Knegtering H, van der Moolen A E G M, Castelein S, Kluiter H, van den Bosch R J
Department of Psychiatry, University Hospital Groningen, Hanzeplein 1, 9700 RB., P.O. Box 30.001, Groningen, The Netherlands.
Psychoneuroendocrinology. 2003 Apr;28 Suppl 2:109-23. doi: 10.1016/s0306-4530(02)00130-0.
The literature is reviewed and preliminary results of new studies are presented showing that treatment with classical antipsychotics, as well as risperidone, induces sexual dysfunctions in 30-60% of the patients. These antipsychotics also frequently induce amenorrhoea and galactorrhoea. Although comparative studies are rare, it is likely that prolactin-sparing antipsychotics, as recently shown in a randomized trial of olanzapine versus risperidone, induce less sexual side effects.From these studies, it becomes apparent that prolactin elevation induced by classical antipsychotics and risperidone is probably a factor in inducing sexual dysfunctions, amenorrhoea and galactorrhoea. The role of other factors inducing sexual dysfunctions like sedation, proportional, variant -blockade, testosterone, dopamine, and serotonin is discussed. Finally, it is concluded that sexual and hormonal effects of antipsychotics, although clearly important, are often neglected in research as in clinical practice. Lowering the dosage or switching to a prolactin-sparing antipsychotic often reduces sexual side effects, amenorrhoea, and galactorrhoea.
本文回顾了相关文献，并展示了新研究的初步结果，结果表明使用传统抗精神病药物以及利培酮进行治疗会导致30%至60%的患者出现性功能障碍。这些抗精神病药物还经常导致闭经和溢乳。尽管比较研究很少见，但催乳素水平较低的抗精神病药物，如最近在一项奥氮平与利培酮的随机试验中所显示的，可能会引起较少的性副作用。从这些研究中可以明显看出，传统抗精神病药物和利培酮引起的催乳素升高可能是导致性功能障碍、闭经和溢乳的一个因素。文中还讨论了其他导致性功能障碍的因素，如镇静作用、比例、变异 - 阻断、睾酮、多巴胺和血清素的作用。最后得出结论，抗精神病药物的性和激素效应虽然显然很重要，但在研究和临床实践中常常被忽视。降低剂量或改用催乳素水平较低的抗精神病药物通常会减少性副作用、闭经和溢乳。
