Diminished general and sexual hedonic capacity in schizophrenia - a clinical and neural characterization

Individuals with Schizophrenia are often reported to suffer from sexual dysfunction, but despite its clinical and individual relevance, the underlying neural mechanisms have not been investigated. To date it is unclear whether sexual problems are inherent to the disease, a secondary symptom, or a side effect of the antipsychotic agents. The present study aimed to investigate issues with sexual functioning in schizophrenia in relation to negative symptoms and anhedonia on a clinical and neural level.

29 people with Schizophrenia and 29 healthy controls were assessed for schizophrenia-specific symptoms, anhedonia and problems in sexual functioning. The SEXpect paradigm, imaging anticipatory and consummatory responses to sexual images, was applied in an MRI scanner to investigate group differences in sexual reward processing and clinical correlates of potentially altered functional brain response.

Healthy individuals showed higher activations during sexual anticipation in the precuneus and cerebellar, occipital, and paracentral regions compared to people with schizophrenia. During image consumption, controls showed increased response in the calcarine gyrus. Functional brain response in all relevant clusters was associated with negative symptoms and sexual functioning scores. Further, clinical scales for negative symptoms, anhedonia and sexual functioning showed strong correlations with each other and were not affected by medication parameters.

Present results suggest that deficits in sexual functioning in schizophrenia are not merely due to antipsychotic medication but could be related to or share common mechanisms with negative symptoms and anhedonia.