Key PointsQuestion听
What is the prevalence of sexual dysfunction in individuals with schizophrenia and the factors associated with heterogeneity of dysfunction?
Findings听
In this systematic review and meta-analysis of 72 studies including 21鈥�076 participants with schizophrenia, prevalence and heterogeneity of global sexual dysfunction were high. Study design, time and location, sociodemographic data, alcohol use disorder, psychiatric diagnosis, illness severity, and the use of antidepressants and anxiolytics were associated with heterogeneity; associations were also found between lower prevalence of sexual dysfunction and use of antidepressant medication.
Meaning听
The findings in this study suggest that prevalence of sexual dysfunction remains high in people with schizophrenia with no obvious improvement over time or better tolerance of second-generation antipsychotics; treating depression may be a key point to reduce sexual dysfunction in individuals with schizophrenia.
Importance听
In individuals with schizophrenia, antipsychotic-induced dysfunctions are frequent but often underexplored in clinical practice.
Objective听
To synthetize the data of observational studies exploring the prevalence of sexual dysfunction in individuals with schizophrenia-spectrum disorders as well as associated factors.
Data Sources听
A systematic literature search without language or time restrictions was conducted in Google, Google Scholar, PubMed/MEDLINE, Science Direct, and Universit茅 Sorbonne Paris Cit茅 for studies published up to June 8, 2022.
Study Selection听
All observational studies reporting a prevalence of sexual dysfunction in schizophrenia-spectrum disorder were included.
Data Extraction and Synthesis听
The MOOSE guidelines with independent extraction by 2 observers and random-effects models were used.
Main Outcomes and Measures听
The prevalence of sexual dysfunction and each specific dysfunction.
Results听
A total of 72 of 1119 studies from 33 countries on 6 continents published from inception to June 2022 were included with a total of 21鈥�076 participants with schizophrenia. The pooled global prevalence of sexual dysfunctions was 56.4% (95% CI, 50.5-62.2), with a prevalence of 55.7% (95% CI, 48.1-63.1) for men and 60.0% (95% CI, 48.0-70.8) for women. The most frequent sexual dysfunction was erectile dysfunction in men (44%; 95% CI, 33.5-55.2), followed by loss of libido in men (41%; 95% CI, 30.7-51.4), ejaculation dysfunction in men (39%; 95% CI, 26.8-51.8), orgasm dysfunction in women (28%; 95% CI, 18.4-40.2), and amenorrhea in women (25%; 95% CI, 17.3-35.0). Factors associated with heterogeneity were study design, time and location, sociodemographic data, alcohol use disorder, psychiatric diagnosis, illness severity, and the use of antidepressants and anxiolytics. Sexual dysfunctions were more frequent in schizophrenia vs schizoaffective disorders, and erectile disorders were less frequent in individuals with longer illness duration. Antidepressant and mood stabilizer prescriptions were associated with lower rates of erection disorders (尾, 鈭�6.30; 95% CI, 鈭�10.82 to 鈭�1.78); P鈥�=鈥�.006 and 鈭�13.21; 95% CI, 鈭�17.59 to 鈭�8.83; P鈥�<鈥�.001, respectively) and ejaculation disorders (尾, 鈭�6.10; 95% CI, 鈭�10.68 to 鈭�1.53; P鈥�=鈥�.009 and 尾, 鈭�11.57; 95% CI, 鈭�16.34 to 鈭�6.80; P鈥�<鈥�.001, respectively). No obvious improvements in the rates of sexual dysfunction at other times were found, and there were conflicting results regarding antipsychotic classes.
Conclusions and Relevance听
This systematic review and meta-analysis found a high prevalence of sexual dysfunction among individuals with schizophrenia, with considerable heterogeneity in associated factors. The findings also suggest that some dysfunctions may be explained by schizophrenia. The association between lower rates of dysfunction and antidepressant use suggests that treating comorbid depression could be an effective strategy to improve sexual health. A lack of data on metabolic parameters and physical health in general was also noted, while these issues are frequent in the care of schizophrenia.
The attention given to sexual health in schizophrenia has increased since the end of the 20th century.1 However, schizophrenia has been associated with increased sexual dysfunction only in a small meta-analysis2 of 10 observational studies (3 case-control studies and 7 cross-sectional studies) published in 2020. An meta-analysis3 of sexual dysfunction in psychiatric patients taking antipsychotics and limited to studies with sexual dysfunction as the primary objective and using validated scales concluded that antipsychotics were a major source of heterogeneity in the prevalence of sexual dysfunction in schizophrenia, with quetiapine, ziprasidone, perphenazine, aripiprazole, olanzapine, risperidone, haloperidol, clozapine, and thioridazine having an increasing impact on sexual function ranging from 16% (quetiapine) to 60% (thioridazine). One of the major pathophysiological mechanisms is probably the inhibition of dopamine D2 receptors. This inhibition in the tuberoinfundibular pathway is associated with increased serum prolactin levels.4 A dose of more than 200 ng/mL of risperidone5 induces amenorrhea, breast tenderness, and galactorrhea in women and hypogonadism in men by disrupting the secretion of GnRH by the hypothalamus.6,7 Antipsychotic-induced sexual dysfunctions may also occur independently of increased prolactinemia due to increased antiparkinsonian adverse effects, including blunted affect and anhedonia.4 Anti鈥撐�1-adrenergic receptor inhibition may also induce sexual dysfunctions through relaxation of the intracavernosal smooth muscle fibers, inducing erection and ejaculation dysfunctions in men.8 Anti鈥揌1 receptor inhibition induces sedation, which may alter satisfactory sexual activity.4
Antipsychotic-induced sexual dysfunctions thus appear to be heterogeneous by their type and pathophysiological mechanism. Distinguishing each specific sexual dysfunction may increase the accuracy of interventions. A recent systematic review9 found that the most frequent disorders in schizophrenia were loss of libido and erectile dysfunction in men. Decreased libido may be the result of the negative syndrome of the illness associated with anhedonia and social withdrawal.10 Major depression is a frequent comorbidity of schizophrenia found in approximately one-third of patients.11 It is underscreened and undertreated due to confusion with the negative symptoms of schizophrenia.11 Several potential risk factors for sexual dysfunction in schizophrenia have been identified, including comorbid major depression, unemployment, singlehood, tobacco smoking, and cannabis and alcohol use disorders.9 In summary, we need to update the data on sexual dysfunction prevalence, as the only meta-analysis on this topic was published more than 10 years ago, and we need a quantitative analysis of associated factors that may explain the heterogeneity of sexual dysfunctions in schizophrenia with a focus on each sexual dysfunction (in each and both sexes) resulting from different pathophysiological mechanisms. The objectives of the present study were to determine the prevalence of sexual dysfunction in schizophrenia and of each specific dysfunction (sexual dysfunctions in each sex, loss of libido, orgasm dysfunction, genital pain, erectile and ejaculation dysfunctions, amenorrhea, and galactorrhea) and to identify factors associated with heterogeneity.
Search Strategy and Sources of Information
The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses () reporting guideline.12 We performed a literature review on 5 digital databases: PubMed/MEDLINE, Science Direct, Google Scholar, Google, and Universit茅 Sorbonne Paris Cit茅 from inception to June 8, 2022. The search paradigm is presented in eAppendix 1 in Supplement 1. The protocol was registered in PROSPERO (). Ethical approval was not sought or required, as the study involved no individual patient data.
All observational studies reporting a prevalence of sexual dysfunction (by any tool of measure, which includes nonvalidated tools, such as binary questions and unstructured clinical interviews) in patients with schizophrenia or schizoaffective disorder were included in the present work. In the case of longitudinal studies, cross-sectional baseline data were included. While English search words were used for PubMed/MEDLINE, Science Direct, Google Scholar, Google and French words for Universit茅 Sorbonne Paris Cit茅, there was no language limitation to ensure the comprehensiveness of the data, and the articles were translated as needed to extract relevant data.
All interventional studies were excluded to eliminate a participation bias and because randomized clinical trials overselect participants.13 Studies including inpatients were excluded, assuming that the stress of the hospitalization and the short-term phase of the disease would have a major impact on sexual dysfunction. Studies assessing only treatment-resistant patients were not included, as we hypothesized an overestimation bias in these patients, who usually receive high doses of treatments with persistent psychotic symptomatology. In summary, the aim of the present work was to assess sexual dysfunction in the daily life of treated patients, not in resistant or hospitalized patients.
Two investigators (M.F. and V.A.) independently performed the literature review and extracted data. Controversial articles were discussed in a meeting between the 2 investigators, and in case of persistent disagreement, a third investigator (G.F.) was consulted and made the final decision. The extracted data are presented in eAppendix 2 in Supplement 1.
Assessment of Methodological Quality
The study quality assessment was carried out independently by 2 investigators (M.F. and V.A.) using the modified version of the Newcastle-Ottawa Scale (NOS).14 Studies were scored from 0 (poor quality) to 10 points (excellent quality). Studies scoring 7 or more points were considered good quality studies.
A random logistic regression model was used to calculate the pooled prevalence estimates of sexual dysfunction and its 95% CI.15 A sensitivity analysis was performed with the inverse-variance random-effects model, confirming the robustness of the findings. Heterogeneity between studies was quantified using the I2 statistic.16 Sensitivity analyses were performed using the leave-one-out method. Publication bias was assessed graphically with a funnel plot and statistically with the Thompson-Sharp test when the number of studies exceeded 10.17 Subgroup analyses for binary variables and univariate meta-regressions for quantitative variables were used to assess factors moderating the pooled prevalence estimate of sexual dysfunction from individual studies. All analyses were performed using the meta package in R version 4.1.3 (R Foundation).18
Seventy-two studies published between 1979 and 2021 were included in the random-effects model.6,7,19-88 The flow diagram is presented in Figure 1. Among those, 35 studies included data on the prevalence of orgasm dysfunction, 34 on loss of libido, 10 on genital pain, 33 on erectile dysfunction, 19 on ejaculation dysfunction, 6 on amenorrhea, and 5 on galactorrhea. The 63 excluded studies and the reason for exclusion are presented in eAppendix 3 in Supplement 1.
The selected articles included 21鈥�076 patients from 33 countries on 6 continents. The study characteristics are reported in eAppendices 4-6 in Supplement 1. The study quality assessment is presented in eAppendix 7 in Supplement 1. Overall, 30 studies (41.7%) were classified in the good quality group. A total of 59 studies (81.9%) used a standardized questionnaire to assess sexual dysfunctions (eAppendices 4-6 in Supplement 1). The most frequent sexual dysfunction scales were the Arizona Sexual Experience scale89 (N鈥�=鈥�19), Changes in Sexual Functioning Questionnaire90 (N鈥�=鈥�7), Sexual Functioning Questionnaire91 (N鈥�=鈥�6), Female Sexual Function Index92 (N鈥�=鈥�6), Udvalg for Kliniske Undersogelser93 (N鈥�=鈥�4), and Psychotropic-Related Sexual Dysfunction Questionnaire94 (N鈥�=鈥�4). Thirteen studies (18.1%) used a clinical semistructured interview, 6 (8.3%) used an original questionnaire, and 1 (1.4%) used medical records.
Pooled Prevalence Estimate of Global Sexual Dysfunctions
The pooled prevalence estimates of global sexual dysfunctions and sexual dysfunctions in men and women with schizophrenia are presented in Figure 2. The pooled estimates and their 95% CIs were as follows: global prevalence of sexual dysfunctions, 56.4% (95% CI, 50.5-62.2), with values ranging from 3% to 98%; loss of libido, 40.6% (95% CI, 30.7-51.4); orgasm dysfunction, 28.0% (95% CI, 18.4-40.2); and genital pain, 6.1% (95% CI, 2.8-12.7). There was significant heterogeneity within the results for global dysfunction and sexual dysfunctions (I2 for men, 98% [P鈥�&濒迟;鈥�.001闭; I2 for women, 96% [P鈥�<鈥�.01]). The forest plots are presented in Figure 3 and eAppendices 8-10 in Supplement 1.
Pooled Prevalence Estimates of Sexual Dysfunctions in Men With Schizophrenia
The pooled estimates and their 95% CIs were as follows: male sexual dysfunction, 55.7% (95% CI, 48.1-63.1); erectile dysfunction, 44.0% (95% CI, 33.5-55.2); and ejaculation dysfunction, 38.6% (95% CI, 26.8-51.8). The forest plots are presented in Figure 3, Figure 4, and eAppendices 11-12 in Supplement 1.
Pooled Prevalence Estimates of Sexual Dysfunctions in Women With Schizophrenia
The pooled estimates and their 95% CIs were as follows: female sexual dysfunction, 60.0% (95% CI, 48.0-70.8); amenorrhea, 25.1% (95% CI, 17.3-35.0); and galactorrhea, 7.7% (95% CI, 3.7-15.3). The forest plots are presented in Figure 3, Figure 5, and eAppendices 13-14 in Supplement 1.
Leave-One-Out Analyses and Publication Bias
The leave-one-out analyses are presented in eAppendices 15-17 in Supplement 1. No study had a disproportionate effect on the pooled prevalence estimate of sexual dysfunction or on heterogeneity. The funnel plots are presented in eAppendices 18-20 in Supplement 1. Visual inspection of the forest plots did not identify substantial asymmetrical shape. The Thompson-Sharp test P values were significant for global sexual dysfunctions (t, 5.63; P鈥�<鈥�.001), sexual dysfunctions among men (t, 4.58; P鈥�<鈥�.001), sexual dysfunctions among women (t, 2.25; P鈥�=鈥�.03), orgasm dysfunction (t, 鈭�3.85; P鈥�<鈥�.001), and ejaculation disorder (t, 鈭�2.33; P鈥�=鈥�.03). The results were not significant for libido dysfunction or erection disorder.
Subgroup and Meta-Regression Analyses
Subgroup and meta-regression analyses are presented in eAppendices 21-23 (global dysfunctions) and 27-29 (specific dysfunctions) in Supplement 1, and meta-regression analyses are in eAppendices 24-26 (global dysfunctions) and 30-32 (specific dysfunctions) in Supplement 1. The significant associations are summarized as follows:
Study Design, Time, and Location
Compared to cohort studies, cross-sectional studies reported significantly higher rates of sexual, orgasm, and male sexual dysfunctions. Studies including consecutive participants reported significantly lower rates of loss of libido, male sexual dysfunction, and erectile dysfunction. Studies including sexual dysfunctions in their primary objective reported significantly higher rates of sexual dysfunctions. Studies including a validated tool for diagnosis reported higher rates of loss of libido. Studies including patient-reported diagnoses reported significantly higher rates of genital pain. Studies including clinical interview diagnosis reported lower rates of loss of libido and orgasm dysfunction. Studies including a clinician-rated tool diagnosis reported significantly higher rates of loss of libido. No significant association was found with study quality. We found that time and location were associated with higher rates of sexual dysfunction in more recent studies and lower rates in North America and Europe compared to the rest of the world.
Sociodemographic Variables
Lower rates of loss of libido were reported in studies including a higher proportion of men. Higher rates of genital pain were reported in studies including more male and single participants, and higher rates of loss of libido were reported in studies including more unemployed participants.
Physical Health and Addictions
There was a significant association between the percentage of patients with alcohol use disorders and lower rates of male sexual dysfunction. No other significant associations were found.
Psychiatric Diagnosis and Illness Severity
Globally, we found that higher loss of libido, orgasm dysfunction, and erection disorder were reported in studies including more patients with schizophrenia vs schizoaffective disorder. The rate of erectile dysfunction decreased with the mean duration of illness. Higher rates of female sexual dysfunction were significantly associated with positive scores on the Positive and Negative Syndrome Scale.
Antipsychotic Classes and Daily Dose (Chlorpromazine Equivalents)
We found contradictory results concerning antipsychotic classes (first generation vs second generation) and sexual dysfunctions, and it was not possible to identify a class or specific antipsychotic associated with a higher or lower prevalence of sexual dysfunction. Sexual dysfunction prevalence was mostly not reported according to the administered antipsychotic, and there were not enough studies to determine the sexual dysfunction prevalence in samples treated with homogenous antipsychotic treatment.
Given that these were observational studies, patients were often administered multiple treatments other than antipsychotics. Compared to other studies, erectile and ejaculation dysfunctions and loss of libido were significantly lower in studies including participants treated with antidepressants, and erectile and ejaculation dysfunctions decreased with the percentage of patients treated with antidepressants and mood stabilizers. Sexual dysfunctions in general among men and erectile and ejaculation dysfunctions were significantly lower in studies including patients with anxiolytics. Antidepressant and mood stabilizer prescriptions were associated with lower rates of erection disorders (尾, 鈭�6.30; 95% CI, 鈭�10.82 to 鈭�1.78); P鈥�=鈥�.006 and 鈭�13.21; 95% CI, 鈭�17.59 to 鈭�8.83; P鈥�<鈥�.001, respectively) and ejaculation disorders (尾, 鈭�6.10; 95% CI, 鈭�10.68 to 鈭�1.53; P鈥�=鈥�.009 and 尾, 鈭�11.57; 95% CI, 鈭�16.34 to 鈭�6.80; P鈥�<鈥�.001, respectively).
Comparative Pooled Prevalence Estimates of Sexual Dysfunction of the Inverse Variance Method vs Random Intercept Logistic Regression Model
The comparative pooled prevalence estimates of sexual dysfunction and 95% CIs for the inverse variance method vs random intercept logistic regression model are presented in eAppendix 33 in Supplement 1.
This systematic review and meta-analysis synthesized a high number of observational studies including quantitative data on the prevalence of sexual dysfunctions in schizophrenia published over 4 decades and 6 continents. The prevalence of sexual dysfunction in schizophrenia was found to be high and heterogeneous. Our results provided important data on the prevalence of each sexual dysfunction. The most frequent sexual dysfunction was erectile dysfunction (44% of men), followed by loss of libido (41%), ejaculation dysfunction (39% of men), orgasm dysfunction (28%), and amenorrhea (25% of women). Galactorrhea and genital pain were less explored and less frequent.
These rates are extremely high. For comparison, erectile dysfunction affects an estimated 30 million men in the US according to the National Institute of Diabetes and Digestive and Kidney Diseases.95 The prevalence of erectile dysfunction increases with age, with approximately 12% of men younger than 60 years experiencing erectile dysfunction compared to 30% of men aged 70 years and older.95 The prevalence of loss of libido, also known as hypoactive sexual desire disorder, is estimated to be approximately 10% in women and 5% in men in the US according to the American Psychiatric Association鈥檚 DSM-5.10
We found multiple factors associated with this heterogeneity beyond the expected association with antipsychotics. Among these factors, study design (recruitment and tools but not quality) are classical factors inducing heterogeneity in prevalence studies. As expected, studies including sexual dysfunction in their primary objective reported a higher prevalence of sexual dysfunction. This may be explained by a selection bias.96,97 Our results suggest that studies including nonconsecutive participants may have included a selection bias overestimating the findings. Cross-sectional studies reported higher rates than cohort studies. Except for population-based studies (which were not available for sexual dysfunctions), cohort studies may induce a selection bias at inclusion. For clinical trials, patients to be included in a follow-up cohort may not be representative of all real-life patients, with better compliance, lower addictions, and other clinical setting鈥搑elated factors explaining lower sexual dysfunctions in cohort studies. Similar to other comorbidities of schizophrenia,11 we found that some sexual dysfunctions were more frequently reported when a validated tool and a self-reported tool were used (compared to clinical interviews or nonvalidated tools). This may be particularly true if some patients are reluctant to answer or ashamed of answering questions about intimate areas during a clinical interview, which may also be modulated by age, sex of the patient, sex of the clinician, and cultural factors. The use of a self-reported validated tool could be actively promoted to improve screening in daily practice. This could be automated with online Patient-Reported Outcomes Measures (PROMs).98 We found that the Arizona Sexual Experience scale was the most frequently used questionnaire in the studies included in this work that could be used as a PROM in clinical practice. Importantly, we found that limiting the results to high-quality studies did not change our results, which reinforces their robustness and the confidence we can have in them.
We found significant associations between the prevalence of sexual dysfunctions and time and location. We found that most sexual dysfunctions had a higher prevalence in recent studies than in ancient studies and no evidence of an improvement in sexual dysfunction prevalence with the release of second-generation antipsychotics. Time and location may also intersect with other factors, such as study design, as discussed above. Geographical discrepancies could also be explained by differences in prescription habits and general social and health factors (including prevention, lifestyle and health care systems). Of note, we found no significant difference in sexual dysfunction prevalence in schizophrenia between high-income countries and low- to middle-income countries, but data in Africa and Polynesia were limited.
Our purpose was to provide a picture of observational studies of real-world stabilized outpatients with schizophrenia. Stabilization does not mean remission, and we found that 3 studies including patients with higher psychotic symptomatology and higher positive and negative symptoms also reported more frequent orgasm dysfunction and loss of libido. However, these few data call for additional studies including participants with high positive or negative symptom levels to confirm these associations. It is probably impossible to discriminate the part of the mental illness itself in the onset of sexual dysfunctions. For example, we found that a lower prevalence of sexual dysfunction was reported in studies including more patients with schizoaffective disorders. We do not know if the results found for antidepressants are explained by an indication bias. A strikingly missing clinical factor is comorbid major depressive disorder. The association of major depressive disorder with sexual dysfunction has been robustly demonstrated in other psychiatric populations and in the general population.99,100 A meta-analysis11 of observational studies recently concluded that approximately one-third of individuals with stabilized schizophrenia are identified with comorbid major depressive disorder, that is, 3 to 4 times the prevalence of the general population. We found that the studies with the highest proportion of antidepressant, mood stabilizer, and anxiolytic prescriptions also reported lower rates of sexual dysfunctions compared to other studies, which is a compelling reason to investigate the role of major depression in the high prevalence of sexual dysfunctions in schizophrenia and their treatment. Thus, the systematic coscreening of sexual dysfunctions combined with major depression may be an effective strategy to improve the care of schizophrenia.
This study has limitations. More than 80% of the included studies used validated tools, and their absence was only associated with a higher prevalence of loss of libido. Most factors known to increase sexual dysfunction in the general population (eg, hypertension, diabetes, overweight and obesity, tobacco smoking, and sleep disorders) were not identified as risk factors in our results; however, they were poorly explored in the included studies. Tobacco smoking and overweight or obesity are 2 major sources of sexual dysfunctions that are frequently present in people with schizophrenia, and their role should be better delimited. It is currently impossible to capture diet parameters, as no questionnaire has been specifically designed for this purpose. This issue will probably be addressed in the coming years.101 These results may not be extrapolated to some continents, such as Africa and Polynesia, which were underrepresented. Additionally, the presence of publication bias in our meta-analysis cannot be entirely ruled out, as indicated by the statistical significance of the Thompson-Sharp test. However, the absence of a clear asymmetrical pattern in the funnel plots suggests that the likelihood of publication bias is relatively low. Heterogeneity or methodological differences may also contribute to the observed results.17
Four decades of studies have reported sexual dysfunction as extremely frequent in schizophrenia. Beyond methodological discrepancies partially explaining heterogeneity, we found important evidence in observational studies suggesting that improving the screening and treatment of depression may be an effective strategy to improve sexual health in patients with schizophrenia. Promoting systematic health assessment in sexual dysfunction studies could also help better understand associations between sexual dysfunction and metabolic parameters.
Accepted for Publication: June 4, 2023.
Published Online: September 13, 2023. doi:10.1001/jamapsychiatry.2023.2696
Corresponding Author: Guillaume Fond, MD, PhD, Assistance Publique-Hopitaux de Marseille, 276 bd Sainte-Marguerite, 13009 Marseille, France (guillaume.fond@gmail.com).
Author Contributions: Drs Fond and Boyer had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Korchia, Archour, and Fond contributed equally.
Concept and design: Boyer.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Achour, Albeash, Yon, Boyer.
Critical review of the manuscript for important intellectual content: Korchia, Faugere, Boyer, Fond.
Statistical analysis: Albeash, Boyer, Fond.
Supervision: Yon, Boyer.
Conflict of Interest Disclosures: None reported.
Data Sharing Statement: See Supplement 2.
1.Verhulst
听J锘�, Schneidman
听B锘�. 听Schizophrenia and sexual functioning.听锘� 听Hosp Community Psychiatry. 1981;32(4):259-262. doi:
2.Zhao
听S锘�, Wang
听X锘�, Qiang
听X锘�,
听et al. 听Is there an association between schizophrenia and sexual dysfunction in both sexes? a systematic review and meta-analysis.听锘� 听J Sex Med. 2020;17(8):1476-1488. doi:
3.Serretti
听A锘�, Chiesa
听A锘�. 听A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics.听锘� 听Int Clin Psychopharmacol. 2011;26(3):130-140. doi:
4.Huhn
听M锘�, Nikolakopoulou
听A锘�, Schneider-Thoma
听J锘�,
听et al. 听Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis.听锘� 听尝补苍肠别迟. 2019;394(10202):939-951. doi:
5.Kleinberg
听DL锘�, Davis
听JM锘�, de Coster
听R锘�, Van Baelen
听B锘�, Brecher
听M锘�. 听Prolactin levels and adverse events in patients treated with risperidone.听锘� 听J Clin Psychopharmacol. 1999;19(1):57-61. doi:
6.Sathish Kumar
听SV锘�, Sinha
听VK锘�. 听Comparative study of sexual dysfunction and serum prolactin level associated with olanzapine, risperidone, and clozapine in patients with remitted schizophrenia.听锘� 听Indian J Psychiatry. 2015;57(4):386-391. doi:
7.Ghadirian
听AM锘�, Chouinard
听G锘�, Annable
听L锘�. 听Sexual dysfunction and plasma prolactin levels in neuroleptic-treated schizophrenic outpatients.听锘� 听J Nerv Ment Dis. 1982;170(8):463-467. doi:
8.Traish
听A锘�, Kim
听NN锘�, Moreland
听RB锘�, Goldstein
听I锘�. 听Role of alpha adrenergic receptors in erectile function.听锘� 听Int J Impot Res. 2000;12(S1):S48-S63. doi:
9.Dumontaud
听M锘�, Korchia
听T锘�, Khouani
听J锘�,
听et al. 听Sexual dysfunctions in schizophrenia: beyond antipsychotics. a systematic review.听锘� 听Prog Neuropsychopharmacol Biol Psychiatry. 2020;98:109804. doi:
10.American Psychiatric Association. 听Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013, doi:.
11.Etchecopar-Etchart
听D锘�, Korchia
听T锘�, Loundou
听A锘�,
听et al. 听Comorbid major depressive disorder in schizophrenia: a systematic review and meta-analysis.听锘� 听Schizophr Bull. 2021;47(2):298-308. doi:
12.Lee
听SW锘�, Koo
听MJ锘�. 听PRISMA 2020 statement and guidelines for systematic review and meta-analysis articles, and their underlying mathematics: Life Cycle committee recommendations.听锘� 听Life Cycle.锘� 2022;2. doi:
13.Taipale
听H锘�, Schneider-Thoma
听J锘�, Pinz贸n-Espinosa
听J锘�,
听et al. 听Representation and outcomes of individuals with schizophrenia seen in everyday practice who are ineligible for randomized clinical trials.听锘� 听JAMA Psychiatry. 2022;79(3):210-218. doi:
14.Herzog
听R锘�, 脕lvarez-Pasquin
听MJ锘�, D铆az
听C锘�, Del Barrio
听JL锘�, Estrada
听JM锘�, Gil
听脕锘�. 听Are healthcare workers鈥� intentions to vaccinate related to their knowledge, beliefs and attitudes? a systematic review.听锘� 听BMC Public Health. 2013;13:154. doi:
15.Stijnen
听T锘�, Hamza
听TH锘�, 脰zdemir
听P锘�. 听Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data.听锘� 听Stat Med. 2010;29(29):3046-3067. doi:
16.Higgins
听JPT锘�, Thompson
听SG锘�, Deeks
听JJ锘�, Altman
听DG锘�. 听Measuring inconsistency in meta-analyses.听锘� 听叠惭闯. 2003;327(7414):557-560. doi:
17.Sterne
听JAC锘�, Sutton
听AJ锘�, Ioannidis
听JPA锘�,
听et al. 听Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials.听锘� 听叠惭闯. 2011;343:d4002. doi:
18.Balduzzi
听S锘�, R眉cker
听G锘�, Schwarzer
听G锘�. 听How to perform a meta-analysis with R: a practical tutorial.听锘� 听Evid Based Ment Health. 2019;22(4):153-160. doi:
19.Arat贸
听M锘�, Erd枚s
听A锘�, Polg谩r
听M锘�. 听Endocrinological changes in patients with sexual dysfunction under long-term neuroleptic treatment.听锘� 听Pharmakopsychiatr Neuropsychopharmakol. 1979;12(6):426-431. doi:
20.Lukoff
听D锘�, Gioia-Hasick
听D锘�, Sullivan
听G锘�, Golden
听JS锘�, Nuechterlein
听KH锘�. 听Sex education and rehabilitation with schizophrenic male outpatients.听锘� 听Schizophr Bull. 1986;12(4):669-677. doi:
21.Kockott
听G锘�, Pfeiffer
听W锘�. 听Sexual disorders in nonacute psychiatric outpatients.听锘� 听Compr Psychiatry. 1996;37(1):56-61. doi:
22.Bhui
听K锘�, Puffet
听A锘�, Strathdee
听G锘�. 听Sexual and relationship problems amongst patients with severe chronic psychoses.听锘� 听Soc Psychiatry Psychiatr Epidemiol. 1997;32(8):459-467. doi:
23.Warden
听SJ锘�. Sex Differences in Response to Treatment With Risperidone. Master鈥檚 thesis. University of Calgary; 1997. Accessed March 13, 2022. doi:
24.Mullen
听B锘�, Brar
听JS锘�, Vagnucci
听AH锘�, Ganguli
听R锘�. 听Frequency of sexual dysfunctions in patients with schizophrenia on haloperidol, clozapine or risperidone.听锘� 听Schizophr Res. 2001;48(1):155-158. doi:
25.Smith
听SM锘�, O鈥橩eane
听V锘�, Murray
听R锘�. 听Sexual dysfunction in patients taking conventional antipsychotic medication.听锘� 听Br J Psychiatry. 2002;181:49-55. doi:
26.Bobes
听J锘�, Garc A-Portilla
听MP锘�, Rejas
听J锘�,
听et al. 听Frequency of sexual dysfunction and other reproductive side-effects in patients with schizophrenia treated with risperidone, olanzapine, quetiapine, or haloperidol: the results of the EIRE study.听锘� 听J Sex Marital Ther. 2003;29(2):125-147. doi:
27.Fortier
听P锘�, Mottard
听JP锘�, Trudel
听G锘�, Even
听S锘�. 听Study of sexuality-related characteristics in young adults with schizophrenia treated with novel neuroleptics and in a comparison group of young adults.听锘� 听Schizophr Bull. 2003;29(3):559-572. doi:
28.Olfson
听M锘�, Uttaro
听T锘�, Carson
听WH锘�, Tafesse
听E锘�. 听Male sexual dysfunction and quality of life in schizophrenia.听锘� 听J Clin Psychiatry. 2005;66(3):331-338. doi:
29.Bitter
听I锘�, Basson
听BR锘�, Dossenbach
听MR锘�. 听Antipsychotic treatment and sexual functioning in first-time neuroleptic-treated schizophrenic patients.听锘� 听Int Clin Psychopharmacol. 2005;20(1):19-21. doi:
30.Khawaja
听MY锘�. 听Sexual dysfunction in male patients taking antipsychotics.听锘� 听J Ayub Med Coll Abbottabad. 2005;17(3):73-75.
31.Dossenbach
听M锘�, Dyachkova
听Y锘�, Pirildar
听S锘�,
听et al. 听Effects of atypical and typical antipsychotic treatments on sexual function in patients with schizophrenia: 12-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study.听锘� 听Eur Psychiatry. 2006;21(4):251-258. doi:
32.Fan
听X锘�, Henderson
听DC锘�, Chiang
听E锘�,
听et al. 听Sexual functioning, psychopathology and quality of life in patients with schizophrenia.听锘� 听Schizophr Res. 2007;94(1-3):119-127. doi:
33.Howes
听OD锘�, Wheeler
听MJ锘�, Pilowsky
听LS锘�, Landau
听S锘�, Murray
听RM锘�, Smith
听S锘�. 听Sexual function and gonadal hormones in patients taking antipsychotic treatment for schizophrenia or schizoaffective disorder.听锘� 听J Clin Psychiatry. 2007;68(3):361-367. doi:
34.U莽ok
听A锘�, Incesu
听C锘�, Aker
听T锘�, Erko莽
听S锘�. 听Sexual dysfunction in patients with schizophrenia on antipsychotic medication.听锘� 听Eur Psychiatry. 2007;22(5):328-333. doi:
35.Yusufi
听B锘�, Mukherjee
听S锘�, Flanagan
听R锘�,
听et al. 听Prevalence and nature of side effects during clozapine maintenance treatment and the relationship with clozapine dose and plasma concentration.听锘� 听Int Clin Psychopharmacol. 2007;22(4):238-243. doi:
36.Plevin
听D锘�, Galletly
听C锘�, Roughan
听P锘�. 听Sexual dysfunction in men treated with depot antipsychotic drugs: a pilot study.听锘� 听Sex Health. 2007;4(4):269-271. doi:
37.Casta帽o
听J锘�, Garnier
听C锘�, Portillo
听F锘�,
听et al. 听P.3.c.039 Sexual dysfunction in patients with schizophrenia on antipsychotic medication.听锘� 听Eur Neuropsychopharmacol. 2008;18:S426. doi:
38.Liu-Seifert
听H锘�, Kinon
听BJ锘�, Tennant
听CJ锘�, Sniadecki
听J锘�, Volavka
听J锘�. 听Sexual dysfunction in patients with schizophrenia treated with conventional antipsychotics or risperidone.听锘� 听Neuropsychiatr Dis Treat. 2009;5:47-54. doi:
39.Sibinovic
听V锘�. 听Sexual dysfunction in patients on antipsychotic therapy Vladica Sibinovic Psychiatry Clinic CC NIS.听锘� 听Eur Psychiatry. 2009;24(S1):1. doi:
40.Nunes
听LVA锘�, Dieckmann
听LHJ锘�, Lacaz
听FS锘�, Bressan
听R锘�, Matsuo
听T锘�, de Jesus Mari
听J锘�. 听The accuracy of the Arizona Sexual Experience Scale (ASEX) to identify sexual dysfunction in patients of the schizophrenia spectrum. A acuracia da Escala de Experiencia Sexual do Arizona (ASEX) para identificar disfuncao sexual em pacientes do espectro da esquizofrenia.听锘� 听Arch Clin Psychiatry. 2009;36(5):189. doi:
41.Hariri
听AG锘�, Karadag
听F锘�, Gurol
听DT锘�, Aksoy
听UM锘�, Tezcan
听AE锘�. 听Sexual problems in a sample of the Turkish psychiatric population.听锘� 听Compr Psychiatry. 2009;50(4):353-360. doi:
42.Nagaraj
听AKM锘�, Pai
听NB锘�, Rao
听S锘�. 听A comparative study of sexual dysfunction involving risperidone, quetiapine, and olanzapine.听锘� 听Indian J Psychiatry. 2009;51(4):265-271. doi:
43.Istikoglou
听C锘�, Vlissides
听D锘�, Michelidakis
听K锘�, Mikirditsian
听OP锘�. 听3.c.001 Quality of life: sexual dysfunction in young people with schizophrenia treated with ziprasidone.听锘� 听Eur Neuropsychopharmacol. 2009;19:S511. doi:
44.Fujii
听A锘�, Yasui-Furukori
听N锘�, Sugawara
听N锘�,
听et al. 听Sexual dysfunction in Japanese patients with schizophrenia treated with antipsychotics.听锘� 听Prog Neuropsychopharmacol Biol Psychiatry. 2010;34(2):288-293. doi:
45.Harley
听EWY锘�, Boardman
听J锘�, Craig
听T锘�. 听Sexual problems in schizophrenia: prevalence and characteristics. a cross sectional survey.听锘� 听Soc Psychiatry Psychiatr Epidemiol. 2010;45(7):759-766. doi:
46.Kokoszka
听A锘�, Abd El Aal
听M锘�, Jodko
听A锘�, Kwiatkowska
听A锘�. 听Frequency of subjectively assessed symptoms of sexual dysfunction and sexual disorders.听 Article in Polish. 听Psychiatr Pol. 2009;43(6):705-718.
47.Montejo
听AL锘�, Majadas
听S锘�, Rico-Villademoros
听F锘�,
听et al; Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. 听Frequency of sexual dysfunction in patients with a psychotic disorder receiving antipsychotics.听锘� 听J Sex Med. 2010;7(10):3404-3413. doi:
48.Zhang
听XR锘�, Zhang
听ZJ锘�, Zhu
听RX锘�, Yuan
听YG锘�, Jenkins
听TA锘�, Reynolds
听GP锘�. 听Sexual dysfunction in male schizophrenia: influence of antipsychotic drugs, prolactin and polymorphisms of the dopamine D2 receptor genes.听锘� 听笔丑补谤尘补肠辞驳别苍辞尘颈肠蝉. 2011;12(8):1127-1136. doi:
49.Xiang
听YT锘�, Wang
听CY锘�, Si
听TM锘�,
听et al. 听The low frequency of reported sexual dysfunction in Asian patients with schizophrenia (2001-2009): low occurrence or ignored side effect?听锘� 听Hum Psychopharmacol. 2011;26(4-5):352-357. doi:
50.Yasui-Furukori
听N锘�, Fujii
听A锘�, Sugawara
听N锘�,
听et al. 听No association between hormonal abnormality and sexual dysfunction in Japanese schizophrenia patients treated with antipsychotics.听锘� 听Hum Psychopharmacol. 2012;27(1):82-89. doi:
51.Hashimoto
听Y锘�, Uno
听J锘�, Miwa
听T锘�, Kurihara
听M锘�, Tanifuji
听H锘�, Tensho
听M锘�. 听Effects of antipsychotic polypharmacy on side-effects and concurrent use of medications in schizophrenic outpatients.听锘� 听Psychiatry Clin Neurosci. 2012;66(5):405-410. doi:
52.Nebhinani
听N锘�, Grover
听S锘�, Avasthi
听A锘�. 听Sexual dysfunction in male subjects receiving trifluoperazine, risperidone, or olanzapine: rates vary with assessment questionnaire.听锘� 听Prim Care Companion CNS Disord. 2012;14(2):PCC.11m01199. doi:
53.Oyekanmi
听AK锘�, Adelufosi
听AO锘�, Abayomi
听O锘�, Adebowale
听TO锘�. 听Demographic and clinical correlates of sexual dysfunction among Nigerian male outpatients on conventional antipsychotic medications.听锘� 听BMC Res Notes. 2012;5:267. doi:
54.Shakir
听AS锘�, Marzook
听AA锘�, Kadim
听J锘�, Khalid
听H锘�, Jassam
听MD锘�. 听Sexual dysfunctions among male schizophrenic patients attending Al-Rashad Sex Clinic.听锘� 听AL-Kindy Coll Med J. 2013;9(2):21-24.
55.Ben Mahmoud
听S锘�, Zouari
听L锘�, Dammak
听M锘�, Ben Thabet
听J锘�, Zouari
听N锘�, Ma芒lej
听M锘�. 听脡valuation de la sexualit茅 d鈥檜ne s茅rie de 61 sujets atteints de psychose chronique. Evaluation of sexuality in 61 subjects suffering from chronic psychosis.听锘� 听厂别虫辞濒辞驳颈别蝉. 2013;22(2):90-96. doi:
56.Bhat
听MY锘�, Abbas
听Z锘�, Farhat
听S锘�, Shoid
听S锘�. 听A comparative study of sexual dysfunction associated with typical and atypical anti-psychotics in outdoor patients.听锘� 听Int J Health Sci Res. 2013;3(4):42-49.
57.Hocaoglu
听C锘�, Celik
听FH锘�, Kandemir
听G锘�, Guveli
听H锘�, Bahceci
听B锘�. 听Sexual dysfunction in outpatients with schizophrenia in Turkey: a cross-sectional study.听锘� 听Shanghai Arch Psychiatry. 2014;26(6):347-356. doi:
58.Nakhli
听J锘�, El Kissi
听Y锘�, Bouhlel
听S锘�,
听et al. 听Reliability and validity of the Arizona sexual experiences scale-Arabic version in Tunisian patients with schizophrenia.听锘� 听Compr Psychiatry. 2014;55(6):1473-1477. doi:
59.Millier
听A锘�, Amri
听I锘�, Boyer
听L锘�, Auquier
听P锘�, Toumi
听M锘�. 听Utility decrements associated with side effects in schizophrenia.听锘� 听J Med Econ. 2014;17(12):853-861. doi:
60.Pairin
听JM锘�. Evaluation de la Qualit茅 de Vie Sexuelle Chez les Patients Schizophr猫nes: Etude Observationnelle a Travers la Passation de l鈥櫭塩helle Arizona Sexual Experience Scale. Doctoral thesis. Universit茅 d鈥橝ngers; 2015.
61.Olisah
听VO锘�, Sheikh
听TL锘�, Abah
听ER锘�, Mahmud-Ajeigbe
听AF锘�. 听Sociodemographic and clinical correlates of sexual dysfunction among psychiatric outpatients receiving common psychotropic medications in a Neuropsychiatric Hospital in Northern Nigeria.听锘� 听Niger J Clin Pract. 2016;19(6):799-806. doi:
62.Hou
听CL锘�, Zang
听Y锘�, Rosen
听RC锘�,
听et al. 听Sexual dysfunction and its impact on quality of life in Chinese patients with schizophrenia treated in primary care.听锘� 听Compr Psychiatry. 2016;65:116-121. doi:
63.Suresh Babu
听P锘�. A Comparative Study on Evaluation of Sexual Dysfunction in Patients Treated With Atypical Antipsychotics Involving Risperidone, Olanzapine, and Quetiapine. Master鈥檚 thesis. Madras Medical College; 2016.
64.Simiyon
听M锘�, Chandra
听PS锘�, Desai
听G锘�. 听Sexual dysfunction among women with schizophrenia鈥攁 cross sectional study from India.听锘� 听Asian J Psychiatr. 2016;24:93-98. doi:
65.Wang
听YX锘�, Zhang
听P锘�, Xin
听LM锘�,
听et al. 听Chinese version of the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX): validity and reliability for schizophrenic patients taking antipsychotics.听锘� 听Psychiatry Res. 2016;246:303-307. doi:
66.Bellnier
听TJ锘�. 听Collee of psychiatric and neurologic pharmacists 2016 poster abstracts.听锘� 听J Pharm Pract. 2016;29(3):270-341. doi:
67.Shetageri
听VN锘�, Bhogale
听GS锘�, Patil
听NM锘�, Nayak
听RB锘�, Chate
听SS锘�. 听Sexual dysfunction among females receiving psychotropic medication: a hospital-based cross-sectional study.听锘� 听Indian J Psychol Med. 2016;38(5):447-454. doi:
68.Romero Guillena
听SL锘�, Plasencia Garcia de Diego
听B锘�, Garcia Salguero,
听M锘�. 听Sexual dysfunction and functionality. assessment of a sexual dysfunction intervention program for patients with schizophrenia.听锘� 听Eur Neuropsychopharmacol. 2016;26(2):S500. doi:
69.Halouani
听N锘�, Ellouze
听S锘�, Aloulou
听J锘�, Charfeddine
听F锘�, Aribi
听L锘�, Amami
听O锘�. 听Sexualit茅 de la femme schizophr猫ne en Tunisie: 茅tude cas鈥搕茅moins.听锘� 听厂别虫辞濒辞驳颈别蝉. 2017;27(4):211-216. doi:
70.Khan
听A锘�, Nawaz
听H锘�, Nazneen
听Z锘�, Yousafzai
听A锘�. 听Anti-psychotics induced sexual dysfunction.听锘� 听Pak J Physiol. 2017;13(3).
71.Kirino
听E锘�. 听Serum prolactin levels and sexual dysfunction in patients with schizophrenia treated with antipsychotics: comparison between aripiprazole and other atypical antipsychotics.听锘� 听Ann Gen Psychiatry. 2017;16:43. doi:
72.Abhilasha
听P锘�. 听Prevalence of sexual dysfunction in females with and without schizophrenia.听锘� 听Am J Psychiatry Neurosci.锘� 2018;6(3):56. doi:
73.Esan
听O锘�, Esan
听A锘�. 听Sexual dysfunction among patients with schizophrenia in southwest Nigeria.听锘� 听J Sex Marital Ther. 2018;44(7):657-666. doi:
74.Mart铆n
听JC锘�, Acu帽a
听MJ锘�, Labrador
听J锘�, Blanco
听M锘�, Casas
听C锘�. 听Sexual dysfunction factors in patients with schizophrenia treated with second generation antipsychotics: not only prolactin.听锘� 听Actas Esp Psiquiatr. 2018;46(6):217-225.
75.Fanta
听T锘�, Haile
听K锘�, Abebaw
听D锘�, Assefa
听D锘�, Hibdye
听G锘�. 听Assessment of sexual dysfunction and associated factors among patients with schizophrenia in Ethiopia, 2017.听锘� 听BMC Psychiatry. 2018;18(1):158. doi:
76.Rowel
听WWJSM锘�, Liyange
听ULNS锘�, Hewawitharana
听UH锘�, Dayabandara
听M锘�, Rodrigo
听A锘�. 听Erectile dysfunction among male patients diagnosed with schizophrenia being treated with antipsychotic medication, and the impact on quality of life.听锘� 听Sri Lanka J Psychiatry. 2018;9(2):10. doi:
77.Aggarwal
听S锘�, Grover
听S锘�, Chakrabarti
听S锘�. 听A comparative study evaluating the marital and sexual functioning in patients with schizophrenia and depressive disorders.听锘� 听Asian J Psychiatr. 2019;39:128-134. doi:
78.Fond
听G锘�, Godin
听O锘�, Dumontaud
听M锘�,
听et al; FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group. 听Sexual dysfunctions are associated with major depression, chronic inflammation and anticholinergic consumption in the real-world schizophrenia FACE-SZ national cohort.听锘� 听Prog Neuropsychopharmacol Biol Psychiatry. 2019;94:109654. doi:
79.Huang
听YH锘�, Hou
听CL锘�, Ng
听CH锘�,
听et al. 听Sexual dysfunction in Chinese rural patients with schizophrenia.听锘� 听BMC Psychiatry. 2019;19(1):218. doi:
80.Souaiby
听L锘�, Kazour
听F锘�, Zoghbi
听M锘�, Bou Khalil
听R锘�, Richa
听S锘�. 听Sexual dysfunction in patients with schizophrenia and schizoaffective disorder and its association with adherence to antipsychotic medication.听锘� 听J Ment Health. 2020;29(6):623-630. doi:
81.Kassew
听T锘�, Demilew
听D锘�, Birhanu
听A锘�, Wonde
听M锘�, Liyew
听B锘�, Shumet
听S锘�. 听Attitude towards antipsychotic medications in patients diagnosed with schizophrenia: a cross-sectional study at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.听锘� 听Schizophr Res Treatment. 2019;2019:5094017. doi:
82.Doane
听MJ锘�, Sajatovic
听M锘�, Weiden
听PJ锘�,
听et al. 听Antipsychotic treatment experiences of people with schizophrenia: patient perspectives from an online survey.听锘� 听Patient Prefer Adherence. 2020;14:2043-2054. doi:
83.Abdelatti
听SI锘�, Ismail
听RM锘�, Hamed
听RA锘�. 听Sexual dysfunctions in a sample of male psychiatric patients compared to medically ill patients.听锘� 听Middle East Curr Psychiatry.锘� 2020;27(1):12. doi:
84.Gaber
听HD锘�, El-Beeh
听KAM锘�, Abd Al-Naser
听FAW锘�, Hosny
听A锘�. 听Erectile dysfunction in patients with first-episode psychosis.听锘� 听础苍诲谤辞濒辞驳颈补. 2020;52(11):e13793. doi:
85.Kantipudi
听S锘�, Suresh
听N锘�, Ayyadurai
听P锘�, Ramanathan
听S锘�. 听Sexual dysfunction and marital relationship in women with schizophrenia in comparison with caregivers: a hospital-based study.听锘� 听J Psychosexual Health. 2020;2:87-92. doi:
86.Redman
听B锘�, Kitchen
听C锘�, Johnson
听KW锘�, Bezwada
听P锘�, Kelly
听DL锘�. 听Levels of prolactin and testosterone and associated sexual dysfunction and breast abnormalities in men with schizophrenia treated with antipsychotic medications.听锘� 听J Psychiatr Res. 2021;143:50-53. doi:
87.Kumar
听PNS锘�, Radhika
听MK锘�, Suresh
听R锘�, Uvais
听NA锘�. 听Comparative study of sexual side effects in female patients with schizophrenia receiving risperidone or olanzapine.听锘� 听Prim Care Companion CNS Disord. 2021;23(4):20m02835. doi:
88.Wu
听TH锘�, Lin
听CH锘�, Goh
听KK锘�,
听et al. 听The relationships between hyperprolactinemia, metabolic disturbance, and sexual dysfunction in patients with schizophrenia under olanzapine treatment.听锘� 听Front Pharmacol. 2021;12:718800. doi:
89.McGahuey
听CA锘�, Gelenberg
听AJ锘�, Laukes
听CA锘�,
听et al. 听The Arizona Sexual Experience scale (ASEX): reliability and validity.听锘� 听J Sex Marital Ther. 2000;26(1):25-40. doi:
90.Clayton
听AH锘�, McGarvey
听EL锘�, Clavet
听GJ锘�. 听The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity.听锘� 听Psychopharmacol Bull. 1997;33(4):731-745.
91.Symonds
听T锘�, Abraham
听L锘�, Bushmakin
听AG锘�, Williams
听K锘�, Martin
听M锘�, Cappelleri
听JC锘�. 听Sexual function questionnaire: further refinement and validation.听锘� 听J Sex Med. 2012;9(10):2609-2616. doi:
92.Rosen
听R锘�, Brown
听C锘�, Heiman
听J锘�,
听et al. 听The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.听锘� 听J Sex Marital Ther. 2000;26(2):191-208. doi:
93.Lingjaerde
听O锘�, Ahlfors
听UG锘�, Bech
听P锘�, Dencker
听SJ锘�, Elgen
听K锘�. 听The UKU side effect rating scale. a new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients.听锘� 听Acta Psychiatr Scand Suppl. 1987;334(s334):1-100. doi:
94.Montejo
听脕L锘�, Rico-Villademoros
听F锘�. 听Psychometric properties of the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) in patients with schizophrenia and other psychotic disorders.听锘� 听J Sex Marital Ther. 2008;34(3):227-239. doi:
95.National Institute of Diabetes and Digestive and Kidney Diseases. Erectile dysfunction (ED). Accessed March 13, 2023.
96.Mark
听DH锘�. 听Interpreting the term selection bias in medical research.听锘� 听Fam Med. 1997;29(2):132-136.
97.Delgado-Rodr铆guez
听M锘�, Llorca
听J锘�. 听Bias.听锘� 听J Epidemiol Community Health. 2004;58(8):635-641. doi:
98.Fernandes
听S锘�, Fond
听G锘�, Zendjidjian
听X锘�,
听et al. 听The Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project in France: study protocol for the development and implementation strategy.听锘� 听Patient Prefer Adherence. 2019;13:165-177. doi:
99.Seidman
听SN锘�, Roose
听SP锘�. 听Sexual dysfunction and depression.听锘� 听Curr Psychiatry Rep. 2001;3(3):202-208. doi:
100.Laurent
听SM锘�, Simons
听AD锘�. 听Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension.听锘� 听Clin Psychol Rev. 2009;29(7):573-585. doi:
101.Achour
听Y锘�, Mallet
听J锘�, Korchia
听T锘�,
听et al. 听D茅velopper la psychonutrition dans la pratique clinique psychiatrique.听锘� 听Ann M茅d-Psychol Rev Psychiatr. 2022;180(7):674-676. doi: