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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00842

Attitudes of Italian psychiatrists towards the evaluation of physical comorbidities and sexual dysfunction in patients with schizophrenia. Implications for clinical practice

  • 1Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry 'Salernitan Medical School', University of Salerno, Italy
  • 2San Martino Hospital (IRCCS), Italy
  • 3Clinical and Experimental Medicine Unit, Department of Medicine and Surgery, University of Parma, Italy
  • 4School of Medicine and Surgery, University of Milano Bicocca, Italy
  • 5Department of Molecular Medicine and Development, University of Siena, Italy
  • 6Department of Neurosciences Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
  • 7Department of Systems Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Italy
  • 8Department of Neuroscience, School of Medicine, University of Turin, Italy
  • 9University of L'Aquila, Italy
  • 10Department of Clinical and Experimental Sciences, University of Brescia, Italy

Treatment guidelines for patients with schizophrenia recommend evaluating their risk of physical comorbidities, especially since these patients are known to have decreased life expectancy due to comorbidities. Therefore, to the authors’ knowledge, this is the first national survey conducted to investigate how Italian psychiatrists deal with the risk of physical comorbidities and sexual dysfunction in patients with schizophrenia. A sample of 750 psychiatrists completed an ad hoc online survey investigating their decision making about performing blood tests, clinical and instrumental examinations, and scheduling follow-up appointments in relation to the different phases of the illness and possible pharmacological side effects. Compared to patients in therapeutic continuation, those diagnosed for the first time and those who received a therapeutic change were visited more frequently (every 15 to 17 days vs. every 40 days, respectively), and were more regularly prescribed blood tests and instrumental examinations (every 4.2 to 4.4 months vs. every 9 months, respectively). There was a high interest in the surveillance of cardiometabolic risk. In 54% of patients, prolactin testing was not requested before starting an antipsychotic. In terms of specialist referrals, only 5% of surveyed psychiatrists “never” sought for additional counselling. There was little attention given to sexual functioning assessment based on the survey results about patients’ daily life and with regard to deciding to prescribe additional examinations. In fact, only up to 3% of psychiatrists reported assessing sexual functioning using specific psychometric tests.

In summary, this survey describes Italian psychiatrists as careful healthcare providers for the physical illnesses of patients with schizophrenia but with several shortcomings. For instance, clinical attention towards patients’ sexual and reproductive healthcare needs remains a challenge.

Psychiatrists should take the lead for the integrated education, assessment, and care of medical needs of their patients with mental illness. Based on the results of this survey, the authors also believe that a future challenge for the management of patients with mental illness will be the classification of patients based on their risk of comorbidities, to help ensure optimal healthcare provision for those at greater risk of other illnesses.

Keywords: Schizophrenia, Physical comorbidities, Sexual dysfunction, Cardiometabolic risk, antipsychotic, Prolactin, psychometric test, Survey

Received: 02 Aug 2019; Accepted: 23 Oct 2019.

Copyright: © 2019 Monteleone, Amore, Cabassi, Clerici, Fagiolini, Girardi, Jannini, Maina, Rossi, Vita and Siracusano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Palmiero Monteleone, Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry 'Salernitan Medical School', University of Salerno, Salerno, Italy, pmonteleone@unisa.it