Background: Sexual dysfunction is one of several factors related to medication compliance in patients taking antipsychotic medication but the magnitude of this problem is unknown.
Aim: Compare 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.
Methods: The 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.
Results: Male 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.
Conclusions: The 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.
背景: 性功能障碍是影响患者对抗精神病药物服药依从性的因素之一，但尚不清楚这个问题的严重程度。
目的: 比较服用抗精神病药物且临床症状稳定的精神分裂症患者和健康对照者自我报告的性功能状况。评估工具采用土耳其语版的5个条目的亚利桑那性体验量表（Arizona Sexual Experience Scale ，ASEX）。该量表的效度已在土耳其得到验证。量表评估性欲、性唤起、阴道润滑/阴茎勃起、达到高潮的能力以及对高潮的满意度等5个方面的性功能。
方法: 采用阳性症状量表、阴性症状量表和ASEX分别对101例临床症状稳定的门诊精神分裂症患者（女性38例、男性63例）进行评估。对89例无精神疾病史的对照者（女性41名、男性48名）也进行了ASEX量表评估。如果ASEX总分（范围5-30）>18，或者任一条目得分（范围1-6）≥5，或者至少有3个条目得分都大于4，则被视为存在性功能障碍。
结果: 自我报告有性功能障碍的男性精神分裂症患者多于健康对照者（46％对8％）。虽然女性患者性功能障碍的患病率显著高于男性患者（68％对46％），但是对照组中健康女性的性功能障碍患病率也非常高（68％），因而女性患者的性功能障碍不能归咎于她们的疾病或是正在服用的药物。患者组中，阳性症状和阴性症状的严重程度与性功能障碍无相关性，服用第一代抗精神病药的患者与服用第二代抗精神病药的患者之间的性功能障碍严重程度无明显差异。
结论: 在土耳其，不同性别的精神分裂症患者性功能状况的研究结果不同，这凸显了在评估精神障碍和药物对性功能的影响时制定特定区域、特定性别的性行为社会规范的重要性。今后需要采用前瞻性研究来区分文化规范、精神疾病以及使用的抗精神病药物在精神分裂症患者性功能障碍的病因和病程中的相对作用。
Keywords: Turkey; antipsychotic medication; schizophrenia; sexual dysfunction; sexual norms.