Kesebir Sermin, Toprak Burak, Baykaran Burak, Hariri Aytül, Bilici Mustafa
Clinic of Psychiatry, Erenköy Psychiatric Training and Research Hospital, İstanbul, Turkey.
Department of Psychiatry, Maltepe University, Faculty of Medicine, İstanbul, Turkey.
Noro Psikiyatr Ars. 2014 Sep;51(3):242-247. doi: 10.4274/npa.y6838. Epub 2014 Sep 1.
The aim of this study was to determine the differences between lithium and atypical antipsychotics (quetiapine and olanzapine) with regard to their effects on sexual functions and hormonal variables and to assess the findings in term of gender differences, in patients with bipolar disorder.
28 female and 29 male patients diagnosed as having bipolar disorder type I according to the DSM-IV, using lithium or quetiapine and quetiapine+lithium or olanzapine and olanzapine+lithium were evaluated consecutively. Being in remission period and given informed consent were set as inclusion criteria in these cases. Interviews with the patients were carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and SKIP-TURK. Sexual functions and satisfaction were evaluated with the Arizona Sexual Experiences Scale (ASEX) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Blood samples of the patients were taken in order to determine prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and free testosterone (T) levels.
GRISS scores in male patients were higher than in female patients (p=.001). The number of manic, depressive and total episodes, and functionality levels were similar between the treatment groups, both in female and male patients. No differences were found between treatment modalities in terms of hormone levels both in female and male patients. Among females, ASEX scores of the patients treated with lithium monotherapy were less than the ones treated with quetiapine and olanzapine. Among patients with quetiapine monotherapy, GRISS scores in male patients were higher than in female patients.
There are some evidences showing gender-based differences in the side effects of atypical antipsychotic drugs. Future studies with a specific focus on this topic are needed in order to have a better understanding of the basic mechanisms of gender differences.
本研究旨在确定锂盐与非典型抗精神病药物（喹硫平和奥氮平）在双相情感障碍患者性功能及激素指标方面的差异，并评估这些差异在性别上的表现。
连续评估28例女性和29例男性双相I型障碍患者，这些患者根据DSM-IV诊断标准，正在使用锂盐或喹硫平、喹硫平+锂盐，或奥氮平、奥氮平+锂盐进行治疗。纳入标准为处于缓解期且签署知情同意书。使用DSM-IV轴I障碍结构化临床访谈（SCID-I）和SKIP-TURK对患者进行访谈。使用亚利桑那性体验量表（ASEX）和戈伦伯克性满意度量表（GRISS）评估性功能和性满意度。采集患者血样以测定催乳素（PRL）、促卵泡激素（FSH）、促黄体生成素（LH）、雌二醇（E2）和游离睾酮（T）水平。
男性患者的GRISS评分高于女性患者（p = 0.001）。男女患者各治疗组间躁狂发作、抑郁发作及总发作次数以及功能水平相似。男女患者不同治疗方式在激素水平方面均未发现差异。在女性患者中，单药使用锂盐治疗的患者ASEX评分低于使用喹硫平和奥氮平治疗的患者。在单药使用喹硫平治疗的患者中，男性患者的GRISS评分高于女性患者。
有证据表明非典型抗精神病药物的副作用存在性别差异。需要针对该主题开展进一步研究，以更好地理解性别差异的基本机制。
