Total ASEX Scores Research Articles

Assessment of Marital Adjustment and Sexuality in Women With Rheumatoid Arthritis

Objectives: Physical distress in patients with rheumatoid arthritis (RA) may affect marital adjustment and sexual functioning. This study aims to investigate marital adjustment and sexuality in female patients with RA. Patients and methods: The patient group consisted of 47 female patients with a diagnosis of RA between the ages of 18-55 (mean age 37.36±7.21 years), married and who have not entered menopause yet. Forty-five healthy women were included as a control group. Golombok Rust Inventory of Sexual Satisfaction (GRISS), Arizona Sexual Experiences Scale (ASEX), Dyadic Adjustment Scale, Beck Depression Scale, Beck Anxiety Scale, and Disease Activity Scores in 28 joints were evaluated. Results: The mean disease duration was 4.77±4.61 years. There was no significant difference between the groups with regard to total and subscale scores of Dyadic Adjustment Scale and GRISS total scores (p>0.05). A significant difference was found between the groups with regard to ASEX total score (p<0.05), ASEX-objective sexual arousal (p<0.05), ASEX-subjective sexual arousal categories (p<0.01), and GRISS-anorgasmia subscale (p<0.01). A positive correlation was found only between the number of tender joints and anorgasmia subscale of GRISS (p<0.05). Conclusion: Rheumatoid arthritis does not affect marital adjustment of patients; however, may affect sexual functioning to some extent leading to a need for psychiatric care.

Sexual dysfunction in outpatients with schizophrenia in Turkey: a cross-sectional study.

BackgroundSexual dysfunction is one of several factors related to medication compliance in patients taking antipsychotic medication but the magnitude of this problem is unknown.AimCompare the self-reported sexual functioning of clinically stable patients with schizophrenia taking antipsychotic medication to that of healthy controls using the Turkish version of the 5-item Arizona Sexual Experience Scale (ASEX). This scale, which has previously been validated in Turkey, assesses 5 components of sexual function: sex drive, sexual arousal, vaginal lubrication/penile erection, ability to achieve orgasm, and satisfaction with orgasm.MethodsThe Scale for the Assessment of Positive Symptoms, the Scale for Assessment of Negative Symptoms, and ASEX were administered to 101 clinically stable outpatients with schizophrenia (38 females and 63 males). The ASEX was also administered to 89 control subjects (41 females and 48 males) without a history of mental illness. Respondents were classified as having sexual dysfunction if ASEX total score (range 5-30) >18, if any ASEX item score (range 1-6) ≥ 5, or if 3 or more ASEX items ≥4.ResultsMale patients with schizophrenia have significantly more self-reported sexual dysfunction than healthy controls (46% vs. 8%). The prevalence of sexual dysfunction is higher in female patients than in male patients (68% vs. 46%), but it was also very high in healthy female controls (68%), so the sexual dysfunction of female patients cannot be attributed to their illness or to the medications they are taking. Within the patient group, there was no significant relationship between the severity of positive or negative symptoms and the severity of sexual dysfunction, and the severity of sexual function was not different between patients taking first-generation or second-generation antipsychotic medications.ConclusionsThe very different findings by gender in Turkey highlights the importance of assessing location-specific and gender-specific sexual norms when trying to assess the role of mental illness and medications on sexual functioning. Prospective studies are needed to distinguish the relative importance of cultural norms, the schizophrenic illness, and the use of antipsychotic medication in the etiology and course of sexual dysfunction among individuals with schizophrenia.

The relation of sexual dysfunction to depression and anxiety in patients with Parkinson’s disease

In this study, we aimed to find out whether sexual dysfunction in patients with Parkinson's Disease (PD) was associated to PD-related disability and whether this relationship was modulated by depressive and anxiety symptoms. Eighty-nine consecutive patients with idiopathic PD who attended to our movement disorders outpatient clinics between January 2011 and June 2014 were included in this study. The diagnosis of PD was confirmed by a movement disorders specialists in Neurology, according to UK Parkinson's Disease Society Brain Bank Criteria. The Unified PD Rating Scale (UPDRS) motor was used to assess motor disability and Hoehn and Yahr stage (H&Y) was used to establish disease severity. Cognitive function was assessed by the Mini-Mental State Examination. Patients were also administered the Hamilton depression (HAMD) and anxiety (HAMA) rating scales. The sexual functions of the patients were rated by applying the Turkish version of the Arizona Sexual Experiences Scale (ASEX). The mean age at the time of the study visit was 67.74±9.05. Male/female ratio was 1.87. Mean UPDRS total was 29.06±13.96 and mean UPDRS motor was 17.62±9.07. Mean HAMD score was 13.92±10.86, 58.4% of the patients had minor or major depression; and mean HAMA score was 7.94±6.49, 56.2% of the patients had minor or major anxiety. The mean ASEX score was 18.54±7.27 out of a maximum of 30. ASEX total scores were correlated with age, H&Y stage and HAMA scores. Age and also age at onset were correlated with ASEX subdomains except sexual desire. There was no correlation between disease duration and ASEX subdomains. UPDRS motor score was correlated with erection/lubrication. HAMD was only correlated with orgasm satisfaction. HAMA score was correlated with stimulation and orgasm. In patients with PD, there may be a common factor that modulates both depression, anxiety and sexual function. Further studies are needed to clarify the exact relationship.

P.3.f.003 Gender differences in psychosis with co-occurring substance use disorder

The mean age of onset of the illness was 24.8±6.1 years. The average PANSS total score and ASEX total score were respectively 51.8±12.8 and 17.7±5.6. The average equivalent dose chlorpromazine was 475±279 mg/day. Sexual dysfunction was present in 55% of outpatients with schizophrenia (total score 19 or ASEX Item 5 or 3 items 4). We didn’t found relationship between sexual dysfunction and sociodemographic characteristics except gender. Female had higher ASEX total score (p = 0.002). Arousal and orgasm disorders were more frequent in women (p = 0.005 and p = 0.001). For clinical factors, patients with continuous evolution of schizophrenia had higher ASEX total score (p = 0.049). There was a relationship between the ASEX total score and dose of treatment (r = 0.36, p = 0.001) and with the severity of symptoms (r = 0.31, p = 0.005). Conclusions: More than half of our outpatients with schizophrenia had sexual dysfunction. Women had more sexual dysfunctions. Sexual dysfunction is correlated to symptoms severity, continuous evolution and dose treatment.

A randomized, double-blind, placebo-controlled study of flexible doses of levomilnacipran ER (40–120 mg/day) in patients with major depressive disorder

Objective:Levomilnacipran ER is a potent and selective serotonin and norepinephrine reuptake inhibitor (SNRI) approved for the treatment of major depressive disorder (MDD). Efficacy and safety have been evaluated in five Phase II/III studies, four of which met the pre-specified primary efficacy outcome. Results of the negative trial (ClinicalTrials.gov NCT00969150) are reported here.Methods:A Phase III randomized, double-blind, placebo-controlled trial comparing flexible-dose levomilnacipran ER 40–120 mg/day with placebo was conducted in outpatients with MDD. Patients met the DSM-IV-TR criteria for MDD, had a current episode of depression of at least 4 weeks’ duration, and a Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≥30. The study comprised a 1-week, single-blind, placebo lead-in, 8-week double-blind treatment, and a 2-week down-taper. The primary and secondary efficacy measures were change from baseline to Week 8 in MADRS and Sheehan Disability Scale (SDS) total scores, respectively, analyzed using a mixed-effects model for repeated measures approach. Safety outcomes included adverse events (AEs), laboratory and vital sign measures, the Columbia-Suicide Severity Rating Scale, and the Arizona Sexual Experiences Scale (ASEX).Results:Three hundred and fifty-five patients received the study drug and had ≥1 post-baseline MADRS total score assessment (ITT Population); 81.9% of placebo and 77.1% of levomilnacipran ER patients completed the study. For levomilnacipran ER vs placebo, MADRS (−15.7 vs −14.2) and SDS (−8.8 vs −8.2) total score improvements, and rates of MADRS response (38.5% vs 34.8%) and remission (25.3% vs 23.8%) were numerically greater but differences were not statistically significant. Levomilnacipran ER was generally well tolerated. More levomilnacipran ER patients vs placebo reported AEs; the most common AEs for levomilnacipran ER were nausea (17%) and headache (16%). Mean changes in most safety measures were small and similar between groups. There were no meaningful differences in total ASEX scores between groups.Limitations:Short duration of treatment, inclusion and exclusion criteria, and lack of an active comparator.Conclusion:Numerical improvements for levomilnacipran ER vs placebo were detected in this study, but the differences were not statistically significant; levomilnacipran ER was generally well tolerated.

P.2.b.058 The relevance of oxidative stress status in first episode and recurrent depression

La présente étude se propose de déterminer la validité de la version française d’une échelle anglo-saxonne validée en 2000 par McGahuey et al. [9], l’Arizona Sexual Experience Scale (ASEX). L’ASEX est un auto-questionnaire simple et rapide permettant de repérer l’existence de troubles sexuels dans une population de patients déprimés. La validité de l’échelle a été testée par comparaison entre un groupe de 37 patients déprimés (critères DSM-IV-TR), et un groupe de 64 sujets témoins. Cette étude montre que la version française de l’échelle ASEX est un outil de mesure des troubles sexuels spécifique, sensible et qui possède une bonne consistance interne. L’ASEX est également un outil bien accepté par le patient. Sa brièveté (seulement cinq minutes de passation) et son faible degré d’intrusion permettent des mesures fréquentes et répétées de la dysfonction sexuelle, provoquant un minimum de gêne et d’embarras pour le patient. En pratique courante, cette échelle permet au clinicien d’identifier rapidement quel élément de la sexualité est affecté d’un trouble et ainsi traiter spécifiquement celui-ci.Since the Beck study (1967), it is well known that sexual dysfunction is particularly prevalent in depressive patients compared to the general population, at 70% and 30% respectively. Depression, psychotropics and antidepressants are responsible for altering sexuality, and patients are considerably affected by these symptoms that dramatically decrease their quality of life. Screening for sexual dysfunctions seems essential, and a scale such as the Arizona Sexual Experience Scale (ASEX) may help practitioners. The English version of this scale was validated in 2000 (McGahuey et al. [9]), and is widely used in scientific research. The aim of this study was to assess the validity of the French version of the ASEX scale.Following authorization from the University of Arizona, the ASEX scale was translated into French by our team at the University hospital of Besançon (France), by the back translation technique, and then checked by a professional translator. ASEX, Mini International Neuropsychiatric Interview (MINI), Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) were filled out by 37 depressed inpatients, and ASEX and PHQ-9 by 64 controls (hospital employees, residents and students at the University of Besançon), and again one to two weeks later. Bivariate correlations were performed using total ASEX scores to determine the test-retest reliability. Internal consistency of the ASEX scale was assessed using Cronbach's alpha analysis. Analyses of variance (Anova) were performed to determine the validity of the ASEX scale to compare patients to controls for total ASEX score and for individual ASEX item scores. In order to determine whether the ASEX criteria accurately reflect sexual dysfunction (determined by the HDRS rating or self-report), positive and negative predictive value and sensitivity and specificity were measured. To determine how well the total ASEX score differentiates between individuals with sexual dysfunction and those without, a Receiver Operating Characteristic (ROC) analysis was performed. We expected similar results between the French version of the ASEX scale and the original one (McGahuey and al., 2000).Patients and controls were similar in terms of sex and age. The test-retest reliability was good, and the internal consistency was excellent using Cronbach's alpha analysis (alpha = 0.9451). Analyses of variance (Anova) showed strong differences between the two groups, confirming the validity of the ASEX scale to compare patients to controls for total ASEX score and individual ASEX item scores. Positive and negative predictive values were respectively 89.66% (PPV) and 85.33% (NPV). Specificity and sensitivity were respectively 95.31% (Sp) and 70.27% (Se). The ROC analysis showed the area under the curve (AUC = 0.8457) and the best ASEX criteria to demonstrate that sexual dysfunction had been correctly identified (total ASEX score ≥ 18).This study assessed the validity and reliability of the French version of the ASEX scale. These findings demonstrate the highly acceptable psychometric properties of ASEX in patients with depression.

Validation française de l’échelle psychométrique ASEX d’évaluation des troubles sexuels dans la dépression

Since the Beck study (1967), it is well known that sexual dysfunction is particularly prevalent in depressive patients compared to the general population, at 70% and 30% respectively. Depression, psychotropics and antidepressants are responsible for altering sexuality, and patients are considerably affected by these symptoms that dramatically decrease their quality of life. Screening for sexual dysfunctions seems essential, and a scale such as the Arizona Sexual Experience Scale (ASEX) may help practitioners. The English version of this scale was validated in 2000 (McGahuey et al. [9]), and is widely used in scientific research. The aim of this study was to assess the validity of the French version of the ASEX scale. Following authorization from the University of Arizona, the ASEX scale was translated into French by our team at the University hospital of Besançon (France), by the back translation technique, and then checked by a professional translator. ASEX, Mini International Neuropsychiatric Interview (MINI), Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) were filled out by 37 depressed inpatients, and ASEX and PHQ-9 by 64 controls (hospital employees, residents and students at the University of Besançon), and again one to two weeks later. Bivariate correlations were performed using total ASEX scores to determine the test-retest reliability. Internal consistency of the ASEX scale was assessed using Cronbach's alpha analysis. Analyses of variance (Anova) were performed to determine the validity of the ASEX scale to compare patients to controls for total ASEX score and for individual ASEX item scores. In order to determine whether the ASEX criteria accurately reflect sexual dysfunction (determined by the HDRS rating or self-report), positive and negative predictive value and sensitivity and specificity were measured. To determine how well the total ASEX score differentiates between individuals with sexual dysfunction and those without, a Receiver Operating Characteristic (ROC) analysis was performed. We expected similar results between the French version of the ASEX scale and the original one (McGahuey and al., 2000). Patients and controls were similar in terms of sex and age. The test-retest reliability was good, and the internal consistency was excellent using Cronbach's alpha analysis (alpha=0.9451). Analyses of variance (Anova) showed strong differences between the two groups, confirming the validity of the ASEX scale to compare patients to controls for total ASEX score and individual ASEX item scores. Positive and negative predictive values were respectively 89.66% (PPV) and 85.33% (NPV). Specificity and sensitivity were respectively 95.31% (Sp) and 70.27% (Se). The ROC analysis showed the area under the curve (AUC=0.8457) and the best ASEX criteria to demonstrate that sexual dysfunction had been correctly identified (total ASEX score ≥ 18). This study assessed the validity and reliability of the French version of the ASEX scale. These findings demonstrate the highly acceptable psychometric properties of ASEX in patients with depression.

Sexuality in Young Adult Men Aged 18–24 with Epilepsy

The aim of this study was to determine the extent of sexual dysfunction in young male patients (18–24 years) with epilepsy. Forty-five male patients with epilepsy aged between 18 and 24, and forty-four age- matched healthy male volunteers were included in the study. Participants completed a battery of self-reported tests (ASEX: Arizona Sexual Experiences Scale, HADS: Hospital Anxiety and Depression Scale). Demographic and clinical variables were recorded. Serum total testosterone was measured between 8:00 and 10:00 a.m. in patients with epilepsy. Sexual function scores (sexual drive and penile erection) were higher in patients with epilepsy than those of the control group (p < 0.001 and p = 0.008, respectively). The difference between the mean total ASEX scores, which were 13.9 and 11.4 in patients with epilepsy and controls, respectively, was significant (p = 0.009). HAD anxiety scores were significantly higher in patients with epilepsy than controls (p = 0.01) (Table 2). HAD-depression scores of both groups were similar (p = 0.09). This study demonstrates that young male patients with epilepsy have lower levels of sexual activity and drive and more erectile problems. Impaired sexual function is associated with anxiety scores.

Panik bozukluk hastalarında çocukluk çağı travmatik yaşantılarının cinsel işlev üzerine etkileri / The effects of childhood trauma on sexual function in panic disorder patients

Objective: The aim of this study is to investigate the relationship between childhood physical/sexual abuse, suicide attempts, self-harming behavior and sexual functioning in patients with panic disorder. Method: 81 patients with panic disorder were included in the study. Participants were evaluated by using Childhood Trauma Questionnaire, sociodemographic form and Arizona Sexual Experiences Scale (ASEX). Results: The frequency of physical abuse history was 48.1% and the frequency of sexual abuse was 9.9% in the sample. Female participants with a history of physical abuse had significantly higher scores in the items of sexual desire, arousal, ability to reach orgasm, satisfaction from orgasm and total ASEX scores than those without a history of physical abuse. Female participants with a sexual abuse history also had higher scores in the items of arousal, ability to reach orgasm and total ASEX scores. No significant difference was found between male participants with regard to physical/sexual abuse history. In a regression model, comorbid major depressive disorder rather than abuse history was found to be a predictor of poor sexual functioning. Conclusion: Female patients with panic disorder who have physical/sexual abuse history have inhibited sexual desire, arousal and orgasm. Sexuality in patients with panic disorder is affected by depression comorbidity as well as sexual and physical abuse history.

Evaluation of the relationship between endogenous gonadotropins and female sexual function and psychological status in predialysis and hemodialysis patients

Objectives: To evaluate sexual function and psychological state and the factors affecting female sexual dysfunction in predialysis and hemodialysis patients. Design and methods: Forty-seven women with chronic renal failure including 22 predialysis patients, 25 hemodialysis patients, and 30 healthy controls were included in this study. Demographic and clinical variables of the patients were recorded. The sexual functions and psychological states of the patients, assessed by the Arizona Sexual Experiences Scale (ASEX) and Beck Depression Inventory (BDI), respectively, were compared between the groups. Results: Total ASEX scores, ability to reach orgasm, and BDI scores were significantly higher in predialysis and hemodialysis patients than controls, reflecting sexual dysfunction. The patients in the predialysis group were 6 and 3.8 times more likely to develop depressive symptoms compared to the controls and hemodialysis patients, respectively. The predialysis patients who showed depressive symptoms were 24 times more likely to develop sexual dysfunction compared to those without depression. Serum FSH and LH levels were also positively correlated with arousal and erection/lubrication scores in the predialysis patients with depressive symptoms. Conclusion: Female predialysis rather than dialysis patients might be more likely to develop depression. Those patients with depressive symptoms may also be at greater risk of developing sexual dysfunction in which increased gonadotropin levels and age may also be contributing factors. Therefore, psychiatric and gynecologic consultations may be beneficial.

Sexual dysfunction in women with migraine versus tension-type headaches: a comparative study

The aim of this study was to compare the incidence of sexual dysfunction between patients with tension-type headaches (T), migraines (M) and healthy controls (C) in order to investigate the relationship between sexual dysfunction and the features of headaches. The population comprised of 44 patients with M, 30 with T and 30 with C. They have completed Arizona Sexual Experiences Scale (ASEX), Visual Analog Scale. The number of sexual activities over the past 30 days and the frequency of masturbation behavior in C were considerably higher than those in the headache groups. The averages for ASEX item no. 1, 2, 3 and 4 were significantly higher in those with M versus C; and both the subscales and total scores of ASEX were also higher in those with T than C. The mean score for ASEX item no. 3 and the total ASEX score were significantly higher in T versus M. In both headache groups, no significant relationship was observed between headache features and ASEX. The present study showed that patients with either M or T do experience problems in several aspects of sexuality compared with C. Further research is essential to augment our understanding of the sexual dysfunction in this field.

Drug-induced sexual dysfunction and mental health patients' attitude to psychotropic medications

The objective of the study was to explore sexual dysfunction in adults with enduring mental health problem treated with psychotropic medications, focusing on associations between drug-induced sexual dysfunction and attitude to prescribed medications. Participants were invited to complete an anonymous self-administered survey questionnaire, which comprised of the 10-Item Drug Attitude Inventory and the Arizona Sexual Experience Scale (ASEX). In addition, participants were asked about their views on discussing sexual problems with healthcare professionals. Of participants, 34 (53%) reported current sexual dysfunction. Of those, 26 (41%) attributed their sexual dysfunction to side-effects of medications. Sixteen (25%) expressed a negative attitude towards their treatment. Compared to patients with a positive attitude, those with a negative attitude reported statistically significant higher ratings of sexual arousal problems, erectile dysfunction/vaginal dryness, orgasmic inhibitions, orgasmic dissatisfactions and higher total ASEX scores. Furthermore, participants were relatively willing to discuss their sexual problems with healthcare professionals. The study found that participants' experience of sexual side-effects has a negative influence on subjective attitude to psychotropic medications. Empathic discussions of sexual side-effects may offer psychiatrists an opportunity to improve treatment adherence and, ultimately, quality of life.

The effects of the adjunctive bupropion on male sexual dysfunction induced by a selective serotonin reuptake inhibitor: a double‐blind placebo‐controlled and randomized study

To determine the safety and efficacy of adjunctive bupropion sustained-release (SR) on male sexual dysfunction (SD) induced by a selective serotonin reuptake inhibitor (SSRI), as SD is a common side-effect of SSRIs and the most effective treatments have yet to be determined. The randomized sample consisted of 234 euthymic men who were receiving some type of SSRI. The men were randomly assigned to bupropion SR (150 mg twice daily, 117) or placebo (twice daily, 117) for 12 weeks. Efficacy was evaluated using the Clinical Global Impression-Sexual Function (CGI-SF; the primary outcome measure), the International Index of Erectile Function (IIEF), Arizona Sexual Experience Scale (ASEX), and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) (secondary outcome measures). Participants were followed biweekly during study period. After 12 weeks of treatment, the mean (sd) scores for CGI-SF were significantly lower, i.e. better, in patients on bupropion SR, at 2.4 (1.2), than in the placebo group, at 3.9 (1.1) (P= 0.01). Men who received bupropion had a significant increase in the total IIEF score (54.4% vs 1.2%; P= 0.003), and in the five different domains of the IIEF. Total ASEX scores were significantly lower, i.e. better, among men who received bupropion than placebo, at 15.5 (4.3) vs 21.5 (4.7) (P= 0.002). The EDITS scores were 67.4 (10.2) for the bupropion and 36.3 (11.7) for the placebo group (P= 0.001). The ASEX score and CGI-SF score were correlated (P= 0.003). In linear regression analyses the CGI-SF score was not affected significantly by the duration of SD, type of SSRI used and age. Bupropion is an effective treatment for male SD induced by SSRIs. These results provide empirical support for conducting a further study of bupropion.

A Pilot Study to Determine a Prolactin Threshold that Identifies Improved Sexual Functioning when Switching from a Prolactin-Elevating to a Prolactin-Neutral Antipsychotic

This pilot study, among men with schizophrenia or schizoaffective disorder who had antipsychotic-associated sexual dysfunction (while taking an antipsychotic with prolactin-elevating effects), examined if there is an antipsychotic-associated prolactin threshold that identified patients who experienced improvement in sexual functioning when switched to an antipsychotic with neutral effects on prolactin levels (quetiapine). Twenty male patients, who were experiencing risperidone-associated sexual dysfunction, were switched to six weeks of either double-blind (n=10) or open-label (n=10) quetiapine (mean dose=295.0 mg/day) treatment. Baseline prolactin levels were obtained. The Arizona Sexual Experience Scale (ASEX) was used to assess sexual functioning. The optimal antipsychotic-associated prolactin threshold that best identified improvement in sexual functioning (defined as ≥20% reduction in ASEX total scores) was determined with a Receiver Operating Characteristic (ROC) analysis and Odds Ratios. A prolacti...

Antidepressant-Induced Sexual Dysfunction among Newer Antidepressants in a Naturalistic Setting

ObjectiveAntidepressants used to treat depression are frequently associated with sexual dysfunction. Sexual side effects affect the patient's quality of life and, in long-term treatment, can lead to non-compliance and relapse. However, studies covering many antidepressants with differing mechanisms of action were scarce. The present study assessed and compared the incidence of sexual dysfunction among different antidepressants in a naturalistic setting.MethodsParticipants were married patients diagnosed with depression, per DSM-IV diagnostic criteria, who had been taking antidepressants for more than 1 month. We assessed the participants via the Arizona Sexual Experiences Scale (ASEX), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI), and assessed their demographic variables, types and dosages of antidepressants, and duration of antidepressant use via their medical records.ResultsOne hundred and one patients (46 male, 55 female, age 42.2±7 years) completed the instruments. Thirteen were taking fluoxetine (mean dose 21.3±8.5 mg/day), 24 were taking paroxetine (mean dose 20.4±7.2 mg/day), 20 taking citalopram (mean dose 22.1±6.5 mg/day), 22, venlafaxine (mean dose 115.7±53.2 mg/day) and 22, mirtazapine (mean dose 18±8.7 mg/day). Mean ages, sex ratios, and BDI and STAI scores did not differ significantly across antidepressants. A substantial number of participants (46.5%, n=47) experienced sexual dysfunction. The prevalence of sexual dysfunction differed across drugs: citalopram 60% (n=12), venlafaxine 54.5% (n=12), paroxetine 54.2% (n=13), fluoxetine 46.2% (n=6), and mirtazapine 18.2% (n=4). Regression analyses revealed the significant factors for sexual dysfunction were being female, total scores on the BDI and SAI, and type of antidepressant (F=4.92, p<0.0001). Of the antidepressants, the mirtarzapine group's total ASEX score was significantly lower than the scores of the citalopram, fluoxetine, and paroxetine groups.ConclusionThe incidence of sexual dysfunction was substantially high during antidepressant treatment. The incidence of sexual dysfunction differed among antidepressants having different mechanisms of action. Our study suggests the need for clinicians to consider the impact of pharmacotherapy on patients' sexual functioning in the course of treatment with antidepressants.

Tolterodine Immediate Release Improves Sexual Function in Women with Overactive Bladder

Quality of life studies indicate that overactive bladder (OAB) has a greater negative impact on everyday life than other serious conditions such as diabetes. The detrimental effect of OAB on female sexual health is more prominent than urinary incontinence. We know that tolterodine immediate release (IR) has a beneficial effect on urinary symptoms in OAB. To evaluate the impact of tolterodine IR on sexual function in patients with OAB. A total of 30 sexually active women with OAB from 20 to 52 years were included. All patients filled out the International Consultation on Incontinence Questionnaire (ICIQ) and the Arizona Sexual Experience Scale (ASEX) before treatment with tolterodine IR and at the end of each month of treatment until 3 months. Expected outcomes were improvements in the ICIQ and ASEX total score. All ASEX items were expected to improve individually. These improvements indicate better sexual function after treatment. Results. The mean of the total ASEX score improved relative to baseline in the first (P<0.01), second (P<0.01), and third (P<0.01) follow-up. The mean of scores for sexual desire, arousal, vaginal lubrication, orgasm, and orgasm satisfaction improved significantly (P<0.01) with each follow-up. Tolterodine IR significantly improves sexual function of women with OAB. Improvement is seen in all domains of sexual function.

Sexual functioning associated with quetiapine switch vs. risperidone continuation in outpatients with schizophrenia or schizoaffective disorder: A randomized double-blind pilot trial

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 ≥ 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 Group × Period 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.

The Relationship between Serum Prolactin Level and Sexual Functioning among Male Outpatients with Schizophrenia or Schizoaffective Disorder: A Randomized Double-Blind Trial of Risperidone vs. Quetiapine

Examine the relationship between serum prolactin level and sexual functioning among male outpatients with schizophrenia or schizoaffective disorder who were treated with risperidone or quetiapine. Male outpatients (N = 22, age ≥ 18 years) with schizophrenia or schizoaffective disorder who had experienced risperidone-associated sexual dysfunction prior to the study were randomized to 6 weeks of double-blind risperidone continuation (mean dose = 4.3 mg/day, SD = 1.2) or quetiapine switch (mean dose = 300 mg/day, SD = 66.7) treatment. Serum prolactin levels at baseline and at the end of week 6 (final visit) were obtained. The five-item Arizona Sexual Experience Scale (ASEX) assessed sexual functioning at baseline and at week 6. A mixed linear model analysis of covariance, with baseline ASEX and Positive and Negative Syndrome Scale (PANSS) scores as covariates, was used to examine the relationship between serum prolactin level (at week 6) and sexual functioning (at week 6). The raw (unadjusted) Spearman rank-order correlations (r s ) were also used to assess the linear association between serum prolactin level and sexual functioning. For the risperidone treated group (n = 12), there was a significant positive relationship between serum prolactin level and ASEX total score (r s = 0.689, β = 0.17, p = .04) and three of the five ASEX subitems (ASEX subitem 1, strength of sex drive, β = 0.03, p = .04; ASEX subitem 2, sexual arousal, β = 0.04, p = .04; and ASEX subitem 3, penile erection, β = 0.04, p = .02). There was no significant relationship, for the quetiapine group (n = 10), between serum prolactin level and ASEX total score (p = .55) and any of the ASEX subitems (p's > .20). In this 6-week randomized double-blind trial, higher serum prolactin level was related to greater impairment of sexual functioning in male outpatients who were treated with risperidone, but not with quetiapine.

An Open-Label Study to Evaluate Switching from an SSRI or SNRI to Tiagabine to Alleviate Antidepressant-Induced Sexual Dysfunction in Generalized Anxiety Disorder

This study investigated tiagabine monotherapy in subjects with generalized anxiety disorder (GAD) who had been switched from selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as a result of antidepressant-induced sexual dysfunction. Adults with DSM-IV GAD, an adequate therapeutic response (> or =50% decrease in Hamilton Rating Scale for Anxiety [HAM-A] total score) to SSRI or SNRI and sexual dysfunction were switched to open-label tiagabine 4-12 mg/day for 14 weeks. Assessments included the HAM-A, Hospital Anxiety & Depression Scale (HADS) and the Arizona Sexual Experiences Scale (ASEX); assessments were made at baseline and at Weeks 4, 8, and 14. Twenty six subjects were included in the analysis. Tiagabine showed no worsening in baseline symptoms of GAD, with non-significant changes from baseline in mean HAM-A total scores and HADS Anxiety and Depression subscale scores. There was a significant (p < 0.001) reduction in ASEX total scores from baseline following tiagabine, indicating an alleviation of sexual dysfunction. Tiagabine was reasonably tolerated; the most commonly reported adverse events were dizziness/light headedness (n = 6; 23%), nausea (n = 6; 23%) and fatigue (n = 2; 8%). Tiagabine may be useful in subjects who respond to previous antidepressant therapy but develop sexual dysfunction as an adverse event.

Sexual dysfunction associated with second-generation antipsychotics in outpatients with schizophrenia or schizoaffective disorder: An empirical evaluation of olanzapine, risperidone, and quetiapine

Objective Evaluate sexual dysfunction, as measured by the Arizona Sexual Experience Scale (ASEX), in olanzapine-, quetiapine-, and risperidone-treated outpatients with schizophrenia or schizoaffective disorder. Method The sexual functioning of 238 outpatients (age ≥ 18 years) with diagnoses of schizophrenia or schizoaffective disorder who took quetiapine ( n = 57), olanzapine ( n = 94), or risperidone ( n = 87) was evaluated with a one-time rating of the ASEX. The dose range for each treatment group was 5 to 40 mg/day ( M = 16.6 mg/day, SD = 7.4) for olanzapine; 1 to 8 mg/day ( M = 3.9 mg/day, SD = 1.6) for risperidone; and 50 to 900 mg/day ( M = 376.8 mg/day, SD = 213.4) for quetiapine. Antipsychotic group designation was based on medication treatment at study entry (i.e., non-random assignment). Participant characteristics were collected to test for treatment group differences and for potential associations with severity of sexual dysfunction. The primary data analysis was a mixed linear model analysis of covariance with age, gender, and presence/absence of antidepressant known to cause sexual dysfunction included as covariates. Results There was a significant treatment effect on severity of sexual dysfunction, as measured by ASEX total scores ( p = .04). The adjusted average ASEX total scores were lower in the quetiapine ( M = 17.80) than in the risperidone ( M = 19.69) or olanzapine ( M = 20.34) groups. Individual comparisons of the treatments on adjusted average ASEX total scores indicated a significant difference between olanzapine and quetiapine ( p = .04), but no difference between risperidone and quetiapine ( p = .17) or olanzapine and risperidone ( p = .76). Conclusions Quetiapine was associated with less severe sexual dysfunction than olanzapine and risperidone (albeit the effect between risperidone and quetiapine was not statistically significant). Olanzapine and risperidone were associated with a comparable degree of sexual dysfunction. Patients in all three treatment groups, nonetheless, experienced a moderately high degree of sexual dysfunction. Because the patients were not randomized, conclusions must be interpreted within the context of the quasi-experimental design.