scholarly journals Switching antipsychotic medication to reduce sexual dysfunction in people with psychosis: the REMEDY RCT

2020 ◽  
Vol 24 (44) ◽  
pp. 1-54
Author(s):  
Michael J Crawford ◽  
Lavanya Thana ◽  
Rachel Evans ◽  
Alexandra Carne ◽  
Lesley O’Connell ◽  
...  
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Antipsychotic Medication ◽  
Sexual Functioning ◽  
Standard Care ◽  
Sexual Experience ◽  
Randomised Trial ◽  
Health Technology ◽  
Internal Pilot

Background Sexual dysfunction is common among people who are prescribed antipsychotic medication for psychosis. Sexual dysfunction can impair quality of life and reduce treatment adherence. Switching antipsychotic medication may help, but the clinical effectiveness and cost-effectiveness of this approach is unclear. Objective To examine whether or not switching antipsychotic medication provides a clinically effective and cost-effective method to reduce sexual dysfunction in people with psychosis. Design A two-arm, researcher-blind, pilot randomised trial with a parallel qualitative study and an internal pilot phase. Study participants were randomised to enhanced standard care plus a switch of antipsychotic medication or enhanced standard care alone in a 1 : 1 ratio. Randomisation was via an independent and remote web-based service using dynamic adaptive allocation, stratified by age, gender, Trust and relationship status. Setting NHS secondary care mental health services in England. Participants Potential participants had to be aged ≥ 18 years, have schizophrenia or related psychoses and experience sexual dysfunction associated with the use of antipsychotic medication. We recruited only people for whom reduction in medication dosage was ineffective or inappropriate. We excluded those who were acutely unwell, had had a change in antipsychotic medication in the last 6 weeks, were currently prescribed clozapine or whose sexual dysfunction was believed to be due to a coexisting physical or mental disorder. Interventions Switching to an equivalent dose of one of three antipsychotic medications that are considered to have a relatively low propensity for sexual side effects (i.e. quetiapine, aripiprazole or olanzapine). All participants were offered brief psychoeducation and support to discuss their sexual health and functioning. Main outcome measures The primary outcome was patient-reported sexual dysfunction, measured using the Arizona Sexual Experience Scale. Secondary outcomes were researcher-rated sexual functioning, mental health, side effects of medication, health-related quality of life and service utilisation. Outcomes were assessed 3 and 6 months after randomisation. Qualitative data were collected from a purposive sample of patients and clinicians to explore barriers to recruitment. Sample size Allowing for a 20% loss to follow-up, we needed to recruit 216 participants to have 90% power to detect a 3-point difference in total Arizona Sexual Experience Scale score (standard deviation 6.0 points) using a 0.05 significance level. Results The internal pilot was discontinued after 12 months because of low recruitment. Ninety-eight patients were referred to the study between 1 July 2018 and 30 June 2019, of whom 10 were randomised. Eight (80%) participants were followed up 3 months later. Barriers to referral and recruitment included staff apprehensions about discussing side effects, reluctance among patients to switch medication and reticence of both staff and patients to talk about sex. Limitations Insufficient numbers of participants were recruited to examine the study hypotheses. Conclusions It may not be possible to conduct a successful randomised trial of switching antipsychotic medication for sexual functioning in people with psychosis in the NHS at this time. Future work Research examining the acceptability and effectiveness of adjuvant phosphodiesterase inhibitors should be considered. Trial registration Current Controlled Trials ISRCTN12307891. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 44. See the NIHR Journals Library website for further project information.

Young-onset colorectal cancer treatment side effects: Infertility, sexual dysfunction, and quality-of-life outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3587-3587
Author(s):  
Laura Diane Porter ◽  
Ronit Yarden ◽  
Kim Lynn Newcomer ◽  
Negeen Fathi ◽  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Side Effects ◽  
Sexual Dysfunction ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Cancer Treatments ◽  
Young Onset

3587 Background: Colorectal cancer is the third-most commonly diagnosed cancer and the second-leading cause of cancer death in men and women combined in the United States. Young-onset colorectal cancer refers to individuals diagnosed under the age of 50. In recent years, the incidence has increased by 2.2% annually in individuals younger than 50 years and 1% in individuals 50-64, in contrast to a 3.3% decrease in adults 65 years and older. Young-onset (YO) CRC patients and survivors face unique clinical challenges with fertility and sexual dysfunctions, but this risk is not well quantified. There is limited data and public discussion on the long-term effects of colorectal cancer treatments on fertility and sexual dysfunction and the long-term impact on the quality of life. Methods: To explore the unique challenges and unmet needs of the young-adult patient population, a cross-sectional study was conducted. Colorectal cancer patients and survivors (N = 884) diagnosed between the ages of 20 to 50 years old (median age 42 ± 7.0) completed an online questionnaire based on established instruments EORTC-QOL-30, EORTC-CR-29, and EORTC-SHC-22. Results: Thirty-one percent of respondents stated that a medical professional spoke to them about fertility preservation at the time of diagnosis and during treatment. Only 31% were referred to a reproductive endocrinologist, even though 37% of women and 16% of men reported that treatment left them infertile or sterile. Among survey respondents, 12% of women had an egg retrieval procedure, and 36% of men had their sperm preserved prior to the start of treatment. Fifty-three percent of women reported treatment led to premature menopause. Sixty-five percent of respondents suffer from some level of sexual dysfunction due to treatment. In patients who received radiation therapy, women were 12% less likely than men to have discussed sexual side effects with the provider before treatment. Patients who have an ostomy reported more severe sexual dysfunction (17.8%). Rectal cancer patients were 2.5 times more likely than those with colon cancer to report severe dysfunction after their treatment. More than 25% of the respondents said they would have considered alternative treatment if they would have known the risks of sexual dysfunction. Conclusions: Our survey demonstrates inadequate communications between patients and providers about the irreversible fertility and sexual effects of colorectal cancer treatments. Younger patients and survivors face unique long-term challenges and require further information about fertility preservation options and emotional support regarding their sexuality post-treatment. Other studies are needed to assess the physical and psychological side effects endured by young-onset CRC patients and survivors.

Secondary sexual dysfunction with antidepressant treatment: Study on 50 patients

2016 ◽  
Vol 33 (S1) ◽  
pp. S591-S591
Author(s):  
O.W. Muquebil Ali Al Shaban Rodriguez ◽  
S. Ocio León ◽  
M. Gómez Simón ◽  
M.J. Hernández González ◽  
E. Álvarez de Morales Gómez-Moreno ◽  
...  
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Treatment Adherence ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Sexual Side Effects ◽  
Competing Interest ◽  
The Relationship ◽  
Transversal Study

IntroductionThe side effects of the various antidepressant drugs on the sexual field (with very few exceptions) are well known, and they affect the quality of life in important manners. The incidence rate, communicated spontaneously by the patient, has been estimated around 10–15%, and can reach amounts of 50–60% with SSRIs when studied specifically. It has been suggested that these effects compromise treatment adherence.ObjectivesTo estimate the incidence and intensity of the side effects on the sexual field with different antidepressants, as well as its relationship with treatment adherence.MethodologyTransversal study on 50 patients assisted in medical consultation. Collection of data in office (October 2014–October 2015).Administration of survey PRSexDQ-SALSEX. In order to research the relationship with treatment adherence, one question surveyed the patient whether he/she had thought about finishing treatment for this reason.ResultsTwenty-nine patients (58% of the sample) presented some degree of sexual dysfunction. Five individuals (17.2%) communicated it spontaneously. Nine individuals (31%) responded that they did not accept positively the changes in their sexual field, and they had thought about withdrawing treatment for this reason. They were given the test of self-compliance statement (Haynes-Sackett), with a result of four non-compliant (44.4%). The most frequently involved drugs were fluoxetine (n = 5, 10% of the sample total) and paroxetine (n = 4, 8%).ConclusionsThe high impact of sexual side effects with a low rate of spontaneous communication coincides with previous existent studies.Limitation when estimating adhesion due to methodological difficulties in the design of the study. However, high impression by using the selected method of determination.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Use of lubricants to correct sexual dysfunction in women

2021 ◽  
pp. 566-570
Author(s):  
Tatyana A. Oboskalova ◽  
◽  
Anna V. Vorontsova ◽  
Maksim A. Zvychaynyy ◽  
◽  
...  
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Reaction Mechanisms ◽  
Genital Tract ◽  
Cytotoxic Effect ◽  
Female Genital Tract ◽  
Initial State ◽  
Sexual Contacts ◽  
Female Genital

A literature review focuses on the use of lubricants in women for sexual dysfunction. The use of lubricants is intended to prevent trauma to the lining of the vagina during intercourse and to facilitate the insertion of pessaries. Along with substances that optimize the action of lubricants, they include a number of compounds that can cause negative reaction mechanisms and aggravate existing discomfort. In addition, an increased pH of the lubricant can have a cytotoxic effect on the epithelium of the female genital tract. Unfortunately, the awareness of obstetricians and gynecologists about the properties and range of lubricants is insufficient. Therefore, knowledge of the initial state of a woman, the reasons for the development of sexual dysfunction, the nature of contraception, and no less important, the structure of the composition of the lubricant will competently make it possible to select the optimal means to improve the quality of sexual contacts without developing side effects and improving the condition of a woman.

scholarly journals GAMBARAN DISFUNGSI SEKSUAL, DISABILITAS, DAN KUALITAS HIDUP PADA PASIEN PASCASTROKE

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Hasanul Arifin ◽  
Alfansuri Kadri ◽  
Yuneldi Anwar
Keyword(s):  
Quality Of Life ◽  
Sexual Dysfunction ◽  
General Hospital ◽  
Outpatient Clinic ◽  
Sexual Functioning ◽  
Modified Rankin Scale ◽  
Cross Sectional ◽  
Post Stroke ◽  
Assess Quality

  A DESCRIPTION OF SEXUAL DYSFUNCTION, DISABILITY, AND QUALITY OF LIFE OF POST-STROKE PATIENTSABSTRACTIntroduction: Sexual function and disability are post-stroke complications that can affect the long-term quality of life. The problem is being neglected, thus cannot be intervened further. There are simple screenings that can be used to detect the disorder.Aim: To determine the characteristics  of sexual dysfunction, disability and quality of life, and also demographic profile of post stroke patients in Neurology Outpatient Clinic at General Hospital Haji Adam Malik, Medan.Method: A cross sectional descriptive study on poststroke patients in Neurology Outpatient Clinic of General Hospital Adam Malik, Medan between March and July 2018. Subjects were asked to fill three questionnaires; Changes in Sexual Functioning Questionnaire (CSFQ-14) to assess sexual dysfunction, Stroke-Specific Quality of Life (SS-QoL-12) to assess quality of life, and Barthel Index (BI) and modified Rankin Scale (mRS) to assess disability.Results: We identified 45 subjects and the mean of age was 60.27+10.12 years, mostly men (75.6%) and was suffered from ischemic stroke (95.6%). Majority of the subjects (93.3%) were reported of having sexual dysfunction, some have symptoms of disability (35.6%) and full dependence (44.5%). The quality of life was relatively better in male, especially in the physical domain.Discussion: In post stroke population, the prevalence of sexual dysfunction is 93.3%, mostly affected male patients. Majority of the subjects were independent and without significant disability. The quality of life was relatively better in male and the lowest value related to health was the power domain.Keywords: Disability, post-stroke, quality of life, sexual dysfunctionABSTRAKPendahuluan: Salah satu komplikasi pascastroke adalah gangguan fungsi dan disabilitas seksual yang dapat memengaruhi kualitas hidup jangka panjang. Namun hal ini masih terabaikan, hingga tidak dapat diintervensi lebih lanjut. Terdapat beberapa skrining sederhana yang dapat digunakan untuk mendeteksi gangguan tersebut.Tujuan: Untuk mengetahui gambaran disfungsi seksual, disabilitas, dan kualitas hidup pada penderita pascastroke di rawat jalan Neurologi RSUP Haji Adam Malik, Medan.Metode:  Penelitian  deskriptif  dengan  studi  potong  lintang  pada  pasien  pascastroke  di  Poliklinik  Neurologi RSUP Haji Adam Malik, Medan pada bulan Maret–Juli 2018. Subjek diminta mengisi 3 kuesioner, yaitu: Changes in Sexual Functioning Questionnaire (CSFQ-14) untuk menilai perubahan fungsi seksual, Stroke-Specific Quality of Life (SS-QoL-12) untuk menilai kualitas hidup, serta Indeks Barthel (IB) dan modified Rankin Scale (mRS) untuk  menilai disabilitas.Hasil: Didapatkan 45 subjek dengan rerata usia 60,27+10,12 tahun, terutama laki-laki (75,6%) dan menderita stroke iskemik (95,6%). Mayoritas subjek mengalami disfungsi seksual (93,3%), sebagian memiliki gejala disabilitas (35,6%) dan ketergantungan penuh (44,5%). Kualitas hidup relatif lebih baik pada laki-laki dan khususnya pada domain fisik.Diskusi: Didapatkan prevalensi disfungsi seksual sebanyak 93,3% pada pasien pascastroke, terutama laki-laki. Mayoritas subjek pada keadaan mandiri dan disabilitas yang tidak signifikan. Gambaran kualitas hidup secara keseluruhan relatif lebih baik pada laki-laki dengan nilai yang berhubungan dengan kesehatan yang relatif paling rendah adalah domain tenaga.Kata Kunci: Disabilitas, disfungsi seksual, kualitas hidup, pascastroke  

scholarly journals Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients

2019 ◽  
Vol 14 (3) ◽  
pp. 173-181 ◽  
Author(s):  
John Read ◽  
James Williams
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Antipsychotic Medication ◽  
Online Survey ◽  
Negative Effects ◽  
Duration Of Treatment ◽  
Direct To Consumer ◽  
Poor Outcomes

Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.

Quality of life assessment of oncologically treated patients because of breast cancer

2019 ◽  
Vol 9 (4) ◽  
pp. 14-20
Author(s):  
Aleksandra Trybulec ◽  
Filip Georgiew ◽  
Katarzyna Borowiec-Trybulec
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Body Image ◽  
Side Effects ◽  
Sexual Functioning ◽  
Personal Control ◽  
Sexual Pleasure ◽  
Life Assessment ◽  
Malignant Neoplasms

Introduction: Currently, in the world, breast cancer is recognized as one in four malignant neoplasms in women. It is the second most common cause of death in cancer patients. The disease, which is a threat to women’s lives, leads to the loss of personal control, during its duration it becomes everyday life with negative emotions such as uncertainty, anxiety and anxiety. Women have contact with a range of negative effects that the disease provides, causing them to resign and destructive to the psychophysical sphere. Disorders in the physical and mental aspect of body image, side effects of therapy, sexual relations with a partner and anxiety about health in the future are factors that have a huge impact on the quality of life of patients. The aim of the study was to assess the quality of life of women with breast cancer. Materials and methods: The quality of life of 40 women with breast cancer who underwent oncological treatment was assessed using the author’s questionnaire with 12 questions and QLQ-BR23 questionnaire with 23 questions.. Results and conclusions: Studies have shown that the biggest problem for women was the side effects of the treatment and the most common discomfort during radiation therapy. They are characterized by redness of the skin, general weakness and fatigue, which in turn later translated into, a change in the perception of their body image, a decrease in their attractiveness, a sense of comfort and confidence. The obtained results showed that the lowest quality of life of the respondents was registered in the domain determining future perspectives. The best result was recorded in the domain of sexual pleasure and sexual functioning. When assessing the quality of life of the respondents, it follows that patients with vocational education have a worse quality of life within the domain of breast symptoms. Employed persons surveyed obtained worse quality of life results in terms of sexual functioning and sexual pleasure. Considering the duration of illness of the respondents, there were no statistically significant differences affecting the quality of life.

scholarly journals Fatigue, quality of life and metabolic changes in men treated with first-line enzalutamide versus abiraterone plus prednisolone for metastatic castration-resistant prostate cancer (HEAT): a randomised trial protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030218
Author(s):  
Klara Kvorning Ternov ◽  
Jens Sønksen ◽  
Mikkel Fode ◽  
Henriette Lindberg ◽  
Caroline Michaela Kistorp ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Adipose Tissue ◽  
Side Effects ◽  
Functional Assessment ◽  
Randomised Trial ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Castration Resistant

IntroductionEnzalutamide and abiraterone acetate plus prednisolone (AAP) are used in combination with androgen-deprivation therapy to further suppress the androgen stimulation of metastatic castration-resistant prostate cancer (mCRPC). First-line mCRPC treatment with enzalutamide and AAP yields similar overall survival and radiographic progression-free survival in phase III trials. Thus, treatment selection relies on patient choice, cost and side effects. The aim of this randomised trial is to investigate differences in fatigue, health-related quality of life (HRQoL) and metabolic side effects in men with mCRPC treated with first-line enzalutamide versus AAP.Methods and analysisIn this ongoing open-label randomised (1:1) clinical trial, enzalutamide is compared with AAP as first-line treatment for men with mCRPC. The primary endpoint is fatigue assessed with the questionnaire Functional Assessment of Chronic Illness Therapy-Fatigue version 4. Secondary endpoints are changes in body composition (ie, fat mass, visceral adipose tissue, subcutaneous adipose tissue and lean body mass assessed with dual energy X-ray absorptiometry), glucose metabolism assessed with a 2-hour oral glucose tolerance test, serum lipids, blood pressure and HRQoL assessed with the questionnaire Functional Assessment of Cancer Therapy-Prostate (FACT-P). All study endpoints are assessed at baseline and 12-week postintervention. Blood and urine samples are collected at baseline and at time of progression on allocated treatment for future investigation of predictive and prognostic biomarkers in prostate cancer treatment. The planned sample size is 170 participants. All participants are recruited from Herlev and Gentofte Hospital, Denmark. Estimated last patient’s last visit is February 2020.Ethics and disseminationThe study received project approval from the National Committee on Health Research Ethics and Danish Data Protection Agency and Danish Medicines Agency (EudraCT no.: 2017-000027-99). The results of the study will be published in peer-reviewed international journals and will be presented at national and international conferences and symposiums.Trial registration numberClinicaltrialsregister.eu (2017-000099-27).

Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life

2020 ◽  
Vol 17 (4) ◽  
pp. 771-783
Author(s):  
Filippo Maria Nimbi ◽  
Valentina Rossi ◽  
Francesca Tripodi ◽  
Mijal Luria ◽  
Matthew Flinchum ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Health ◽  
Sexual Functioning ◽  
Sexual Experience ◽  
Genital Pain

Fewer symptoms vs. more side-effects in schizophrenia? Opposing pathways between antipsychotic medication compliance and quality of life

2009 ◽  
Vol 113 (1) ◽  
pp. 27-33 ◽  
Author(s):  
A.B.P. Staring ◽  
C.L. Mulder ◽  
H.J. Duivenvoorden ◽  
L. De Haan ◽  
M. Van der Gaag
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Antipsychotic Medication ◽  
Medication Compliance

Sexual Dysfunction in Patients on Antipsychotic Therapy Vladica Sibinovic Psychiatry Clinic CC NIS

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
V. Sibinovic
Keyword(s):  
Erectile Dysfunction ◽  
Side Effects ◽  
Sexual Dysfunction ◽  
Psychotic Disorders ◽  
Rating Scale ◽  
Sexual Experience ◽  
Typical Antipsychotic ◽  
Antipsychotic Therapy ◽  
Icd 10 ◽  
Ejaculatory Dysfunction

The aim of this study was to determine difference in sexual dysfunction between 137 stabilized male outpatients who met ICD-10 criteria for acute and transient psychotic disorders (F 23) and schizophrenia (F 20) under therapy atypical and typical antipsychotic.Arizona Sexual Experience Scale (ASEX) and the subscale on sexual function of the UKU Side Effects Rating Scale were applied at a single interview.Sexual dysfunction was observed in 55, 47% (76 patients). We find higher ASEX and UKU score in patient with schizophrenia under therapy atypical and typical antipsychotic (p=0, 01). in patients with schizophrenia under typical antipsychotic, orgastic dysfunction (p< 0, 05) is more common.Ejaculatory dysfunction and erectile dysfunction are also high in that group (p< 0, 05).Therapies with atypical and typical antipsychotic have the same effects on increased or diminished sexual desire in bout group of patients.In patients with schizophrenia under typical antipsychotic there is higher ASEX score then in patients under atypical antipsychotic (p< 0, 05). Patients with acute and transient psychotic disorders do not have difference on level of sexual dysfunction in correlation with treated by atypical and typical antipsychotic.Results show that sexual dysfunction is more common in patients with schizophrenia under therapy with typical antipsychotic. in group of patients with acute and transient psychotic disorders there is no difference betven therapy atypical or typical antipsychotic in sexual dysfunction.

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