Olanzapine으로 항정신병약물을 교체한 정신분열병 환자에서 주관적 성기능 변화에 영향을 미치는 요인

Factors Influencing the Subjective Sexual Function in Patients with Schizophrenia Switched to Olanzapine

본 연구는 기존의 항정신병약물을 olanzapine으로 변경하여 복용한 정신분열병 환자들을 대상으로 나이, 몸무게, 병력들을 조사하고, 프로락틴 혈중 농도, LUNSERS, CGI, PA-NSS, AIMS, SAS, BARS를 시행하여 주관적인 성기능 장애에 대한 예측인자를 알아보고자 하였다. 6주간의 연구 기간 동안 주관적인 성기능 장애는 호전된 것으로 평가되었으며, 추체외로 증상의 호전 정도가 이에 대한 종적인 예측인자임을 알 수 있었다. 또한 프로락틴의 표준변화량(프로락틴의 혈중 농도 변화량/기저치의 프로락틴 혈중 농도)도 종적인 예측인자임을 알 수 있었다. 그러나, 다른 히스타민 수용체 차단, 콜린성 수용체의 차단, 아드레날린 수용체의 차단과 성기능 장애와는 뚜렷한 연관성을 보이지 않았다. 성기능 장애는 환자의 삶의 질과 치료 결과에 영향을 끼치는 인자로서 더욱 이러한 부작용에 대한 관심과 평가가 필요할 것으로 생각된다.

Objective Sexual dysfunction is highly prevalent in both untreated and treated patients with schizophrenia. Sexual dysfunction is a major cause of poor quality of life, negative attitude to therapy and treatment non-compliance. We thereby conducted this study to better understand the predictors of subjective sexual dysfunction. Methods The subjects consisted of 83 patients (46 men; 37 women) who participated in an open label study on switching antipsychotics to olanzapine. All subjects met the Tenth Revision of International Classification of Diseases diagnostic criteria for schizophrenia. To better understand the predictors of subjective sexual dysfunction, we used the Liverpool University Neuroleptic Side-effect Rating scale (LUNSERS), a comprehensive self-rating instrument for assessing and quantifying the subjective adverse events during antipsychotic treatment. All patients were taking antipsychotics at the initiation of the study and were assessed using LUNSERS, the Simpson-Angus Scale (SAS), the Barnes Akathisia Rating scale (BARS), Abnormal Involuntary Movement Scale (AIMS), Clinical Global Impression (CGI), and the Positive and Negative Syndrome Scale (PA-NSS). They were also checked for their serum prolactin levels and vital signs before and after a 6-week treatment with olanzapine. In order to identify the cross-sectional and longitudinal predictors of LUNSERS hormonal side effect, we carried out multiple regression analyses. Results Prolactin levels, LUNSERS hormonal side effect, CGI, PANSS, SAS, AIMS, and BARS decreased after a 6-week treatment with olanzapine. At initial evaluation, cross-sectional predictors of LUNSERS hormonal side effect were red herring and allergic reaction subscale, but after the 6-week treatment with olanzapine, none of the variables were found to significantly predict LUNSERS hormonal side effect. Longitudinal predictors of LUNSERS hormonal side effect were LUNSERS extrapyramidal system side effect and prolactin levels. Conclusion These findings suggested relationships among prolactin, extrapyramidal symptom, motor function and sexual dysfunction. After switching to olanzapine, sexual function of the patients improved subjectively. More studies are warranted as these results have significant implications for quality of life and treatment adherence.