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Change in sexual dysfunction with aripiprazole: a switching or add-on study

COAST Team (Croydon Early Intervention in Psychosis Service), Westways Resource Centre, Croydon, UK

Kuppuswami Shivakumar

COAST Team (Croydon Early Intervention in Psychosis Service), Westways Resource Centre, Croydon, UK and MRC Social, Genetic and Developmental Psychiatry Research Centre and Institute of Psychiatry, Clinical Neuropharmacology, Division of Psychological Medicine and Psychiatry, London, UK

Richard J Williamson

MRC Social, Genetic and Developmental Psychiatry Research Centre and Institute of Psychiatry, Clinical Neuropharmacology, Division of Psychological Medicine and Psychiatry, London, UK

Victoria McAllister

COAST Team (Croydon Early Intervention in Psychosis Service), Westways Resource Centre, Croydon, UK

Veronica O'Keane

Perinatal Psychiatry Section, Institute of Psychiatry, Division of Psychological Medicine and Psychiatry, London, UK

Katherine J Aitchison

MRC Social, Genetic and Developmental Psychiatry Research Centre and Institute of Psychiatry, Clinical Neuropharmacology, Division of Psychological Medicine and Psychiatry, London, UK and COAST Team (Croydon Early Intervention in Psychosis Service), Westways Resource Centre, Croydon, UK, k.aitchison{at}iop.kcl.ac.uk

Sexual dysfunction and raised prolactin are common adverse effects of many anti-psychotics. Aripiprazole is an atypical anti-psychotic associated with a reduction in prolactin level in anti-psychotic-induced hyperprolactinemia. Our hypothesis was that switching from another anti-psychotic to aripiprazole would be associated with a reduction in sexual dysfunction. An open label switch to aripiprazole was offered to 27 subjects with inadequate therapeutic response or intolerance to another anti-psychotic, who were followed up for 26 weeks. Serial clinical ratings included the Anti-psychotic Non-Neurological Side-Effects Rating Scale (ANNSERS), and the Sexual Functioning Questionnaire. Our primary analysis point was week 12. In both sexes, there was a significant reduction in prolactin by week 12 (P = 0.003), accompanied by a significant improvement in libido (P = 0.028). In males, both erectile and ejaculatory difficulties were also significantly reduced (P = 0.04 and P = 0.017, respectively). In females, menstrual dysfunction was also significantly reduced at week 12 (P = 0.04). By week 26, the changes in all of the above remained significant, and were accompanied by a significant increase in satisfaction in overall sexual functioning (P = 0.007), despite the fact that 54.5% of subjects at were also taking their original antipsychotic. There was also a significant decrease in the total ANNSERS score (P < 0.001) and a significant improvement in all other measures of psychopathology (PANSS, CGI-S/I, GAF-S/D, and QoL). We conclude that switching to aripiprazole or the addition of aripiprazole to another antipsychotic regime is associated with a reduction in sexual dysfunction.

Key Words: aripiprazole • anti-spsychotic agent • prolactin • sexual dysfunction • dopamine agonist

This version was published on May 1, 2008

Journal of Psychopharmacology, Vol. 22, No. 3, 244-253 (2008)
DOI: 10.1177/0269881107082901


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