ABSTRACT
Reduction in sexual desire and performance are frequently reported by patients with various psychiatric disorders. Sexual dysfunction can also be induced by all classes of psychotropic medication. Distinguishing illness-associated sexual dysfunction from that induced by medications can be extremely difficult. Patients are apt to ascribe any reduction in sexual desire or inadequacy in sexual performance that they experience to the adverse effects of the prescribed medication, whereas the treating mental health professional is equally likely to attribute such sexual dysfunction to the patient's illness. The considerable clinical significance of the sexual dysfunction associated with psychotropic medications and the inadequate attention paid to this problem by treating physicians is illustrated by the following study. In 1990, Finn, Bailey, Schultz & Faber asked 41 patients with schizophrenia being treated with neuroleptics to rate the relative discomfort of symptoms and the side effects of the neuroleptics. A group of psychiatrists was asked to make parallel ratings from the perspective of the patient. Twenty side effects (i.e., akathisia, dystonia, dry mouth, ortho-static hypotension, impotence, inhibited/painful ejaculation, etc.) and 19 symptoms (i.e., persecutory delusions, thought blocking, auditory hallucinations, etc.) were rated. Overall, genital/sexual side effects were rated by the patients as the most bothersome of the symptoms or side effects; impotence was more bothersome than any of the schizophrenic symptoms. Although psychiatrists predicted patients' ratings moderately well, they misjudged the discomfort to patients of side effects and symptoms overall. Given this discrepancy, it is no surprise that compliance becomes an issue for many patients. The chapter by Deegan (Chapter 2) also provides clear testimony to the importance of this sideeffect.
