. Day hospital is used for the treatment of different mental disorders.

Goran Arbanas, Ena Ivezic,

Zagreb

Results
Regarding diagnosis, patients were using psychotropic drugs as shown in Figure 2.

Objective
The aim of this study was to see how different psychotropic drugs influence sexual functioning in patients with PTSD, depression, anxiety disorders, and alcohol dependence.

Method
Patients treated in three day hospitals in two different cities (Karlovac and Zagreb) were assessed on their sexual functioning. The sample consisted of 192 patients; 11 refused to participate or gave incomplete data. Three quarters were male (74.7%). The mean age was 48.1 (range 19-72). They were almost equally distributed among four diagnoses (Figure 1.)

Logistic regression showed that there was a correlation between some of the drugs with some aspects of sexual functioning: anxiolytics and antidepressants were correlated with low sexual desire, anxiolytics with problems of sexual excitement, orgasm and erectile problems/problems with lubrication (Table 1.). Table 1. Influence of particular psychotropic drugs on different components of sexual functioning Sexual desire Mood stabilizers Anxiolytics Antidepressants Disulfiram Excitement Orgasm Erection/vaginal lubrication

Regarding diagnosis, the lowest sexual functioning was established for PTSD patients (Figure 3.). On each component of sexual functioning (desire, excitement, arousal, orgasm), PTSD patients had the highest results (the worst functioning) and subjects with alcohol dependence had the best functioning.

Figure 1. Distribution of mental disorders in the sample

The patients were questioned about their sexual life and problems using the Sexual Functioning Scale (FSF), which consists of six items regarding (1) sexual desire (drive), (2) sexual excitement, (3) achieving orgasm, (4) satisfaction with orgasm, (5) premature/delayed ejaculation, and (6) erection/vaginal lubrication. The validity of the scale was high ( = 0.94).

Conclusion
Patients with PTSD have the worst sexual functioning, and patients with alcohol dependence the best, in the group of patients treated in a day hospital. Anxiolytics showed the worst effect on sexual function: negatively influencing sexual desire, excitement, orgasm, and erection/vaginal lubrication. Antidepressants had negative effect on sexual desire. It is important to evaluate sexual functioning in patients with different mental disorders, because both their disorder and the drugs used to treat the disorder (especially anxiolytics) can have a negative influence.

General Hospital Karlovac

Sanja Maroevic, Lana Muzinic,

Psychiatric Clinic Vrapce Psychiatric Clinic Vrapce

Figure 2. Usage of psychotropic drugs in patients with different diagnoses

Neg. effect Neg. effect

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Figure 3. Total results on the Sexual Functioning Scale