Translation and cross-cultural adaptation of the Arizona Sexual Scale (ASEX) into Portuguese / Tradução e adaptação transcultural da Arizona Sexual Scale (ASEX) para a língua portuguesa

Abstract Introduction Sexual dysfunction is common in individuals with psychiatric disorders and under psychotropic medication such as antidepressants and antipsychotics. Several scales have been developed to assess sexual function in these patients. The Arizona Sexual Scale (ASEX) is a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. We describe the translation and cross-cultural adaptation of the ASEX into the Portuguese language, with the goal of contributing to the assessment of sexual function in Portuguese-speaking psychiatric patients under treatment with psychotropic drugs. Methods The translation and cross-cultural adaptation process thoroughly followed the steps recommended by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), namely: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalization, proofreading, and final version. Results The process was successfully completed and no major differences were found between the translation, reconciliation and back-translation phases, with only small adjustments being made. Conclusion The translation of the ASEX was completed successfully, following international reference guidelines. The use of these guidelines is a guarantee of a Portuguese version that is qualitatively and semantically equivalent to the original scale. This availability of this new scale version will enable studies evaluating the sexual function of Portuguese-speaking psychiatric patients. Future studies may assess the validity of the scale for Portuguese-speaking populations.

Resumo Introdução A disfunção sexual é comum em indivíduos com doenças psiquiátricas e sob o uso de medicações como antidepressivos e antipsicóticos. Várias escalas foram desenvolvidas para avaliar a função sexual desses doentes. A Arizona Sexual Scale (ASEX) é uma escala de cinco itens de avaliação que quantifica desejo sexual, excitação, lubrificação vaginal/ereção peniana, capacidade para atingir o orgasmo e satisfação com o orgasmo. Este artigo descreve o processo de tradução e adaptação transcultural da escala ASEX para a língua portuguesa, com o objetivo de contribuir para a avaliação da função sexual dos doentes medicados com fármacos psicotrópicos nos vários países onde se utiliza essa língua. Métodos A tradução e a adaptação transcultural seguiram de forma detalhada os passos recomendados pelo grupo de trabalho da International Society for Pharmacoeconomics and Outcomes Research (ISPOR), nomeadamente: preparação, tradução inicial, reconciliação, retroversão, revisão da retroversão, harmonização, teste cognitivo, revisão do teste cognitivo, finalização, leitura final e versão final. Resultados O processo foi completado com sucesso, e não foram observadas diferenças grandes entre as fases de tradução, reconciliação e retroversão, tendo sido feitos apenas pequenos ajustes. Conclusão A tradução da escala ASEX foi bem-sucedida, seguindo orientações internacionais de referência. A aplicação dessas orientações é a garantia de uma versão em língua portuguesa que é qualitativa e semanticamente equivalente à versão original da escala. A existência desta nova versão da escala permitirá estudos que avaliem a função sexual dos doentes em países nos quais se fale a língua portuguesa. Estudos futuros poderão atestar a validade da escala para essas populações.

Sexual addiction in drug addicts: The impact of drug of choice and poly-addiction / Dependência sexual em dependentes químicos: o impacto de diferentes drogas de escolha e de polidependência

Summary Objective: To compare the risk of comorbid sexual addiction in a sample of individuals with a diagnosis of substance dependence, stratifying the sample by drug of choice as well as by mono versus polysubstance addiction. Method: All data were collected at Santa Casa de São Paulo, Brazil. The study sample comprised all alcohol or drug dependents admitted to the Addiction Treatment Unit between November 2013 and August 2014. A generalized linear model with a binomial distribution was performed to compare the odds of having a Sexual Addiction Screening Test (SAST) score greater than 6 points in the subgroups analyzed. Results: A total of 133 participants were included in our analysis, all reporting cocaine/crack and/or alcohol as drug of choice. Polysubstance addicts had a significant higher risk of a positive screening for sexual addiction compared to monosubstance addicts, age-sex adjusted odds ratios of sexual addiction being respectively 2.72 (95CI 1.1-6.71) and 0.37 (95CI 0.15-0.91). The odds of a SAST score greater than 6 was not statistically different between the cocaine/crack and alcohol groups, respectively 0.38 (95CI 0.14-1.02) and 2.67 (95CI 0.98-7.25). We found a significant relation between stronger drug addiction and greater levels of sexual addiction in the cocaine/crack group (p=0.0012), but not in the alcohol group. Conclusion: Our study reinforces the importance of assessing sexual behavior of drug addicts in clinical practice, especially considering users of multiple substances or with severe dependence.

Resumo Objetivo: Comparar o risco de dependência sexual em uma amostra de indivíduos com diagnóstico de dependência química, estratificados por droga de escolha e por dependência única ou de múltiplas substâncias. Método: Todos os dados foram coletados na Santa Casa de São Paulo, Brasil. A amostra estudada correspondeu a todos os indivíduos dependentes de álcool ou outras substâncias admitidos no Ambulatório de Dependência Química entre novembro de 2013 e agosto de 2014. Modelos lineares generalizados com distribuição binomial foram utilizados para comparar o risco de escores maiores que seis na Escala de Rastreamento para Dependência de Sexo (SAST) nos subgrupos analisados. Resultados: Foram analisados os dados de 133 pacientes usuários de cocaína/crack e/ou álcool. Usuários de múltiplas substâncias apresentaram risco significativamente maior de um screening positivo para dependência sexual comparados com usuários de uma única substância. Os odds ratios de dependência sexual ajustados por sexo e idade obtidos nos dois grupos foram, respectivamente, 2.72 (IC95% 1.1-6.71) e 0.37 (IC95% 0.15-0.91). O risco de dependência sexual entre usuários de cocaína/crack e álcool foi estimado, respectivamente, em 0.38 (IC95% 0.14-1.02) e 2.67 (IC95% 0.98-7.25), não indicando diferença significativa. Foi encontrada uma relação significativa entre severidade de dependência química e maiores níveis de dependência sexual entre dependentes de cocaína/crack, mas não de álcool. Conclusão: Nosso estudo reforça a importância de avaliar o comportamento sexual de dependentes químicos na prática clínica, especialmente considerando usuários de múltiplas substâncias, ou casos de maior severidade.

randomized, double-blind, placebo - controlled study of safety of the adjunctive saffron on sexual dysfunction induced by a selective serotonin reuptake inhibitor

Recent studies have indicated potential of saffron for applying in a wide variety of diseases such as psychiatric and neurologic disorders. The concurrent use of saffron with SSRIs can lead to reducing the dose of SSRIs. Saffron at a dose of 200 mg may change some hematological and biochemical parameters. The goal of this trial was to assess the safety of concomitant administration of saffron and SSRI in patients with major depressive disorder [MDD]. Twenty adult outpatients between 18 to 55 years-old with the diagnosis of MDD who were receiving an SSRI for at least 1 month prior to the initiation of the study entered this double-blind trial. They were randomly assigned to receive capsule of saffron [15 mg twice daily] or placebo. Some laboratory parameters were measured at baseline and week 4 of the study. Other side effects checked on a prepared list of side effects, were systematically recorded throughout the study at baseline and on a weekly basis. Saffron as an add-on medication to SSRIs for 4 weeks did not cause any statistically significant changes in laboratory parameters including AST, ALT, ALP, BUN, Cr., FBS, TG, TC, WBC, RBC, Hgb, Ht, PT, INR, and Pl count. This preliminary study provides safety evidences of concurrent intake of saffron and SSRI

Antidepressant-Induced Sexual Dysfunction: A comparison between Duloxetine and Escitalopram.

Background: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) have the potential to produce delayed ejaculation in men, delayed orgasm or anorgasmia in women and decreased libido that is independent of the gender. The occurrence of medication-associated sexual dysfunction increases the likelihood of medication non-compliance (or non-adherence) in patients, which may contribute to untreated depression and/or disease relapse. Materials & Methods: 60 patients with diagnosis of Depressive episode (in remission at the time of study), divided into 2 groups of 30 patients taking Duloxetine and the remaining 30 patients taking Escitalopram, were recruited on consecutive basis from the patients attending Psychiatry OPD of Lady Hardinge Medical College (LHMC). Each subject was rated on Arizona Sexual Experience Scale (ASEX) and the results obtained were statistically analyzed. Results: In the present study the average ASEX score obtained in the Escitalopram group (12.63) was found to be more than that in Duloxetine group (12.36), though this difference was not found to be statistically significant. Conclusions: These results illustrate that antidepressant-induced sexual dysfunction is reported frequently by patients taking SSRIs or SNRIs. Our study did not find any significant difference between escitalopram and duloxetine with respect to their sexual dysfunction profile but in view of the limitations of our study there is need for further research in this domain of psychopharmacology.

Hiperprolactinemia y disfunción sexual en el primer episodio psicótico tratado con risperidona / Hiperprolactinaemia and sexual disfunction in first psychotic episode treated with risperidone

Hyperprolactinemia and Sexual dysfunction are frequent, yet seldom studied, complications of the use of risperidone Objectives: To determine the prevalence and clinical correlates of sexual dysfunctions and hyperprolactinemia in a sample of young people with schizophrenia treated with risperidone. Methods: 40 outpatients (19 females; mean age: 27 years) with schizophrenia treated with risperidone, participated in the study Sexual dysfunction and quality of life were assessed with the Massachusetts General Hospital Sexual Functioning Questionnaire (MGH-SFQ) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), respectively All patients were evaluated with the Positive and Negative Syndrome Scale and the UKU side effect rating scale. Blood samples were analyzed for prolactine. Results: Hyperprolactinemia was found in 90 percent of patients, with levels significantly higher in women. Sexual dysfunctions occurred in 25 (62.5 percent) patients. Patients with and without sexual dysfunction, did not significantly differ in gender, age or years of treatment. Although no association was found with prolactinemia or the dose of risperidone, patients with sexual dysfunction reported more psychic and neurologic side effects, and had higher scores in the negative symptoms and general psychopatology subscales of the PANSS and lower scores in the physical health and mood items of the Q-LES-Q. Conclusions: Results confirm the high prevalence of hyperprolactinemia and sexual dysfunctions in people with schizophrenia. Further study is warranted in order to clarify the association between sexual dysfunction and risperidone treatment in clinical practice and its impact in the quality of life of the patients.

La hiperprolactinemia y las disfunciones sexuales son complicaciones frecuentes, pero poco estudiadas del tratamiento con risperidona. Objetivos: Determinar la prevalencia de hiperprolactinemia y disfunciones sexuales en un grupo de personas jóvenes con esquizofrenia, tratadas con risperidona. Métodos: Un total de 40 pacientes (19 mujeres, edad promedio: 27 años) completaron el Cuestionario de Funcionamiento Sexual del Hospital General de Massachussets y el Cuestionario sobre Calidad de Vida: Satisfacción y Placer. Todos los pacientes fueron evaluados con las escalas PANSS y UKU y se determinó su nivel plasmático de prolactina. Resultados: El 90 por ciento de los pacientes presenta hiperprolactinemia, con valores significativamente más altos para las mujeres. El 62,5 por ciento de los pacientes, informó padecer alguna disfunción sexual, sin diferencias con la contraparte no afectada, en cuanto a género, edad ni tiempo de tratamiento. Aunque no se encontró relación con la prolactinemia, ni con la dosis de risperidona, quienes reportaron alguna disfunción sexual obtuvieron mayores puntajes de efectos adversos psíquicos y neurológicos en la escala UKU. Las disfunciones sexuales se asociaron con los síntomas negativos y generales de la PANSS y con menores puntajes en las subescalas de salud física y ánimo del Cuestionario sobre Calidad de Vida: Satisfacción y Placer. Conclusiones: Los resultados confirman la elevada frecuencia de disfunciones sexuales e hiperprolactinemia en las personas enfermas de esquizofrenia. Nuevos estudios se requieren para clarificar, en la práctica clínica habitual, la asociación entre disfunción sexual y el empleo de la risperidona, y su impacto en la calidad de vida de los pacientes.

Antidepresivos y disfunción sexual / Antidepressants and sexual disfunction

The purpose of this work is to check the existing information in literature about the relationship between antidepressant medication and sexual dysfunctions, in order to optimize the selection of a therapeutical plan that avoids these side effects. A method of manual revision of the publications related to the topic was used utilizing the data bases available. Results: tricycles are the drugs that present the most undesired symptoms in the sexual area; the reversible IMAO compromise the sexuality in a minor way, in comparison to classical IMAO s, but they have less antidepressant effectiveness; SSRIs and venlafaxine involve the sexual response in all its phases; bupropion, nefaxodone and mirtazapine are the safest drugs in this respect; according to animal samples, various neurotransmitters, hormones and endogens opioids are directly or indirectly involved in the sexual response of antidepressants; the finding of new drugs with different action profiles has allowed amplifying the alternatives for treatment. This knowledge permits the establishment of better decision taking in the management and monitoring of these unwanted side effects.

El objetivo de este trabajo es revisar la información en la literatura sobre la relación entre la medicación antidepresiva y las disfunciones sexuales, con la finalidad de optimizar la elección de un esquema terapéutico que evite estos efectos secundarios. Se utilizó un método de revisión anual de las publicaciones relacionadas con el tema en diversas bases de datos disponibles. Resultados: los triciclicos son los fármacos que presentan mayores síntomas adversos en la esfera sexual; los IMAO reversibles si bien comprometen en menor forma la sexualidad en comparación con los irreversibles, poseen una menor eficacia antidepresiva; ISRS y venlafaxina comprometen la respuesta sexual en todas sus fases; Bupropion, nefazodona, mirtazapina se constituyen como los fármacos más seguros respecto, según modelos animales diversos neurotransmisores, hormonas y opiodes endógenos están involucrados de forma directa o indirecta sobre la respuesta sexual de los antidepresivos; La aparición de nuevos fármacos con distintos perfiles de acción ha permitido contar con un mayor número de alternativas de tratamiento cuyo conocimiento permite establecer conductas útiles en el manejo y monitorización de estos efectos adversos.

Tratamento das disfunçöes sexuais conseqüentes ao uso de antidepressivos / Sexual dysfunction treatment as a complication of antidepressives use

A disfunçao sexual é um dos efeitos adversos, mais freqüentes, induzidos pelo uso de antidepressivos. Diminuiçao da libido, disfunçao erétil, alteraçoes do orgasmo e da ejaculaçao, dor, anestesia vaginal e peniana sao relatos mais comuns. Estratégias para reverter a disfunçao sexual induzida pelos antidepressivos sao usadas com freqüência, entre elas destacam-se: tempo de tolerância para o desenvolvimento, reduçao da dosagem, suspensao do tratamento no final da semana, troca do antidepressivo ou o acréscimo de um novo medicamento. A escolha para que se proceda uma destas intervençoes dependerá das queixas do paciente.

Disfunçäo sexual associada ao uso de antidepressivos / Sexual dysfunction associated with antidepressant therapy

A disfunçÝo sexual é um efeito colateral bastante conhecido relacionado ao uso de antidepressivos. Noventa pacientes em uso de vários antidepressivos foram avaliados. Observou-se que a maioria dos casos nÝo cumpriam seus programas terapêuticos devido à disfunçÝo sexual. As principais alteraçSes encontradas foram diminuiçÝo da libido, retardo ou inibiçÝo da ejaculaçÝo, inibiçÝo do orgasmo, disfunçÝo erétil e orgasmo doloroso