Importance In individuals with schizophrenia, antipsychotic-induced dysfunctions are frequent but often underexplored in clinical practice. Objective To synthetize the data of observational studies exploring the prevalence of sexual dysfunction in individuals with schizophrenia-spectrum disorders as well as associated factors. Data Sources A systematic literature search without language or time restrictions was conducted in Google, Google Scholar, PubMed/MEDLINE, Science Direct, and Université Sorbonne Paris Cité for studies published up to June 8, 2022. Study Selection All observational studies reporting a prevalence of sexual dysfunction in schizophrenia-spectrum disorder were included. Data Extraction and Synthesis The MOOSE guidelines with independent extraction by 2 observers and random-effects models were used. Main Outcomes and Measures The prevalence of sexual dysfunction and each specific dysfunction. Results A total of 72 of 1119 studies from 33 countries on 6 continents published from inception to June 2022 were included with a total of 21 076 participants with schizophrenia. The pooled global prevalence of sexual dysfunctions was 56.4% (95% CI, 50.5-62.2), with a prevalence of 55.7% (95% CI, 48.1-63.1) for men and 60.0% (95% CI, 48.0-70.8) for women. The most frequent sexual dysfunction was erectile dysfunction in men (44%; 95% CI, 33.5-55.2), followed by loss of libido in men (41%; 95% CI, 30.7-51.4), ejaculation dysfunction in men (39%; 95% CI, 26.8-51.8), orgasm dysfunction in women (28%; 95% CI, 18.4-40.2), and amenorrhea in women (25%; 95% CI, 17.3-35.0). Factors associated with heterogeneity were study design, time and location, sociodemographic data, alcohol use disorder, psychiatric diagnosis, illness severity, and the use of antidepressants and anxiolytics. Sexual dysfunctions were more frequent in schizophrenia vs schizoaffective disorders, and erectile disorders were less frequent in individuals with longer illness duration. Antidepressant and mood stabilizer prescriptions were associated with lower rates of erection disorders (β, -6.30; 95% CI, -10.82 to -1.78); P = .006 and -13.21; 95% CI, -17.59 to -8.83; P < .001, respectively) and ejaculation disorders (β, -6.10; 95% CI, -10.68 to -1.53; P = .009 and β, -11.57; 95% CI, -16.34 to -6.80; P < .001, respectively). No obvious improvements in the rates of sexual dysfunction at other times were found, and there were conflicting results regarding antipsychotic classes. Conclusions and Relevance This systematic review and meta-analysis found a high prevalence of sexual dysfunction among individuals with schizophrenia, with considerable heterogeneity in associated factors. The findings also suggest that some dysfunctions may be explained by schizophrenia. The association between lower rates of dysfunction and antidepressant use suggests that treating comorbid depression could be an effective strategy to improve sexual health. A lack of data on metabolic parameters and physical health in general was also noted, while these issues are frequent in the care of schizophrenia.

中文翻译：

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精神分裂症的性功能障碍：系统回顾和荟萃分析。

重要性 在精神分裂症患者中，抗精神病药物引起的功能障碍很常见，但在临床实践中往往未被充分探索。目的 综合探索精神分裂症谱系疾病个体性功能障碍患病率以及相关因素的观察性研究数据。数据来源 在 Google、Google Scholar、PubMed/MEDLINE、Science Direct 和 Université Sorbonne Paris Cité 中对截至 2022 年 6 月 8 日发表的研究进行了系统性文献检索，不受语言或时间限制。 研究选择 所有报告流行病患病率的观察性研究精神分裂症谱系障碍中的性功能障碍也包括在内。数据提取和综合 使用由 2 名观察者独立提取的 MOOSE 指南和随机效应模型。主要结果和措施 性功能障碍的患病率和每种特定功能障碍。结果 自启动至 2022 年 6 月发表的来自六大洲 33 个国家的 1119 项研究中，共有 72 项研究纳入了 21076 名精神分裂症患者。性功能障碍的全球汇总患病率为 56.4%（95% CI，50.5-62.2），其中男性患病率为 55.7%（95% CI，48.1-63.1），女性患病率为 60.0%（95% CI，48.0-70.8）。女性。最常见的性功能障碍是男性勃起功能障碍（44%；95% CI，33.5-55.2），其次是男性性欲丧失（41%；95% CI，30.7-51.4）和男性射精功能障碍（39%） ；95% CI，26.8-51.8）、女性性高潮功能障碍（28%；95% CI，18.4-40.2）和女性闭经（25%；95% CI，17.3-35.0）。与异质性相关的因素包括研究设计、时间和地点、社会人口统计数据、酒精使用障碍、精神病学诊断、疾病严重程度以及抗抑郁药和抗焦虑药的使用。与分裂情感障碍相比，精神分裂症的性功能障碍更为常见，而病程较长的个体中勃起障碍的发生率较低。抗抑郁药和情绪稳定剂处方与较低的勃起障碍发生率相关（β，-6.30；95% CI，-10.82 至 -1.78）；P = .006 和 -13.21；95% CI，-17.59 至 -8.83；P < .001，分别）和射精障碍（β，-6.10；95% CI，-10.68 至 -1.53​​；P = .009 和 β，-11.57；95% CI，-16.34 至 -6.80；P < .001 ， 分别）。其他时间的性功能障碍发生率没有明显改善，并且抗精神病药物类别的结果相互矛盾。结论和相关性 这项系统评价和荟萃分析发现，精神分裂症患者性功能障碍的患病率很高，且相关因素存在相当大的异质性。研究结果还表明，某些功能障碍可能可以用精神分裂症来解释。较低的功能障碍发生率与抗抑郁药物的使用之间的关联表明，治疗共病抑郁症可能是改善性健康的有效策略。