Table 1.
Studies inserted in the review analysis about the sexuality in ultra-high risk for psychosis and first-episode psychosis.
| References | Psychiatric condition | Design of the study | Sample size | Tools and measures | Main findings | |
|---|---|---|---|---|---|---|
| Sexual behavior measures | Other psychiatric measures | |||||
| Adan Sanchez et al. (23) | UHR | Cross-sectional | 103 | Items relating to sexual risk behavior | Brief Psychiatric Rating Scale (BPRS) | Young people with mental disorders reported major sexual risk behaviors and also a relevant frequency of sexually transmitted infections (STIs). The contraceptive methods use are few, and also the most of pregnancy is unplanned. |
| Appiah-Kusi et al. (24) | UHR | Case-control | 68 | N/A | Childhood Trauma Questionnaire (CTQ); Beck Depression Inventory (BDI); State-Trait Anxiety Inventory (STAI); Cannabis Experience Questionnaire (CEQ); Paranoid Thought Scales (PTS); Psychosis Screening Questionnaire (PSQ) | The 21% of UHR patients assessed had been exposed to sexual abuse. On the whole, this study confirmed the pathogenetic role of childhood trauma in the development of psychosis. Moreover, major negative self-schemas were found in UHR patients compared to healthy controls. |
| Bechdolf et al. (25) | UHR | Cross-sectional | 92 | Comprehensive Assessment of At-Risk Mental States (CAARMS); General Trauma Questionnaire (GTQ) | UHR patients with past sexual trauma have a major risk to develop psychosis. About one-quarter of UHR patients had a history of sexual abuse. Sexual trauma in the UHR population is, therefore, a predictive factor for the conversion in FEP and frank psychosis. | |
| Dragt et al. (26) | UHR | Cross-sectional | 72 | N/A | Basic Data Form (BDF); Client Service Receipt Inventory (CSRI); Premorbid Adjustment Scale (PAS) | Social–sexual aspects together with the social–personal adjustment were the best predictors for developing a first psychotic episode in the assessed UHR group. |
| Egerton et al. (27) | UHR | Case-control | 67 | Childhood Experience of Care and Abuse Questionnaire (CECA-Q) | Comprehensive Assessment of At-Risk Mental States (CAARMS); Positive and Negative Syndrome Scale (PANSS); Hamilton Depression and Anxiety Rating Scales; Positron Emission Tomography (PET). | Among childhood adversities, only sexual and physical abuse was found with a higher prevalence in the UHR group compared to the healthy control. Subjects with experiences of physical or sexual abuse in childhood show higher dopamine function in the associative striatum. |
| Marques et al. (28) | UHR | Case-control | 124 | Sexual Function Questionnaire (SFQ) | Positive and Negative Syndrome Scale (PANSS); Calgary Depression Scale | UHR people then converted into psychotic patients primarily revealed a great sexual impairment, as sexual dysfunctions, compared to UHR individuals no developed psychosis. |
| Rapado-Castro et al. (29) | UHR | Cross-sectional | 62 | N/A | Comprehensive Assessment of At-Risk Mental States (CAARMS); Scale for the Assessment of Negative Symptoms (SANS); Brief Psychiatric Rating Scale (BPRS); Hamilton Rating Scale for Depression (HRSD); Global Assessment of functioning Scale (GAF); Quality of Life Scale (QLS); Adult Intelligence Scale-Revised (WAIS-R); Wechsler Abbreviated Scale of Intelligence (WASI); Intelligence Scale for Children (WISC-III); Childhood Trauma Questionnaire (CTQ); magnetic resonance imaging (MRI) | UHR patients with experiences of sexual abuse show reductions in prefrontal and temporal brain regions, highlighting a particular morphological vulnerability of superior prefrontal and temporal structures to sexual trauma. Sexual abuse, inducing a reduction of cortical thickness in the right middle temporal gyrus, has an indirect effect on the transition to psychosis. |
| Sahin et al. (30) | UHR | Case-control | 193 | N/A | Brief Psychiatric Rating Scale (BPRS); Scale for the Assessment of Negative Symptoms (SANS); Scale for the Assessment of Positive Symptoms (SAPS) | In UHR females the scores for the sexual abuse of CTQ were significantly higher than in males and in the overall group. The sexual abuse was related to positive symptoms. Moreover, the UHR group |
| Trauma Questionnaire (CTQ); Calgary Depression Scale for Schizophrenia (CDSS). | showed higher scores at sexual abuse compared to healthy controls. Overall, childhood trauma is a predictive factor related to both patients with UHR and first-episode schizophrenia. | |||||
| Schmidt et al. (31) | UHR | Cross-sectional | 73 | N/A | Structured Interview for Psychosis-Risk Syndromes (SIPS); Trauma And Distress Scale (TADS); German Stress-Coping-Questionnaires; German Competence and Control Beliefs Questionnaire (FKK); Beck Depression Inventory (BDI-II); Mini International Neuropsychiatric Interview in its version for adults (MINI)-suicidality scale. | The 21.5% of CHR patients reported sexual abuse and this aspect is inserted in the relationship between traumatic experience and suicidality. Moreover, sexual abuse is correlated with the major use of dysfunctional coping strategies. On the whole, sexual abuse has resulted related to suicidal ideation in CHR patients. |
| Thompson et al. (32) | UHR | Cross-sectional | 93 | N/A | Comprehensive Assessment of At-Risk Mental States (CAARMS) | Being watched in the shower/toilet or undressing were more frequent sexual delusions relived in UHR people. These delusion types in UHR are often related to a history of sexual trauma. |
| Thompson et al. (33) | UHR | Cross-sectional | 416 (233) | N/A | Childhood Trauma Questionnaire (CTQ); Comprehensive Assessment of At-Risk Mental States (CAARMS); Brief Psychiatric Rating Scale (BPRS); Global Assessment of Functioning (GAF); Schedule for the Assessment of Negative Symptoms; Hamilton Rating Scale for Depression; Quality of Life Scale. | Females with UHR showed a higher score to CTQ for sexual abuse and physical abuse and in the overall sample the sexual abuse is related to the transition to psychosis. Therefore, past sexual trauma is the main risk factor to develop a frank psychosis in the UHR population, suggesting clinicians to investigate the sexual abuse experiences in people at risk of severe mental disorders. |
| Üçok et al. (34) | UHR | Cross-sectional | 53 | N/A | Brief Psychiatric Rating Scale (BPRS); Global Assessment of Functioning (GAF); Scale for the Assessment of Negative Symptoms (SANS); the Scale for the Assessment of Positive Symptoms (SAPS); the Childhood Trauma Questionnaire (CTQ); the Calgary Depression Scale for Schizophrenia (CDSS) and neuropsychological tests. | Patients with a history of physical trauma performed worse in attention, interference inhibition, working memory, and cognitive flexibility tests than individuals without physical trauma. However, no differences between subjects with and without a history of childhood emotional/sexual trauma were found in terms of cognitive performance |
| Velthorst et al. (35) | UHR | Case-control | 127 | N/A | Comprehensive Assessment of At-Risk Mental State (CAARMS). | A major association between female gender and sexual abuse was found in UHR patients. Moreover, sexual abuse was related to post-traumatic stress disorder symptoms and perceptual disturbance with sexual contents. |
| Ajnakina et al. (36) | FEP | Retrospective study | 236 | Childhood Experience of Care and Abuse Questionnaire (CECA-Q) | Positive and Negative Syndrome Scale (PANSS) | Childhood sexual abuse, physical abuse, and parental separation had a significant association with positive dimensions. |
| Bendall et al. (37) | FEP | Cross-sectional | 28 | Childhood Trauma Questionnaire (CTQ) | Positive and Negative Syndrome Scale (PANSS); Impact of Events Scale-Revised (IES-R); National Adult Reading Test (NART) | FEP patients who suffered a sexual abuse presented more positive and depressive symptoms, more severe delusions and hallucinations compared to their counterparts |
| Braehler et al. (38) | FEP | Cross-sectional | 171 | Childhood Trauma Questionnaire (CTQ); | Dissociative Experiences Scale (DES) | Severe childhood trauma is associated with greater dissociative symptoms, with emotional abuse showing the greatest association with dissociation |
| Brown et al. (39) | FEP | Cross-sectional | 115 | Broad indicators of sexual risk behavior were either developed or adapted from Visser and Smith (40) | Brief Psychiatric Rating Scale, Expanded Version (BPRS-E) | Increased frequency of unprotected sex in people with FEP suggests that those with psychosis are at increased STI risk and have distinct needs |
| Brown et al. (41) | FEP | Cross-sectional | 112 | Patient-reported questionnaire on sexual behavior | Kessler 10 Psychological Distress Scale; Rosenberg Self-Esteem Scale; Multidimensional Scale of Perceived Social Support; Opiate Treatment Index | Increased probability of inconsistent condom use was associated with clinical status, younger age, unemployment, and the absence of peer support for condom use. |
| Brown et al. (42) | FEP | Cross-sectional | 112 | Patient-reported questionnaire on sexual behavior; | Kessler 10 Psychological Distress Scale; Rosenberg Self-Esteem Scale; Multidimensional Scale of Perceived Social Support; Opiate Treatment Index; | Inconsistent condom use was predicted by clinical status, unemployment, and the absence of peer support for condom use. |
| Conus et al. (43) | FEP | Case-control | 658 | N/A | Early Psychosis File Questionnaire; EPFQ | |
| Ciocca et al. (44) | FEP | Cross-sectional | 77 | Udvalg for Kliniske Undersøgelser (UKU); | Positive and Negative Syndrome Scale (PANSS) | Correlation between sexual dysfunctions and psychopathology did not reveal any association in males. On the other hand, in females, general psychopathology and positive symptoms were linked to the alteration in vaginal lubrication. |
| Ciufolini et al. (45) | FEP | Cross-sectional | 302 | Childhood Experience of Care and Abuse Questionnaire (CECA-Q); cortisol saliva levels | N/A | Divergent effect of severe childhood abuse on HPA axis activity in patients with FEP and controls, with FEP showing a reduced cortisol awakening response and a less reactive HPA axis. |
| Del Cacho et al. (46) | FEP | Cross-sectional | 118 | Changes in Sexual Function Questionnaire (CSFQ); hormone blood levels | Positive and Negative Syndrome Scale (PANSS) | Evidence of better sexual function in healthy controls compared to patients with FEP. No association between both prolactin and testosterone and sexual function. |
| El Sayed El Taweel et al. (47) | FEP | Cross-sectional | 50 | Arizona Sexual Experience Scale (ASEX); designed questionnaire | Mini International Neuropsychiatric Interview (MINI); Positive and Negative Syndrome Scale (PANSS); the Montgomery–Asberg Depression Scale (MADRS) | Male patients with FEP reported significantly more sexual dysfunctions compared to controls. A statistically significant correlation was seen between the long duration of untreated psychosis, the severity of negative symptoms, and depressive symptoms with the severity of sexual dysfunction among patients with schizophrenia. |
| Gaber et al. (48) | FEP | Cross-sectional | 80 | International Index of Erectile Function (IIEF-5) | N/A | Males with FEP are more likely to develop erectile dysfunction (ED); the duration of untreated psychosis also leads a higher incidence of ED and hyperprolactinemia. |
| Hui et al. (49) | FEP | Cross-sectional | 343 | Udvalg for Kliniske Undersøgelser (UKU); | Scale for the Assessment of Positive Symptoms (SAPS); Scale for the Assessment of Negative Symptoms (SANS); Role Functioning Scale (RFS); | Sexual dysfunction was significantly and independently associated with being married, more general side effects, poorer functioning, and higher monthly income |
| Malik et al. (50) | FEP | Randomized controlled trial | 498 | Udvalg for Kliniske Undersugelser (UKU) | Positive and Negative Syndrome Scale (PANSS); St Hans Rating Scale | Only mild differences in sexual dysfunctions were seen among five antipsychotics groups, underscoring the role of the disease itself on the onset of these adverse effects. |
| Misiak et al. (51) | FEP | Cross-sectional | 141 | Childhood Experience of Care and Abuse Questionnaire (CECA-Q) | Positive and Negative Syndrome Scale (PANSS); the Montgomery–Asberg Depression Rating Scale (MADRS); the Young Mania Rating Scale (YMRS); the Global Assessment of Functioning (GAF) | FKBP5 gene methylation is significantly lower in FEP compared to controls. In particular, patients with parental apathy and sex abuse had significantly lower levels of FKBP5 methylation. |
| Ravichandran et al. (52) | Drug-naïve patients with psychosis | Cross-sectional | 100 | International Index of Erectile Functioning (IIEF) | Positive and Negative Syndrome Scale (PANSS) | Sexual dysfunction may be found in patients with psychotic disorders before starting their pharmacotherapy. |
| Reininghaus et al. (53) | FEP | Cross-sectional | 147 | N/A | Experience sampling method (ESM) | Elevated sensitivity to minor stressful events and enhanced threat anticipation are associated with more psychotic experiences. |
| Theleritis et al. (54) | FEP | Cross-sectional | 239 | Childhood Experience of Care and Abuse Questionnaire (CECA-Q); Brain-derived Neurotrophic Factor (BDNF) plasmatic levels | N/A | Significant effect of separation, physical, and sexual abuse on Brain-derived Neurotrophic Factor (BDNF), with patients with a history of sexual trauma showing lower plasmatic levels of Brain-derived Neurotrophic Factor (BDNF). |
| Theleritis et al. (55) | FEP | Cross-sectional | 116 | Sexual Function Questionnaire (SFQ); weight; BMI; waist; waist-hip ratio; hormone blood levels | Positive and Negative Syndrome Scale (PANSS); Calgary Depression Score (CDS) | Results showed a correlation of higher SFQ and higher BMI, leptin levels, waist-hip ratio, and lower testosterone levels |
| Tomassi et al. (56) | FEP | Cross-sectional | 345 | Childhood Experience of Care and Abuse Questionnaire (CECA-Q) | Cannabis Experiences Questionnaire (CEQ) | Sexual abuse was associated with a diagnosis of affective psychosis and higher rates of cannabis and heroin abuse; physical abuse was associated with lifetime use of heroin. |
| van Bruggen et al. (57) | FEP | Cross-sectional | 40 | Questionnaire for Sexual Dysfunction (QSD); hormone blood levels | Positive and Negative Syndrome Scale (PANSS) | Patients reported a significantly higher frequency of problems with ejaculation and problems with insensibility of genitals compared to controls. However, no relation between medication, hormonal levels, frequency of sexual activity, overall satisfaction with sexuality, and any of all sexual dysfunctions was found. |