Do atypical antipsychotics cause sexual dysfunction???
INTRODUCTON
I have chosen to focus on atypical antipsychotics and sexual dysfunction for my summative assignment as I am interested in this topic. I will explain the process of gathering information and relevant to my topic. I will then discuss the strengths and limitations of four chosen articles and explain its implication to practice.
RATIONALE
While on my Common foundation programme in an acute ward I attended a ward round for different patients. For confidentiality reasons the patients name is withheld to respects patient’s right to confidentiality (NMC, 2009). One of the service users raised a concern regarding his medication, when asked for the reasons, he expressed that the medication was affecting his sex life. I found this to be an interesting topic to explore evidence on sexual dysfunction as one of the side effects of antipsychotic.
The American Psychiatric Association (1997) describes sexual dysfunction as “the inability to maintain erection to complete intercourse or sexual activity”. Sexual dysfunction can cause extreme difficulties in relationship and can lead to low self-esteem and depression (Kell & Dinsmore, 2008). The Oxford Dictionary for Nurses (2008) describes atypical antipsychotics as drugs that are used to treat severe mental disorders (psychoses) including schizophrenia, mania and anxiety in small dosages.
SEARCH STRATEGY
To find the information relevant for my topic I will use key words and Boolean operators such as AND, OR and “ “.
My key words are: 1. Atypical 2. Antipsychotic 3. Sexual dysfunction 4. Erectile dysfunction To gather my evidence firstly I searched on medical health data base electronically. I decided to search on Pubmead which is user friendly and proved to have good information. I used the keywords “atypical antipsychotics and sexual dysfunction and I got 78 results. I then limited my search and ended up with 7 results see Appendix (1). I first draw an interest in article titled “Sexual dysfunction in patients treated with atypical antipsychotics” as it focused directly on my topic. As I could not obtain a full article, I kept on checking other articles. I then limited my search from 81 and ended up with 3 results. I chose the article titled “Comparison study of sexual dysfunction involving risperidone, quetapine and olanzapine” see Appendix (2). I read the abstracts and found that the article was useful and relevant to my topic as it explained in different types of antipsychotic affecting sexual dysfunction in individuals with mental health disorders.
I then went to search on PsychINFO, I used key words, “atypical and sexual dysfunction” and came up with 10 results, see Appendix (3). After browsing through the articles I chose the 6th article titled “Sexual dysfunction in patients treated with schizophrenia on antipsychotic medication”. The abstract was straightforward to read and relevant to my topic.
I kept on searching different sources to gather more information and evidence. I searched on CINAHL Plus as it is the database for nursing. Using the key words “antipsychotic and sexual dysfunction”, I came up with 17 results, and then I attempted to limit my search but was unsuccessful. I then chose article number 3 titled “Sexual dysfunction and schizophrenia”, see Appendix (4). I browsed through the article and I found it relevant as it focused on sexual dysfunction.
I then continued to gather more evidence by searching on journals through study net. I typed in Royal College of Psychiatrist. I used the key words “atypical antipsychotic and sexual dysfunction” and this gave me 1180 but I could not limit my search as there is no way of limiting searches provided. I then chose 1st article from the first 10 results see Appendix (5). I found this article relevant to my topic as it looks at other information from other studies.
To continue with my search I went on to mind website. I used key words “antipsychotic and sexual dysfunction” and came up with 2 results (see Appendix 6). The first article contained basic knowledge and information of antipsychotics which I found relevant and useful to my topic. While I was within the website I checked on “Useful information” and clicked on Rethink which gave me 14 results using the same key words (see Appendix 7). However, I decided to use the 2nd article entitled “antipsychotic medication” as it contains relevant information related to my topic.
I then collected two leaflets for two different types of antipsychotics, which had sexual dysfunction as one of the side effects (see Appendix8).
DISCUSSION OF EVIDENCE
A comparative study of sexual dysfunction involving respiridone, quetapine and olanzapine: Appendix (2)
This article is a comparative study of sexual dysfunction involved with three different types of antipsychotics named above. This is a qualitative research and cross-sectional sample was use to select participants. Ethical issues were considered as authors obtained clearance from the local ethical committee. Participants were enrolled in the study after completing and signing their consent forms, meaning ethical issues were put into consideration. Munhall (2006) illustrates that ethical approval should be considered in order to commence a research. Services users will feel honoured and valued which gives them a willingness to participate in the future. The limitation is that it was done from one locality area which excluded women. The female patients were not involved and the results can be biased and lack reliability and validity. According to Cohen et al (2007) validity plays an important role to effective research. Invalid piece of research makes evidence worthless therefore validity is a requirement. The study was a one hospital based study and the sample size was small which makes it difficult to draw generalised conclusions as information might be biased. The authors suggested that they could deal with higher sample sizes and implement in future research to reach a reliable conclusion.
Sexual dysfunction in patients with schizophrenia treated on antipsychotic medication: Appendix (3).
In this article a quantitative approach was used as methodology to carry out the study. The strength identified is that the authors are renounced psychiatrists and experts in that particular field (Burns & Grove, 2003). The authors all come from different institutions and they will have different knowledge and ideas in the field. The article focused on the main objective of the study to investigate the prevalence of sexual dysfunction affecting patients taking antipsychotic. Anil et al (2009) agreed that antipsychotic drugs are among other factors that affect optimal sexual functioning. Most atypical antipsychotics’ are associated with significant sexual side effects which affect a sexual life for most people. The limitation identified is the use of quantitative research. Knapp (1998) states that using quantitative methods to advance nursing practice by studying facts and observations. Hughes (2006) further added that quantitative research does not take account of people’s unique ability and interpret their experiences to construct a meaningful life. The other limitation identified is that outpatients who met the DSM-IV criteria were selected in the study. However the diagnostic criteria used to select participants is not globally used and this can lead to biased results.
Sexual dysfunction in schizophrenia: Appendix (4)
This review article is discussing significant sexual dysfunction in schizophrenia patients based on different studies. The introduction clearly indicates that sexual dysfunction plays an important factor both with regards to adherence to medication mainly influenced by side effects of antipsychotics. This includes other outcomes such as quality of life. Bancroft (1989) outlines that women experience low sexual desire while men complain of sexual dysfunction. Similar studies have been reported by other studies that erectile dysfunction is the most sexual dysfunction in men. However, the tools used in different studies can have an impact in the frequency of erectile dysfunction reported. In group studies (10, 12, 13) the limitations were use of small sample size used to recruit participants as it can leads to biased and results. Burns & Grove (2000) highlighted that a good study should eliminate and be free of bias. In groups (9, 12) lack of control groups made the results difficult to interpret. In group (13) the authors did not give exact scores but reported sexual complaints. No significant differences were formed between the groups. In groups (14, 15) the strength of the both studies is that they used large sample of patients in the study. Parahoo (2001) suggests that studies have to be representative of the the population. The other strength is patients recruited in study group (14) were treatment naïve. This was the easy way to differentiate between treatment induced illnesses and induced sexual dysfunction. However, all the authors agreed that it is important to conduct larger controlled trials in both treated and pre-treated patients. This will help to investigate issues leading to sexual dysfunction.
Sexual side effects of antidepressant and antipsychotic drugs: Appendix (5)
This article is a review article that looks at information from different studies. The review is relevant because it’s focusing on different range of antipsychotic medication to compare the prevalence of sexual dysfunction. The strength of the journal is that it gives an overview of information given covering area and up to date information published in the last 10 years. Sharts-Hopko (2003) stated that research that seeks to improve care should be evidenced based. The limitation is that women were excluded from this study whereas sexual dysfunction can affect both sexes. This can lead to a bias in conclusion and results. The review showed that clozapine treatment was significantly associated with better sexual functioning when assessing sexual satisfaction and enjoyment. Leppard (2008) highlighted the efficacy of clozapine in relieving symptoms and positive favourable effects on sexual health and relationships In a comparison with olanzapine and clozapine a study revealed that sexual dysfunction was significantly less common with olanzapine. Clozapine is the only atypical antipsychotic with proven efficacy in treatment- resistant schizophrenia (NICE, 2002).
ISSUES IN APPLYING TO PRACTICE.
After gathering information as evidence I have managed to highlight the importance of evidence based practice. Parahoo (2006) states that the nursing research aims to improve care for patients therefore professionals should ensure that up to date evidence is implemented. Sexual dysfunction remains the side effect of atypical antipsychotic which hinders an individual from having a quality of life. It is also researched to be the most reason leading to non-compliance. One survey was carried out to carry out attitudes and practices of sexual dysfunction in their patients, most of them agreed that good sexual function was essential to service users. However, most of them did not feel competent to assess and most practitioners had no training in this area. Funding will be needed from the government for staff training as well as raising awareness to service users. Therefore health professionals must be offered training to raise awareness and offer support to patients with sexual dysfunction (Nnaji, 2008). As patients might have difficulties to complain about these delicate issues, psychiatrists may struggle to inquire. Kantz et al (1990) identified that research has shown that nurses are reluctant to discuss sexuality with patients due to lack of knowledge and ability to deal with personal issues. Therefore health care professionals needs to change their attitude and be professional in order deliver and improve patient’s life. Kenworthy et al (2000) agreed that professionalism is important to maintain good relationship and can leads to effective care being delivered to patients. Sexual dysfunction maybe unrecognised factor on non-compliance to treatment, therefore it should be assessed with caution and offer treatment to patients according to their needs. Furthermore health care professional must have an understanding of evidence based practice in order to provide the best quality of care.
REFERENCES
American Psychiatric Association (1997). Diagnostic and Standard Manual of Mental Disorders. 4, APA, Washington DC
Bancroft, J. (1969). Sexual aspects of medical practice. In: Human Sexuality and its problems. Edinburgh: Churchill Livingstone, 552-618.
Burnes, N & Grove, S.K (2003). Understanding Nursing Research. (3rded). Philadelphia.
Burns, N. & Grove, S.K (2000). The practice of nursing research: Critique and utilization. (4thed). London: WBS Saunders Co.
Cohen, L. Manion, L. &Morrison, K. Research methods in Education. (6thed) Routledge, New York.
Hughes, M. (2006). Different types of research. The International Christmas Post-graduate School "Qualitative and Quantitative Research in Sport Science” Berzsenyi College, Szombathely: Hungary, December.
Kantz, DD. Dickey, CA, & Stevens, MN. (1990). Using Research to identify why nurses do not meet established sexuality nursing care standards. J Nursing Qual Ass 43(3):69-78
Kell P & Dinsmore, W (2002). Impotence: A guide for men of all ages. Royal Society of Medicine Press: London
Kenworthy, N. Snowey, G & Gilling, C (2002). Common foundation studies in nursing. LONDON. Churchill, Livingstone
Leppard, J. (2008). Running a clozapine clinic: Considerations and challenged. Nurse Prescribing. (6) 4, 162
Munhall, PL. (2006). Nursing research a qualitative perspective. Journal of Advanced Nursing 53 (3), 304-310
Nnaji, N.R. (2008). Sexual dysfunction & schizophrenia: Psychiatrists’ attitude & training needs. The Royal College of psychiatrists. 32, 208-2106.
NICE (2002). Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia. 43. NICE, London
Nursing and Midwifery Council, (2009). The Code: Standards of conduct and performance and ethics for nurses and midwives. London
Oxford Minidictionary for Nurses (6thed) Oxford: University Press
Parahoo, K. (2001) Nursing Research principles, process and issues. (2nded). London. Palgrave: Macmillan
Parahoo, K. (2006). Nursing research principles & issues. Bassingstoke. Palgrave MacMillan
Sharts-Hopko, N.C (2008) Evidence Based Practice. What constitutes evidence? Journal of the Association of Nurses in Aids care. (14), 3 76-78.