Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 108033

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : VC11 - VC14 Full Version

A Case-control Study of Sexual Dysfunction and Serum Prolactin Levels in Patients with Psychotic Disorders

Published: May 1, 2022 | DOI:
Mohd Rashid Alam, Pali Rastogi, Rahul Mathur, Vijay Niranjan

1. Resident Medical Officer, Department of Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India. 2. Associate Professor, Department of Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India. 3. Assistant Professor, Department of Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India. 4. Assistant Professor, Department of Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India.

Correspondence Address :
Dr. Vijay Niranjan,
E-2 Quarter, Mental Hospital Campus, Banganga, Indore, Madhya Pradesh, India.


Introduction: Sexual functioning has remained widely neglected aspect of patient care for those suffering from severe mental disorders and has received little attention. Yet, it has been construed as one of the major factors contributing to non-adherence with antipsychotic medications.

Aim: To study sexual dysfunction in patients with psychotic disorders and its clinical association with serum prolactin levels.

Materials and Methods: This case-control study was conducted in the Department of Psychiatry at MGM Medical College and associated Mental Hospital, Indore, Madhya Pradesh, India, from 13th February 2020 to 21st January 2021. The study sample consisted of 200 subjects including 100 cases and 100 controls. The case group included patients with a diagnosis of psychotic disorders currently in remission for atleast one month. Remission of the patients was ensured by Brief Psychiatric Rating Scale (BPRS) with a score of <4 on all items and <28 total score. Assessment of sexual dysfunction was done using Arizona Sexual Experience Scale (ASEX). The control group included healthy subjects aged between 18-65 years, either sex having active sexual partners with a score of <3 on all the items of the General Health Questionnaire (GHQ-12). Collection of blood sample was done and serum was analysed for prolactin levels using the Chemiluminescent Microparticle Immunoassay (CMIA) method. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 28.0 for windows.

Results: The mean age of the case group was 39.9±7.457 years while that of the control group was 35.60±9.37 years. The number of male patients (71% and 73%) was higher than females (29% and 27%) in the control group and case group respectively. The difference between the two were statistically significant. The total number of cases who experienced sexual dysfunction came out to be 59 out of 100. Total 55.93% of those having sexual dysfunction were suffering from difficulty in sexual arousal, followed by difficulty with penile erection/vaginal lubrication (49.15%), orgasmic dysfunction (34.48%), and reduced sexual drive (23.72%). Among the cases, the mean serum prolactin level (14.14±10.60 ng/mL) was seen to be significantly higher (p-value <0.001) than the control group (9.46±6.05 ng/mL). Maximum serum prolactin level (29.00±9.95 ng/mL) was seen to be associated with usage of a combination of both 1st and 2nd generation antipsychotics.

Conclusion: There was a significant prevalence of sexual dysfunction in psychotic patients and is associated significantly with elevated serum prolactin levels.


Antipsychotics, Arousal, Hyperprolactinaemia, Schizophrenia

Psychotic disorders comprise of a variety of clinical diagnosis including schizophrenia, schizoaffective disorder, other functional psychoses and schizotypal personality disorder. Psychotic disorders are associated with significant morbidity, disability and impaired quality of life (1). Sexual dysfunction among patients with psychosis could be a symptom of the psychiatric disorder, side effect of psychotropic medication, or can be related to psychiatric co-morbidities, especially depression and substance abuse (2). In particular, sexual dysfunction affects 30-80% of patients with schizophrenia and is much more prevalent in comparison to the general population (3).

Treatment related sexual adverse effects in psychotic disorders are partially mediated by antagonism of pituitary D2 receptors thereby increasing secretion of prolactin. Hyperprolactinaemia can lead to reduced testosterone levels, in turn causing disruption of the normal functioning of the hypothalamic-pituitary-gonadal axis. This may further manifest as amenorrhea, infertility, gynaecomastia, galactorrhea, decreased libido, erectile dysfunction and anorgasmia (4). Though, sexual dysfunction can happen with any antipsychotic, significant differences exist amid different drugs (5),(6).

Sexual functioning has received little consideration as an important aspect of patient care for those suffering from severe mental disorders. Yet, it has been implicated as one of the major factors contributing to non compliance with antipsychotic medications. Also, people with schizophrenia recognise management of sexual dysfunction to be a major unmet need (6).

Only a few of the studies. have tried to address sexual dysfunction associated with antipsychotic use, however biological parameter like serum prolactin was not included in them (7),(8),(9),(10). Hence, the present study was conducted with an aim to study sexual dysfunction in patients with psychotic disorders and its clinical association with serum prolactin levels.

Material and Methods

This case-control study was conducted in the Department of Psychiatry at MGM Medical College and associated Mental Hospital, Indore, Madhya Pradesh, India, from 13th February 2020 to 21st January 2021. Ethics Committee (IEC approval number-EC/MGM/Feb-20/62) approval was obtained.

Sample size calculation: The study sample consisted of 200 subjects including 100 cases and 100 controls calculated as per the prevalence of psychotic disorders in India (3/1000 individuals) (11).

Sample size was calculated using the formula

n=4 pq/d2,

where confidence interval=95%; Margin of error=1.

Inclusion criteria:

For cases:

• Patients aged between 18-65 years, with the diagnosis of psychotic disorders currently in remission for at least one month which included schizophrenia, psychosis not otherwise specified, acute transient psychotic disorders, persistent delusional disorder as per International Classification of Diseases 10th revision (12).
• Patients were on continuous antipsychotic treatment (1st generation/2nd generation/combination) for at least last three months.
• Remission of patient was defined using Brief Psychiatric Rating Scale (BPRS) with a score <4 on all items and <28 total score (13).

For controls:

• Controls were healthy subjects free of any psychiatric illness, general medical condition, or a history of a surgical procedure known to cause sexual dysfunction.
• Subjects were aged between 18-65 years, either sex having active sexual partners and a score of <3 on all the items of General Health Questionnaire-12 (14).

Exclusion criteria for cases and controls:

• Menopausal, pregnant and lactating women were excluded from the study.
• Patients were excluded if they had other co-morbid psychiatric illness, substance abuse, a general medical condition or a history of a surgical procedure known to cause sexual dysfunction.
• Other exclusions were patients taking medications known to affect sexuality and patients with primary sexual dysfunction prior to the onset of psychotic disorders.

Study Procedure

After a complete description of study to the subjects, a detailed physical examination was done to rule out major medical or neurological illnesses. Socio-demographic data was collected. After that clinical assessment of case group was done using BPRS (13). to ensure remission and sexual functioning was assessed using Arizona Sexual Experience Scale (ASEX) (15). Assessment of the control group was done by GHQ-12 questionnaire to rule out any mental disorder (14).

Brief Psychiatric Rating Scale (BPRS): The BPRS was used for ensuring remission in cases of psychosis. BPRS is a clinician-administered rating scale for assessing the positive, negative and affective symptoms of individuals having psychotic disorders. The BPRS includes the 18 items associated with positive symptoms, negative symptoms and mood. For each item, the rater enters a number ranging from 1 (not present) to 7 (extremely severe). The BPRS is scored by adding together the scores from the individual items, with higher scores indicating more severe pathology. In the present study, all the cases had a score of <4 on all items and <28 total score (13),(16).

General Health Questionnaire-12 (GHQ): The GHQ-12 was used to rule out any psychiatric disorder in control group. The GHQ-12 is a self-administered screening questionnaire, designed for detecting individuals with a diagnosable psychiatric disorder (14). The positive items were corrected from 0 (always) to 3 (never) and the negative ones from 3 (always) to 0 (never). The total score ranges from 0-36 and higher scores indicate worse health. A score of 2 or less indicates an absence of a mental disorder and a score of 3 or more indicates the presence of disorder (14).

Arizona Sexual Experience Scale (ASEX): The ASEX scale designed to measure five item identified as core elements of sexual function:

• Sexual drive
• Arousal
• Penile erection/vaginal lubrication
• Ability to reach orgasm
• Satisfaction from the orgasm

The items are rated on a 6 point scale ranging from 1 (hyperfunction) to 6 (hypofunction), possible total scores range from 5-30 with higher scores indicating more sexual dysfunction. The scale has two versions, one for males and one for females, with a difference in question three that references penile erections versus vaginal lubrication (15).

A 5 mL blood samples of all groups were drawn after explaining the procedure and were collected in a clot activator (red top) tube. Post which serum was processed from the sample via centrifuge machine and the serum was analysed for prolactin levels using the Chemiluminescent Microparticle Immunoassay (CMIA) method. Reference range was 2.1-17.7 ng/mL for male and 2.8-29.2 ng/mL for female.

Statistical Analysis

Student’s t-test was applied to compare mean age and serum prolactin values between case and control group, Chi-square test to compare gender, marital status and locality between case and control group. Pearson’s correlation test was used for assessment of correlation between serum prolactin values and total ASEX score. Analysis of Variance (ANOVA) was used to see association between class of drugs and serum prolactin values. Results were analysed using SPSS version 28.0.


The mean age of the case group was 39.9±7.457 years while that of the control group was 35.60±9.37 years. The number of male patients (71% and 73%) was higher than females (29% and 27%) in the control group and case group respectively (Table/Fig 1).

Total number of cases who experienced sexual dysfunction as per specified criteria of ASEX scale were 59 (59%). It was observed that 55.93% of those having sexual dysfunction were suffering from difficulty in sexual arousal (Table/Fig 2).

Among the cases, the mean serum prolactin level (14.14±10.60 ng/mL) was seen to be significantly higher than control group (9.46±6.05 ng/mL) (Table/Fig 3). Serum prolactin values were significantly higher (18.71±11.45 ng/mL) in patients with sexual dysfunction as compared to those without sexual dysfunction (7.57±3.60 ng/mL) (Table/Fig 4).

On applying pearson correlation for the total ASEX score and serum prolactin values, there was moderate correlation between the two, with an r-value of 0.4 which was statistically significant (p-value <0.05) (Table/Fig 5).

Maximum serum prolactin level was seen to be associated with usage of combination of both 1st and 2nd generation of drugs (29.00±9.95 ng/mL). This was followed by 1st generation (13.54±10.34 ng/mL) and 2nd generation (9.19±3.32 ng/mL) of drugs respectively. The difference in means was seen to be highly statistically significant with p-value of <0.001 (Table/Fig 6).


In present study, the mean age of the case group was 39.9±7.45 years while that of the control group was 35.60±9.37 years which is in concordance of Rosenberg KP et al., who found the mean age in psychotic cases to be 36 years and Montejo A et al., who found the mean age to be 34.6 years for males and 33.5 for females (8),(9).

The number of male subjects was higher in both case and control groups (73% and 71% respectively) which is in agreement with Montejo A et al., but higher than that in Rosenberg KP et al., (8),(9). The current trend is due to differences in health-seeking patterns among the male and female population of India, where males reach out for help easily as compared to females and also in a developing country like India, females are mostly unaware of sexual issues and are hesitant to speak out owing to the stigma surrounding sexual health.

Most participants in both the case (90%) and control (85%) groups were married. The proportion of married participants was higher than in most of the previous studies (9),(10),(12). The finding is consistent with the fact that only subjects having sexual partners were included in the study group which usually corresponds to a married status concerning the socio-cultural background of India. Apart from this, the mean age of study participants was 39.9 and 35.6 (years) in the case and control group respectively which explains the married status of the majority of participants.

It was found that 59% of cases had sexual dysfunction of some kind, similar results were found by Kelly DL and Conley RR, with sexual dysfunction ranging from 50-80% in the psychotic population (17). The total number of cases with sexual dysfunction was 59, few patients had more than one type of sexual dysfunction together. About 55.93% of those having sexual dysfunction were suffering from difficulty in sexual arousal. This was followed by difficulty with penile erection/vaginal lubrication (49.15%), orgasmic dysfunction (34.48%) and reduced sexual drive (23.72%). The present study findings were consistent with Ravichandran D et al., Kantipudi SJ et al., and Ucok A et al., who also observed difficulty in sexual arousal and erectile dysfunction to be in the greater majority (18),(19),(20).

On further evaluation within the case group, we found higher mean serum prolactin values in patients with psychosis having sexual dysfunction (18.7 ng/mL) than those without sexual dysfunction (7.5 ng/mL) and was statistically significant (p-value <0.001). This finding is corroborated by Düring SW et al., in patients with schizophrenia (21).

On applying the Pearson’s correlation between serum prolactin and ASEX score, we found a moderate correlation (r-value=0.4) between the two which was statistically significant (p-value=0.001). This finding is corroborated by various studies like Wu TH et al., and can be explained by the physiological antagonism of dopamine and prolactin (22). The secretion of prolactin is under direct inhibitory control of dopamine neurons located in the tuberoinfundibular region of the hypothalamus and is, therefore, increased by the dopamine blocking action of antipsychotic medications, causing hyperprolactinaemia and in turn sexual dysfunctions (3),(10),(23).

Maximum serum prolactin level was seen to be associated with the usage of a combination of both 1st and 2nd generation of drugs (29.00±9.95 ng/mL), followed by 1st generation (13.54±10.34 ng/mL) and 2nd generation (9.19±3.32 ng/mL) of drugs respectively. The difference in means was seen to be highly statistically significant with a p-value <0.001. The higher serum prolactin level and greater ASEX score in patients taking FGA and combination drugs of FGA and SGA can be explained by strong D2 blockade and rise of prolactin levels leading to greater dysfunction. Secondarily, the low sexual desire could be due to the negative symptoms of psychosis which are not that efficiently targeted by FGAs (24).


The topic of the study was sensitive and some respondents may have been reluctant to discuss their true concerns. Also, this was not a longitudinal study, and there were no measurements of the effects of illness on sexual functioning before medication treatment.


In the present study there was a significant prevalence of sexual dysfunction in psychotic patients with difficulty in sexual arousal and erectile dysfunction being most common. Also, raised serum prolactin levels were found to be significantly associated with sexual dysfunction.


Jongsma HE, Turner C, Kirkbride JB, Jones PB. International incidence of psychotic disorders, 2002-17: A systematic review and meta-analysis. The Lancet Public Health. 2019;4(5):e229-44. Available from: [crossref]
Dervaux A, El Omari F. Sexual dysfunction in schizophrenics patients, the role of antipsychotics. Presse Med. 2005;34(7):529-32. [crossref]
Baggaley M. Sexual dysfunction in schizophrenia: Focus on recent evidence. Hum Psychopharmacol. 2008;23(3):201-09. [crossref] [PubMed]
Haddad PM, Wieck A. Antipsychotic-induced hyperprolactinaemia: Mechanisms, clinical features and management. Drugs. 2004;64(20):2291-314. [crossref] [PubMed]
Lambert M, Naber D. Current issues in schizophrenia: Overview of patient acceptability, functioning capacity and quality of life. CNS Drugs. 2004;18(Suppl 2):05-17. [crossref] [PubMed]
Perkins DO. Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry. 2002;63(12):1121-28. [crossref] [PubMed]
Nagaraj AKM, Pai NB, Rao S. A comparative study of sexual dysfunction involving risperidone, quetiapine, and olanzapine. Indian J Psychiatry. 2009;51(4):265-71. [crossref] [PubMed]
Rosenberg KP, Bleiberg KL, Koscis J, Gross C. A survey of sexual side effects among severely mentally ill patients taking psychotropic medications: Impact on compliance. J Sex Marital Ther. 2003;29(4):289-96. [crossref] [PubMed]
Montejo A, Majadas S, Rico-Villademoros F, Llorca G, De La Gandara J, Franco M, et al. Frequency of Sexual Dysfunction in Patients with a Psychotic Disorder Receiving Antipsychotics. J Clin Med. 2010;7:3404-13. [crossref] [PubMed]
Park YW, Kim Y, Lee JH. Antipsychotic-Induced Sexual Dysfunction and Its Management. World J Mens Health. 2012;30(3):153-59. Available from: [crossref] [PubMed]
Loganathan S, Murthy RS. Living with schizophrenia in India: Gender perspectives. Transcultural psychiatry. 2011;48(5):569-84. Available from: [crossref] [PubMed]
World Health Organisation. (1992). ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva. World Health Organisation.
Hunter EE, Murphy M, Kreutzer JS, DeLuca J, Caplan B (eds.), "Brief Psychiatric Rating Scale", Encyclopedia of Clinical Neuropsychology, New York, NY: Springe. 2011;447-49. Doi: 10.1007/978-0-387-79948-3_1976, ISBN 978-0-387-79948-3, retrieved 2021-03-02. [crossref]
Qin M, Vlachantoni A, Evandrou M, Falkingham J. General Health Questionnaire-12 reliability, factor structure, and external validity among older adults in India. Indian Journal of Psychiatry. 2018;60(1):56-59. [crossref] [PubMed]
McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): Reliability and validity. J Sex Marital Ther. 2000;26(1):25-40. Doi: 10.1080/009262300278623. PMID: 10693114. [crossref] [PubMed]
Andreasen NC, Carpenter WT, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in Schizophrenia: Proposed criteria and Rationale for Consensus. Am J Psychiatry. 2005;162(3):441-49. [crossref] [PubMed]
Kelly DL, Conley RR. Sexuality and schizophrenia: A review. Schizophr Bull. 2004;30(4):767-79. [crossref] [PubMed]
Ravichandran D, Gopalakrishnan R, Kuruvilla A, Jacob KS. Sexual Dysfunction in Drug-Naïve or Drug-Free Male Patients with Psychosis: Prevalence and Risk Factors. Indian J Psychol Med. 2021;41(5):434-39. Available from: [crossref] [PubMed]
Kantipudi SJ, Suresh N, Ayyadurai P, Ramanathan S. Sexual Dysfunction and Marital Relationship in Women With Schizophrenia in Comparison with Caregivers: A Hospital-based Study. Journal of Psychosexual Health. 2020;2(1):87-92. Available from: [crossref]
Ucok A, Incesu C, Aker A, Erkoç S. Sexual dysfunction in patients with schizophrenia on antipsychotic medication. Eur Psychiatry. 2007;22:328-33. [crossref] [PubMed]
Düring SW, Nielsen MØ, Bak N, Glenthøj BY, Ebdrup BH. Sexual dysfunction and hyperprolactinemia in schizophrenia before and after six weeks of D2/3 receptor blockade- An exploratory study. Psychiatry Res. 2019;274:58-65. [crossref] [PubMed]
Wu TH, Lin CH, Goh KK, Chen CYA, Chen CH, Lane HY, et al. The Relationships Between Hyperprolactinemia, Metabolic Disturbance, and Sexual Dysfunction in Patients With Schizophrenia Under Olanzapine Treatment. Frontiers in Pharmacology. 2021;12:2015. Available from: [crossref] [PubMed]
Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs. 2007;21(11):911-36. [crossref] [PubMed]
Negative Symptoms of Schizophrenia: Treatments. Living With Schizophrenia. [cited 2021 Dec 2]. Available from:

DOI and Others

DOI: 10.7860/JCDR/2022/55675.16377

Date of Submission: Feb 13, 2022
Date of Peer Review: Mar 03, 2022
Date of Acceptance: Apr 18, 2022
Date of Publishing: May 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Feb 19, 2022
• Manual Googling: Apr 09, 2022
• iThenticate Software: Apr 27, 2022 (25%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)