Publication:

Sexual function in patients with schizophrenia on anti-psychotics: a comparative study of hyperprolactinemia-inducing and hyperprolactinemia non-inducing antipsychotics

Background Sexual dysfunction is a common but often under-recognized adverse effect in patients with schizophrenia receiving antipsychotic therapy. Hyperprolactinemia induced by certain antipsychotics has been implicated as a major contributing factor. This study aimed to compare sexual function among patients receiving hyperprolactinemia-inducing and hyperprolactinemia non-inducing antipsychotics and to assess whether sexual dysfunction is related to antipsychotic-induced hyperprolactinemia or the underlying illness itself.

Methods A prospective observational study was conducted in the Department of Psychiatry at Sri Ramachandra Hospital, Chennai, from March to July 2025. Sixty patients diagnosed with schizophrenia according to ICD-10 criteria and receiving antipsychotic therapy were enrolled. Patients were categorized into two groups: hyperprolactinemia-inducing antipsychotics (olanzapine, haloperidol, risperidone) and hyperprolactinemia non-inducing antipsychotics (aripiprazole, cariprazine, lurasidone). Sexual function was assessed using the Arizona Sexual Experience Scale (ASEX), and serum prolactin levels were measured. Statistical analyses included independent t-tests and one-way ANOVA, with p<0.05 considered significant.

Results Of the 60 participants, 32 (53.3%) were males and 28 (46.7%) were females. Patients receiving hyperprolactinemia-inducing antipsychotics demonstrated significantly higher ASEX scores compared with those receiving hyperprolactinemia non-inducing agents (21.53±2.97 vs 15.70±2.93; p=0.0005). Serum prolactin levels were also significantly elevated in the hyperprolactinemia-inducing group (137.5±51.60 ng/mL vs 33.2±17.14 ng/mL; p=0.0005). Within-group analysis revealed that haloperidol was associated with the highest ASEX scores and prolactin levels among prolactin-raising agents, while aripiprazole exhibited the lowest values among prolactin-sparing drugs.

Conclusions Sexual dysfunction was significantly more prevalent among patients receiving hyperprolactinemia-inducing antipsychotics and was strongly associated with elevated serum prolactin levels. However, the presence of sexual dysfunction in some patients receiving prolactin-sparing agents suggests that factors related to schizophrenia itself may also contribute. Careful selection of antipsychotic therapy and routine monitoring of sexual function and prolactin levels may improve treatment adherence and quality of life in patients with schizophrenia.