Open Access

Demographic and clinical correlates of sexual dysfunction among Nigerian male outpatients on conventional antipsychotic medications

  • Aina Kikelomo Oyekanmi1,
  • Adegoke Oloruntoba Adelufosi2Email author,
  • Olukayode Abayomi2 and
  • Timothy Olaolu Adebowale1
BMC Research Notes20125:267

https://doi.org/10.1186/1756-0500-5-267

Received: 28 March 2012

Accepted: 28 May 2012

Published: 7 June 2012

Abstract

Background

In psychotic disorders, early intervention with antipsychotic medications increases the likelihood of favourable long-term course. However, the pharmacologic management especially with conventional antipsychotic medications is complicated by a high rate of adverse effects including sexual dysfunction. This study aims to determine the demographic and clinical factors associated with sexual dysfunction among male psychiatric outpatients on conventional antipsychotic medications in South-western Nigeria.

Methods

Two hundred and seventy five consecutive male outpatients with psychotic disorders on conventional antipsychotic medications were interviewed. Data was collected on demographic characteristics, illness-related and medication-related variables. Illness severity was assessed with the Brief psychiatric rating scale. The International Index of Erectile Function questionnaire was used to assess for sexual dysfunctions.

Results

A total of 111 (40.4%) respondents had one or more forms of sexual dysfunction. Sexual desire dysfunction was present in 47 (17.1%) of respondents, erectile dysfunction in 95 (34.5%), orgasmic dysfunctions in 51 (18.5%), intercourse dissatisfaction in 72 (26.2%) and overall dissatisfaction in 64 (23.3%). Sexual dysfunction was significantly associated with employment status, age, marital status, haloperidol use, medication dosage, and presence of psychopathology. Unemployment was the only significant independent correlate of sexual dysfunction, with unemployed respondents twice more likely to have sexual dysfunction compared with those employed (Wald = 3.865, Odds Ratio = 2.033, 95% confidence interval = 1.002 - 4.124, p = 0.049).

Conclusions

The high prevalence of sexual dysfunction found in this study suggests a need among clinicians for increased awareness and recognition of the sexual side effects in patients taking conventional antipsychotic medications. This knowledge should guide conventional antipsychotic medication prescription in the at-risk population to improve treatment adherence.

Keywords

Sexual dysfunction Conventional antipsychotics Schizophrenia

Background

Sexual dysfunction is commonly associated with the pharmacologic management of psychotic illnesses especially conventional antipsychotic medications [13]. This is further complicated by the effects of major psychotic illness itself on sexual functioning, among which are reduced libido, decreased sexual performance and satisfaction [4].

Previous studies showed that sexual dysfunction occurred in as many as 60% of outpatients with schizophrenia [57]. Sexual adverse effects have been reported in up to 45–50% of patients taking conventional antipsychotics and are more likely to be disturbing to men than women [810]. Other authors reported that more than 50% of males on conventional antipsychotics experienced sexual dysfunction [11]. Commonly experienced sexual side effects in males are poor penile erection, ejaculatory and orgasmic disturbance [12, 13]. Despite this high rate, complaints about sexual dysfunction are largely unexplored or ignored by clinicians, or attracted only vague reassurances resulting in poor medication adherence and quality of life [2, 14, 15].

There is a paucity of studies on sexual dysfunction in Nigeria [16]. Many of the available studies were conducted among medical outpatient clinic attendees and community samples, with findings which cannot be generalized to patients in specific diagnostic groups like schizophrenia and other psychotic disorders [17, 18]. A recent study by Mosaku & Ukpong [19] conducted among outpatients attending a psychiatric clinic in Southwest Nigeria reported a prevalence of 86.5% for erectile dysfunction, with varying prevalences reported for other forms of sexual dysfunctions. However, aside patients with schizophrenia, the study included patients diagnosed with other mental illnesses such as depression, bipolar affective disorder, and psychoactive substance dependence, who may actually have differing patterns and prevalences of sexual dysfunction. To the best knowledge of the authors, no Nigerian studies have reported the prevalence and correlates of sexual dysfunction among patients in a specific diagnostic group like those with schizophrenia and delusional disorders.

The aim of this study was to determine the prevalence of sexual dysfunction, associated socio-demographic and clinical factors among male patients with psychotic disorders on conventional antipsychotic, in Southwestern Nigeria.

Methods

Study design and setting

This was a descriptive cross sectional survey of sexual dysfunction among male out-patients with schizophrenia on conventional antipsychotic medications for at least six months. The study was carried out at the out-patient clinic of the Neuropsychiatric Hospital Aro, Abeokuta, Nigeria between August 2005 and February 2006. The annual report of the medical records department of the hospital showed that 3,270 patients with a diagnosis of schizophrenia attended the outpatient clinic in 2004 (Unpublished data, medical records department). The hospital has a total capacity of 526 beds and attends to all patients that come to the hospital through referrals and those brought by relatives. It has an Emergency/Assessment Unit that provides a 24-hour first-contact and Emergency services, 7 days of the week while outpatient clinics are run for follow-up consultations on Mondays, Tuesdays, Thursdays and Fridays after the first contact or following discharge from the in-patient care.

Participants

Participants were consecutive male outpatient between the ages of 18–60 years. Only subjects meeting the ICD-10 criteria for schizophrenia and delusional disorders (F20 – F29) based on information from patients` case notes’ were included in the study. Patients with clinical history/record of conditions and medications that may contribute to sexual dysfunctions viz Diabetes, hypertension, cerebrovascular disorder e.g. stroke, gonadal injury, endocrine disorder/medications, alcohol dependence, antidepressant medication were excluded from the study (all patients undergo routine laboratory screening including fasting/random blood sugar and full physical examination at presentation and regular intervals for any concomitant physical illness at the study center; body weight and BP checks are also carried out at every visit).

Instruments

The following instruments were administered:
  1. 1.

    A questionnaire drawn up by the researchers (AKO and TOA) to elicit information on socio-demographic characteristics of respondents and their clinical characteristics, such as illness and medication history.

     
  2. 2.

    Brief Psychiatric Rating Scale (BPRS) - The BPRS is a widely used instrument developed by Overall & Gorham to measure psychotic symptoms and psychopathology profiles [20]. It is a semi-structured interview schedule originally comprising 16 items. Each item is scored on a 7-point scale and produces sub scores (profiles) for affective, psychotic and negative symptoms. The 16 items of the original scale was used in this study to measure current psychopathological profile of the subjects. The BPRS has been used by previous researchers in Nigeria [21]

     
  3. 3.

    The International Index of Erectile Function (IIEF) questionnaire - This is a self administered questionnaire that evaluates male sexual functions. The IIEF was developed by an International panel of experts through an extensive review of the literature and existing questionnaires in addition to detailed interview of men with sexual dysfunction and their partners [22]. The IIEF instrument consists of 15 questions (Q), rated on a scale of 1–5, with 0 indicating no sexual activity or no attempt. It has 5 domains: Erectile dysfunction (Q1 – 5, 15), Orgasmic Function (Q9, 10), Sexual Desire (Q11, 12), Intercourse Satisfaction (Q6 – 8), and Overall Satisfaction (Q13, 14), each addressing a unique dimension of sexual function. Total IIEF questionnaire score ranged from 0–30, with higher scores indicating better sexual functioning. Responses to each question are based on a man’s experience over the past 4 weeks. The IIEF has been used by previous authors in Nigeria [19] and in their study, a reliability coefficient (cronbach’s alpha) of 0.921 was obtained.

     

All the questionnaires were translated to Yoruba (the predominant language in the locality of the study) through the process of back translation.

Procedure

Consecutive male outpatient clinic attenders between the ages of 18–60 who were married and/or who had a regular sexual partner and who had fulfilled the ICD-10 criteria for schizophrenia, and delusional disorders (F20 – F29) at one time or the other based on information from patients` case notes’, and were currently on conventional antipsychotic medications for at least six months (including those that still had active or residual symptoms but not acutely disturbed with gross excitement or disorientation) were included. The interviews were conducted by AKO and two trained research assistants (resident doctors in psychiatry) in the outpatient clinic consultation rooms after routine consultation, to ensure confidentiality. Assistance in completing the questionnaires was provided for the respondents where necessary.

Ethical considerations

Approval of the Research Ethical Committee of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria was obtained to carry out the study. This study complied with the Declaration of Helsinki protocol and informed verbal consent was obtained from the participants after a detailed explanation of the study.

Data analysis

Statistical Package for Social Sciences (SPSS) version 11.0 for Windows™ was used for data analysis. Most of the variables were grouped for ease of statistical analysis. Results were calculated as frequency (%) and mean. Group differences were determined using Chi-square (χ2) test for categorical variables and student t-test for continuous variables. Variables that were found to be significantly associated with any form of sexual dysfunction (independent variables) were then included in a logistic regression model with presence or absence of sexual dysfunction as the outcome (dependent variable). Level of significance was set at p < 0.05.

Results

Sociodemographic characteristics

Two hundred and seventy nine male outpatients who met the inclusion criteria were invited to participate in the study. There were 5 outright refusals, giving a response rate of 98.6%. The data of 275 male outpatients meeting the inclusion criteria for the study were analysed. Mean age was 39.5 ± 9.4 years, and they were mainly between 30 and 39 years old (36.4%). Respondents were predominantly married (60.7%) and the majority of patients (86.9%) were employed. The patients were predominantly Christians (62.9%) Table 1.
Table 1

Demographic, Clinical and Medication Related Characteristics of Respondents

Variable

 

Frequency (%)

Age

18–29 years

44 (16.0)

30–39 years

100 (36.4)

40–49 years

85 (30.9)

50–60 years

46 (16.7)

Mean (SD) years:

39.5 (9.4)

 

Education

No Formal Education

10 (3.7)

Primary School

84 (30.5)

Secondary School

110 (40)

Tertiary

71 (25.8)

Marital Status

Single

93 (33.8)

Married

167 (60.7)

Separated

4 (1.5)

Divorced

8 (2.9)

Widowed

3 (1.1)

Employment Status

Employed

239 (86.9)

Unemployed

36 (13.1)

Religion

Christian

173 (62.9)

Muslim

101 (36.7)

Traditional Worshipper

1 (0.4)

Age at onset of illness

<15 yrs

6 (2.2)

15–25 yrs

117 (42.5)

26–35 yrs

111 (40.4)

>35

41 (14.9)

Mean (SD): 27.4 (7.4)

 

Diagnosis

Schizophrenia

241 (87.7)

Persistent delusional disorder

1 (0.4)

Acute & transient psychotic disorder

2 (0.7)

Schizoaffective disorder

2 (0.7)

Unspecified non organic psychotic disorder

29 (10.5)

Duration of Antipsychotic Medication Use

<2 yrs

28 (10.2)

2–5 yrs

56 (20.4)

5–10 yrs

60 (21.8)

>10

131 (47.6)

Mean (SD): 8.4 (2.1)

 

Daily medication Dose*

<500 mg

170 (61.8)

500–1000 mg

82 (29.8)

>1000mgs

23 (8.4)

Mean: 462 mg

 

Number of Antipsychotics

One

97 (35.3)

Two

152 (55.3)

Three or more

26 (9.4)

* In Chlorpromazine equivalents.

Clinical characteristics and medication related variables

The majority of patients (87.6%) had a diagnosis of schizophrenia. The mean age at onset of illness was 27.4 ± 7.4 years. The majority of respondents (42.5%) had their onset of illness between 15 and 25 years. The mean (SD) BPRS score was 0.40 (1.2).

The mean duration of conventional antipsychotic medication use was 8.4 ± 2.1 years. One hundred and thirty one patients (47.6%) had been using medications for more than 35 years. Majority of the patients (55.3%) were taking more than two conventional antipsychotic at the time of the study. The mean chlorpromazine equivalent daily medication dose taken by the patients was 462 mg, with the majority (61.8%) being maintained on less than 500 mg chlorpromazine equivalent daily dose (Table 1).

Prevalence of sexual dysfunction

One or more forms of sexual dysfunction existed among 111 (40.4%) of the respondents. Sexual desire dysfunction was present in 47 (17.1%) of subjects, Erectile dysfunction in 95 (34.5%), Orgasmic Dysfunctions 51 (18.5%), Intercourse Dissatisfaction 72 (26.2%) and Overall Dissatisfaction 64 (23.3%).

Correlates of sexual dysfunction

The demographic, medication and illness related variables associated with one or more forms of sexual dysfunction were: Employment status (sexual desire dysfunction, orgasmic dysfunction, intercourse dissatisfaction and overall dissatisfaction), age group (orgasmic dysfunction), marital status (overall dissatisfaction), haloperidol use (erectile dysfunction, orgasmic dysfunction), medication dose (erectile dysfunction, orgasmic dysfunction, overall dissatisfaction), any psychopathology on the BPRS (overall dissatisfaction) Table 2.
Table 2

Association between Specific Sexual dysfunctions and Sociodemographic, Illness-related and Medication-related Variables

VARIABLES OPTIONS

 

Sexual Desire

Erectile

Orgasmic

Intercourse

Overall

Dysfunction

Dysfunction

Dysfunction

Dissatisfaction

Dissatisfaction

χ2,df,(p -Value)

χ2,df,(p -Value)

χ2,df,(p -Value)

χ2,df,(p -Value)

χ2,df,(p -Value)

Sociodemographic

Age Group

<30 yrs/31–40 yrs/41–50 yrs/51–60 yrs

4.330, 3, (0.228)

4.581, 3, (0.205)

9.231, 3, (0.026)

5.111,3, (0.164)

3.514, 3, (0.319)

Age at Onset of Illness

<15 yrs/15–25 yrs/26–35 yrs/>35 yrs

1.997, 3, (0.573)

1.329, 3, (0.722)

2.635, 3, (0.451)

1.435, 3, (0.697)

0.688, 3, (0.876)

Marital Status

Married/Single/Separated/Divorced/Widowed

1.653,4, (0.799)

5.332, 4, (0.255)

6.084, 4, (0.193)

8.543, 4, (0.074)

12.067, 4,(0.017)

Level of Education

Nil/Primary/Secondary/Tertiary

5.659, 3, (0.129)

1.709, 3, (0.635)

2.718, 3, (0.437)

5.281,3, (0.152)

0.106, 3, (0.991)

Employment Status

Employed/Unemployed

9.087, 1, (0.003)

2.334, 1, (0.092)

9.852, 1, (0.002)

4.259, 1, (0.039)

4.696, 1, (0.030)

Medication Related

Duration of Medication Use

<2 yrs/2–5 yrs/6–10 yrs/>10 yrs

1.013, 3, (0.798)

1.566, 3, (0.667)

2.343, 3, (0.504)

1.794, 3, (0.616)

6.215, 3, (0.102)

Number of Medications

One/Two/Three or more

3.537, 2, (0.171)

4.506, 2, (0.105)

1.960, 2, (0.375)

0.687, 2, (0.709)

3.390, 2, (0.184)

Haloperidol

Yes/No

0.697, 1, (0.404)

4.979, 1, (0.026)

4.620, 1, (0.032)

1.041, 1, (0.308)

3.145, 1, (0.076)

Chlorpromazine

Yes/No

0.041, 1, (0.713)

0.053, 1, (0.818)

0.136, 1, (0.712)

0.005, 1, (0.943)

0.000, 1, (1.000)

Thioridazine

Yes/No

0.000, 1, (1.000)

0.547, 1, (0.460)

0.618, 1, (0.432)

0.084, 1, (0.772)

0.014, 1, (0.907)

Trifluoperazine

Yes/No

0.000, 1, (1.000)

0.000, 1, (1.000)

0.116, 1, (0.733)

0.003, 1, (0.956)

0.036, 1, (0.850)

Fluphenazinedecanoate

Yes/No

1.164, 1, (0.281)

1.357, 1, (0.244)

0.000, 1, (1.000)

0.007, 1, (0.933)

0.815, 1, (0.367)

Flupenthixoldecanoate

Yes/No

0.181, 1, (0.671)

0.000, 1, (1.000)

0.246, 1, (0.620)

0.000, 1, (1.000)

0.000, 1, (1.000)

Dose of Medication*

<500 mg/500 mg-1000 mg/>1000 mg

5.179, 2, (0.075)

6.851, 2, (0.033)

7.094, 2, (0.029)

4.197, 2, (0.123)

6.929, 2, (0.031)

Illness Related

Diagnosis

Schiz/PDD/APD/SZA/UPD

2.149, 4, (0.708)

4.769, 4, (0.312)

3.015, 4, (0.555)

6.669, 4, (0.154)

1.943, 4, (0.746)

Any Psychopathology on BPRS

Present/Not Present

2.293, 1, (0.130)

0.031, 1, (0.860)

0.075, 1, (0.784)

0.000, 1, (1.000)

5.056, 1, (0.025)

*Chlorpromazine Equivalents;

Schiz – Schizophrenia; PDD – Persistent Delusional Disorder; APD – Acute Psychotic Disorder; SZA – Schizoaffective Disorder; UPD – Unspecified Psychotic Disorder.

BPRS – Brief Psychiatric Rating Scale.

Variables having significant association with any form of sexual dysfunction are in bold.

Independent correlates of sexual dysfunction

Result of the logistic regression analysis showed unemployment as the only independent correlate of sexual dysfunction, with unemployed respondents twice as likely to have sexual dysfunction as those employed (Wald = 3.865, Odds ratio = 2.033, 95% confidence interval = 1.002 - 4.124, p = 0.049).

Discussion

This study examined the prevalence and correlates of sexual dysfunction among Nigerian men with psychotic illness attending a psychiatric outpatient clinic.

Overall, about 40% of the respondents had at least one form of sexual dysfunction. This rate of sexual dysfunction is similar to that reported in other previous studies [8, 10, 18]. Considering the finding that the mean age (39.5 years) of the respondents fell within the reproductive age group, problems with their sexual functioning may be a significant source of concern for them with far reaching consequences if left untreated.

Most of the patients (64.7%) in this study were taking more than one conventional antipsychotics, an observation also made in a study examining the prescribing habits for psychiatric in-patient admissions [23]. Other authors have found that despite extensive research and recommendations regarding the rational prescription of antipsychotic drugs, polypharmacy exists even among clinically stable patients [24].

This study reports an association between poly-pharmacy and sexual dysfunction which can be explained by the fact that increasing the number of medications result in increased risk of adverse effects experienced by patients. Our finding is similar to what previous authors reported that combination of antipsychotics adds to the risks of developing medication side effects [25]. In addition, we found a significant relationship between medication dosages (chlorpromazine equivalents) and some forms of sexual dysfunction, similar to that reported by some authors [7]. Higher dosages of conventional antipsychotics are therefore associated with higher prevalence of sexual dysfunction since there will be more drugs to act at the various pathways leading to sexual dysfunction [8].

Among the conventional antipsychotics medications prescribed, only haloperidol showed a significant relationship with sexual dysfunction (erectile and orgasmic dysfunctions). This may be attributed to the high affinity of haloperidol for dopamine D2 receptor and inhibition of dopamine release, resulting in impaired libido and erection [26]. On the other hand, the sexual dysfunction observed may be a result of severe psychopathologies experienced by the patients [4], which then necessitated the use of a highly potent typical antipsychotic medication like haloperidol.

Erectile dysfunction was the commonest type of sexual dysfunction reported by the respondents, a finding also reported in previous studies [19, 27, 28]. Poor penile erection interferes with subjective enjoyment of other stages of sexual intercourse and because it was the commonest sexual dysfunction reported by respondents, it may account for the high prevalence of intercourse dissatisfaction and overall dissatisfaction with sex observed in this sample. Inability to achieve good penile erection for optimal sexual satisfaction may be associated with feelings of inadequacy in the sufferer. In many societies, including Nigeria, individuals with poor or absent penile erection are often stigmatized, subjected to public ridicule and may be deserted by their spouse. Erectile dysfunction may result in poor treatment adherence and negatively impacts on patients’ quality of life [15].

Our study revealed a significant relationship between marital status and sexual dysfunction, specifically with overall dissatisfaction with sex. It may be that patients with medication induced sexual dysfunction were likely to be dissatisfied with their overall sexual functioning. For married men, the marriage setting provides an opportunity for a ‘feedback’ from the spouse about sexual performance, which may result in subjective awareness of an existing sexual inadequacy, otherwise unnoticed by the patient. This raises a possibility that the relationship between marital status and sexual dysfunction seen in these patients may be psychogenic in origin, rather than organic. Unfortunately, the IEFF could not distinguish between organic and psychogenic sexual dysfunction, an important limitation of this study. However, other authors have also reported a significant association between marital status and sexual dysfunction among patients taking conventional antipsychotics in Nigeria [19]

In this study, unemployed respondents were more likely to have sexual dysfunction than those who are employed. Previous studies have found an association between sexual dysfunction, depression and socioeconomic disadvantages like unemployment [8, 29]. Unemployment may result in role reversal within a relationship, engendering feelings of shame and inadequacy in the male partner. Previous authors have reported that unemployment in a person with mental illness is associated with public and self-stigmatization, a “double jeopardy”, which may negatively impact on self-worth and sexual performance or satisfaction [21].

This study has a number of limitations. First, it was cross-sectional in nature, so the direction of causality between sexual dysfunction and the sociodemographic and clinical variables could not be inferred from the findings. Second, there is a limitation regarding the generalizability of the result to other patients on conventional antipsychotics in Nigeria, as the study was conducted in just one centre. Third, the absence of a control group is also an important limitation to the generalizability of our results. However, to the best of our knowledge, it is the first to examine sexual dysfunction among specific group of psychiatric outpatients on conventional antipsychotics in Nigeria. It is also one of the few available studies on sexual dysfunction in a developing country setting where conventional antipsychotic medications are commonly prescribed for the treatment of psychotic illnesses [30].

Conclusions

Sexual dysfunction is common among outpatients with psychotic disorders on conventional antipsychotics. It is associated with demographic, illness and medication related variables. Unemployment was found to be the most important independent correlate of sexual dysfunction. Therefore, there is a need among clinicians for increased awareness and recognition of the sexual side effects of conventional medications on patients, especially those socially disadvantaged. This should guide antipsychotic medication prescription resulting possible improvement in treatment adherence and outcome.

Source of financial support

None.

Declarations

Authors’ Affiliations

(1)
Neuropsychiatric Hospital
(2)
Ladoke Akintola University Teaching Hospital

References

  1. Aizenberg D, Modai I, Landa A, et al: Comparison of sexual dysfunction in male schizophrenic patients maintained on treatment with classical antipsychotics versus clozapine. J Clin Psychiatry. 2001, 62 (7): 541-544. 10.4088/JCP.v62n07a07.PubMedView ArticleGoogle Scholar
  2. Cutler AJ: Sexual dysfunction and antipsychotic treatment. Psychoneuroendocrinology. 2003, 28 (Suppl 1): 69-82.PubMedView ArticleGoogle Scholar
  3. Wesby R, Bullimore E, Earle J, Heavey A: A survey of psychosexual arousability in male patients on depot neuroleptic medication. Eur Psychiatry. 1996, 11: 81-86. 10.1016/0924-9338(96)84784-5.PubMedView ArticleGoogle Scholar
  4. Milner K, Tandon R, Tomori O, Florence T: Psychotropic medications and sexual dysfunction. Sexuality and Serious Mental Illness. Edited by: Buckley PF. 1999, Harwood Academic Publishers, AmsterdamGoogle Scholar
  5. Menon A, Williams RH, Watson S: Increased libido associated with quetiapine. J Psychopharm. 2006, 20 (1): 125-127.View ArticleGoogle Scholar
  6. Ucok A, Incesu C, Aker T, Erkoc S: Sexual dysfunction in patients with schizophrenia on antipsychotic medication. Eur Psychiatry. 2007, 22: 328-333. 10.1016/j.eurpsy.2007.01.001.PubMedView ArticleGoogle Scholar
  7. Fujii A, Yasui-Furukori N, Sugawara N, Sato Y, Nakagami T, Saito M, Kaneko S: Sexual dysfunction in Japanese patients with schizophrenia treated with antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry. 2010, 34: 288-293. 10.1016/j.pnpbp.2009.11.022.PubMedView ArticleGoogle Scholar
  8. Smith SM, O’Keane V, Murray R: Sexual dysfunction in patients taking conventional antipsychotics. Br J Psychiatry. 2002, 181: 49-55. 10.1192/bjp.181.1.49.PubMedView ArticleGoogle Scholar
  9. Fakhoury WK, Wright D, Wallace M: Prevalence and extent of distress of adverse effects of antipsychotics among callers to a United Kingdom National Mental Health Helpline. Int Clin Psychopharmacol. 2001, 16 (3): 153-162. 10.1097/00004850-200105000-00004.PubMedView ArticleGoogle Scholar
  10. Knegtering H, Boks M, Blijd C, Castelein S, Van den Bosch RJ, Wiersma DA: Randomized open-label comparison of the impact of olanzapine versus risperidone on sexual functioning. J Sex Marital Ther. 2006, 32: 315-326. 10.1080/00926230600666378.PubMedView ArticleGoogle Scholar
  11. Ghadirian AM, Chouinard G, Annable L: Sexual dysfunction and plasma proclatinlevels in neuroleptic-treated schizophrenic outpatients. J Nerv Mental Disease. 1982, 170: 463-467. 10.1097/00005053-198208000-00004.View ArticleGoogle Scholar
  12. Segraves RT: Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry. 1989, 46 (3): 275-284. 10.1001/archpsyc.1989.01810030081011.PubMedView ArticleGoogle Scholar
  13. Gitlin MJ: Psychotropic medications and their effects on sexual function: diagnosis, biology, and treatment approaches. J Clin Psychiatry. 1994, 55: 406-413.PubMedGoogle Scholar
  14. Aviv A, Shelef A, Weizman A: An open-label trial of sildenafil addition in risperidone– treated male schizophrenia patients with erectile dysfunction. J Clin Psychiatry. 2004, 65 (1): 97-103. 10.4088/JCP.v65n0117.PubMedView ArticleGoogle Scholar
  15. Gopalakrishnan R, Jacob KS, Kuruvilla A, Vasantharaj B, John JK: Sildenafil in the treatment of antipsychotic induced erectile dysfunction: a randomized, double-blind, placebo-controlled, flexible-dose, two-way crossover trial. Am J Psychiatry. 2006, 163 (3): 494-499. 10.1176/appi.ajp.163.3.494.PubMedView ArticleGoogle Scholar
  16. Modebe O: Erectile failure among medical clinic patients. Afr J Med Science. 1990, 19: 259-264.Google Scholar
  17. Okulate G, Oladokun O, Dogunro AS: Erectile dysfunction: Prevalence and relationship with depression, alcohol abuse and Panic disorder. Gen Hosp Psychiatry. 2003, 25 (3): 209-213. 10.1016/S0163-8343(03)00015-X.PubMedView ArticleGoogle Scholar
  18. Adegunloye OA, Makanjuola AB, Adelekan ML: Sexual dysfunction among secondary school teachers in Ilorin, Nigeria. J Sex Med. 2010, 7: 3835-3844. 10.1111/j.1743-6109.2010.01764.x.PubMedView ArticleGoogle Scholar
  19. Mosaku KS, Ukpong DI: Erectile dysfunction in a sample of patients attending a psychiatric outpatient department. Int J Impotence Res. 2009, 21: 235-239. 10.1038/ijir.2009.16.View ArticleGoogle Scholar
  20. Overall JE, Gorham DR: The Brief Psychiatric Rating Scale. Psychol Reports. 1962, 10: 799-812. 10.2466/pr0.1962.10.3.799.View ArticleGoogle Scholar
  21. Adewuya AO, Owoeye AO, Erinfolami AO, Ola BA: Correlates of self-stigma among outpatients with mental illness in Lagos, Nigeria. Int J Soc Psychiatry. 2011, 57 (4): 418-427. 10.1177/0020764010363522.PubMedView ArticleGoogle Scholar
  22. Rosen RC, Riley A, Wagner G, et al: The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997, 49 (6): 822-830. 10.1016/S0090-4295(97)00238-0.PubMedView ArticleGoogle Scholar
  23. Adamson TA: Prescribing habits for psychiatric in-patient admissions in a Nigerian psychiatric hospital. Afr J Med Sci. 1995, 24: 261-265. ref for pg 74Google Scholar
  24. Hiroto I, Asuka K, Teruhiko H: Polypharmacy and excessive dosing: psychiatrists' perceptions of antipsychotic drug prescription. Br J Psychiatry. 2005, 187: 243-247. 10.1192/bjp.187.3.243.View ArticleGoogle Scholar
  25. Harrington M, Lelliott P, Paton C, et al: The result of a multicentre audit of the prescribing of antipsychotic drugs for in-patient in the U.K. Psychiatr Bull. 2002, 26: 414-418. 10.1192/pb.26.11.414.View ArticleGoogle Scholar
  26. Collins AC, Kellner R: Neuroleptics and sexual functioning. Integr Psychiatry. 1986, 4: 96-108.Google Scholar
  27. Teusch L, Scherbaum N, Bohme H, et al: Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semi structured interview of schizophrenic and neurotic patients and methadone-substituted opiate addicts. Pharmacopsychiatry. 1995, 28 (3): 84-92.PubMedView ArticleGoogle Scholar
  28. Khawaja MY: Sexual dysfunction in male patients taking antipsychotics. J Ayub Med Coll. 2005, 17 (3):Google Scholar
  29. Abdo CHN, Oliveira Júnior WM, Júnior EM, Abdo JA, Fittipaldi JAS: The impact of psychosocial factors on the risk of erectile dysfunction and inhibition of sexual desire in a sample of the Brazilian population. Sao Paulo Med J. 2005, 123 (1): 11-14.PubMedView ArticleGoogle Scholar
  30. Adelufosi AO, Adebowale TO, Abayomi O, Mosanya JT: Medication adherence and quality of life among Nigerian outpatients with Schizophrenia. Gen Hosp Psychiatry. 2012, 34: 72-79. 10.1016/j.genhosppsych.2011.09.001.PubMedView ArticleGoogle Scholar

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© Oyekanmi et al.; licensee BioMed Central Ltd. 2012

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