Sexuelle Dysfunktion in der psychiatrischen Therapie

 

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Zusammenfassung

Sexuelle Funktionsstörungen stellen eine häufige unerwünschte Nebenwirkung von Psychopharmaka dar, bei männlichen Patienten treten insbesondere die Ejakulationsstörung und die erektile Dysfunktion auf. Trotz ihrer hohen Prävalenz werden sie in der psychiatrischen Diagnostik nicht ausreichend erfasst. Die medikamentöse Compliance kann durch diese Nebenwirkungen deutlich reduziert werden, insbesondere wenn die Patienten die psychotrope Medikation für ihre sexuellen Dysfunktionen verantwortlich machen. Pharmakainduzierte sexuelle Funktionsstörungen können in jeder Phase der menschlichen sexuellen Reaktion auftreten. Grundsätzlich ist zu beachten, dass der pharmakogene vom morbogenen Einfluss getrennt betrachtet werden muss und der Einfluss von Psychopharmaka alleine auf die Sexualität nicht überbewertet werden darf. Bei der Behandlung von antidepressiva-induzierter erektiler Dysfunktion haben sich PDE-5 Hemmer bewährt. Hinsichtlich neuroleptika-induzierter sexueller Funktionsstörungen kann ein Wechsel zu einem nicht-prolaktin erhöhenden Antipsychotikum hilfreich sein.

Summary

Disturbances in sexual functioning are a common side effect in the treatment of psychopharmacological agents. In male patients ejaculatory disturbance and erectile dysfunction are the common complaints on presentation. Despite their high prevalence these disturbances are not consistently documented. Patient compliance can be markedly reduced as a result of such complications, especially when patients associate their medication with such side effects. Pharmacologically induced disturbance of sexual functioning can occur in every stage of human sexual response. As a rule pharmacogenic and illness-related influences must be distinguished, the influence of psychopharmacological agents must not be over-estimated. In treatment of antidepressive-induced erectile dysfunction PDE-5-inhibitors have proven to be very useful. Regarding neuroleptic-induced functional disturbance a change toa non-prolactin elevating antipsychotic agent may be useful.

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