SEXUAL RELATIONSHIPS AND QUALITY OF LIFE OF THE SCHIZOPHRENICS. [Original Research]
Kaswa. KJ , MD1, Mampunza MS, PhD1, KAYEMBE KT, PhD1, Kaswa KM, MD2
1. Department of psychiatry, Neuro – Psycho – Pathological Center, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
2. National TB Control Program, Ministry of Health, Kinshasa, Democratic Republic of Congo.

[emedpub – Psychiatry & Mental Health: Vol 1:4] [Date of Publication: 07.21.2013]
ISSN 2231-6019

July 21, 2013 at 12:53 AM

Correspondence:

Jean Kasiama KASWA, MD, Department of Psychiatry CNPP, University of Kinshasa – RDC

Contact: + 243 99 71 36 894, E-mail : Doctakaswa@gmail.com, http://Kaswa.blog4ever.com

RESUME:

Contexte. Le concept de Qualité de vie a commencé à servir de base à de nombreuses recherches en psychiatrie et en psychologie. Au-delà de l’éducation thérapeutique centrée seulement sur l’organe, la question de la sexualité des schizophrènes commence à être envisagée comme un élément important de la vie et doit mériter une réflexion clinique parce que la santé sexuelle est aujourd’hui considérée comme une composante de la qualité de vie.Cette étude a été menée le 13 Décembre 2009, de 11h30 à 13h00, au pavillon 3 du CNPP (Département de Psychiatrie), avec un groupe de quatre étudiants de 3ème graduat de la faculté de médecine, sous la supervision de Kaswa et dans le cadre du travail de fin cycle.

Objectif. Améliorer la prise charge des schizophrènes en prenant en compte leur sexualité et leur qualité de vie.

Méthodes. Il s’agit d’une étude clinique d’autoévaluation par 4 patients de leur qualité de vie avec le questionnaire EQVS, en comparaison avec une autre recherche avec l’échelle WHOQOL-26 sur 432 patients. Des tous les domaines de la vie de ces instruments de mesure, seule nous intéresse la vie affective et sexuelle (rapports sociaux et amoureux).

Résultats. D’après les résultats obtenus, la tendance porte à croire que les relations amoureuses ne sont pas très développées chez les schizophrènes et la qualité de vie n’est pas bonne avec le score de 46% pour l’EQVS et 38,89% pour le WHOQOL-26.

Conclusion. Les rapports socio-amoureux font partie des besoins de tout être humain, qu’il soit malade ou non. La qualité de vie dans le domaine de la sexualité n’est pas bonne chez les schizophrènes. La sexualité n’est pas très développée et contribue à la mauvaise qualité de vie telle que nous la démontrent les résultats de cette étude.

Mots-clefs :Rapports, Socio-Amoureux, Qualité, vie, Schizophrènes

Abstract:

Context. The concept of “quality of life” began to act as a basis to numerous researches in psychiatry and in psychology. Sexual health is today considered a major component of life quality.  Now moving beyond therapeutic education, which only centers on the genital organs, the sexuality of schizophrenics is finally being recognized as an important element of life that deserves a clinical entity.. This study was conducted in December, 2011, in the department of Psychiatry.

Objective. To improve understanding of sexuality of schizophrenics while taking in account their quality of life.

Method. It is a clinical study of self-assessment of 4 patients about their quality of life with the EQVS questionnaire, in comparison with the data base of the WHOQOL-26 scale on 432 patients. We are only interested in the subjects’ emotional and sexual (social and in love-life reports).

Results. According to the calculated results, schizophrenics’ love relationships are not very developed and they have a poorer quality of life with the score of 46% for the EQVS and 38 (89%) for the WHOQOL-26.

Conclusion. All human beings require love, regardless of whether or not they are sick.  In regard to sexuality, quality of life is poor among schizophrenics.  Their sexuality is not very developed, which results in a poor quality of life.

Keywords: Sexuality, Quality of Life, Schizophrenics

INTRODUCTION:

The schizophrenia is associated with a big disadvantage, namely the sexual dysfunction and therefore affects the quality of life (1). Although the antipsychotic treatment cut most positive symptoms and certain negative symptoms, the sexual dysfunction stays and reinforces itself, with a possible relapse.  This illness that starts early in life—especially in males–has serious repercussions on a person’s capacity to function efficiently in all aspects of life, such as: intimate and domestic relations, education, housing, autonomy, communal and social life. This results in sexual and social isolation and a lack of social and sexual training. This does not change the fact that sexuality is still a fundamental need of all humans (2).

Very few psychiatrists are interested in managing the schizophrenic patients for their sexual dysfunction, all as the patient’s side doesn’t have any spontaneous complaints. Yet, sexuality is certainly one of the most influential factors in regard to the quality of life of these chronic psychotics (3).

The goal of this work is to scrutinize the quality of life of the schizophrenics after their hospitalization in the Neuro-Psycho-Pathological Center (CNPP) of the University of Kinshasa; to appreciate the importance of sexuality to the patients’ lives; and to incite the practitioners to enrich their level of care to these often marginalized patients.

The objective is to improve the quality of life of schizophrenics while taking in to account their sexuality, so that we may all further value it.  However, it is not easy to value a notion as complex as the quality of life of a schizophrenic patient.

PATIENTS AND METHODS:

Our survey is on 4 schizophrenic patients, according to the DSM IV, who were hospitalized and consolidated in the Neuro-Psycho – Pathological Center (CNPP) of the University of Kinshasa, and also uses the database of 432 surveyed for the assessment and improvement of the schizophrenic’s quality of life(4).

For reasons of sociocultural adaptation, we used the scales of assessment of the quality of life of the Schizophrenic EQVS, under validation, and WHOQOL-26, which has already been validated, to compare the results.  The EQVS was constructed by the collaboration of three mental hospitals (Zimbabwe, Zambia, and the Democratic Republic of Congo) in 2005 by Kaswa KJ, Mampunza MMS.,Odimba, Yassa P, Haworth A, and Tsakala. It is composed of an auto-questionnaire that consists of 44 items distributed in 11 domains of the quality of life: health, psychic symptoms, self-esteem/ well-being, familial relationships, social and sexual reports, recreation/creativity, community involvement/productivity, religion, financial situation, conditions of life, and autonomy (5).   The WHOQOL-26, scale of the WHO, consists of 6 domains (health and quality of life in general, physical health, psychic health, level of independence, social relationships, and environment). Domain 17  addresses if the patient is satisfied with his sexual life?) (4).

Our study is composed of a clinical survey that is based on a self-evaluation by the patients, along with the help of the scale of assessment of the quality of life of the schizophrenic. Upon first interacting with the patients, we noticed that they were initially distrusting and anxious, but those feelings vanished as we went into our questioning and they learned the reason for our work. Patients gladly accepted to help us in researching the quality of life in regard to sexuality and to the questions put in the scale of assessment of the quality of life (EQVS).

Of the 11 domains of life explored, we exploited the social and in-love reports, particularly the ones associated with the emotional and sexual life, with four (4) items below.

Domain of life (D5) of the EQVS: Social and in-love reports

1. Items:

D5.1 I have a friend, D5.2 The friends return to me to visit, D5.3 quoted it, I have a sexual life, D5.4 I am satisfied with this sexual life

2. Answers:

Never, rarely, sometimes, often, always

3. Score:

“Each item can be described as 0, never (worse quality of life, 0%), to 5, always (excellent quality of life, 100%). The patient picks only one for each domain.  “For the domain of life D5, the score is the average of the scores of the 4 items.”

A good quality of life is when the middle score is equal or greater than 75% (6), either when the answer is “often” or “always.”

RESULTS:

After collecting the patients’ answers, we arrived at the following results:

EQVS – 4 topics

Table 1: I have a friend

Patients Score
Bad

QV

Good QV

75

%

Excellent QV

100

%

0% 25% 50%
Patient 1 x
Patient 2 x
Patient 3 x
Patient 4 x
Total 0 0 2 2 0

Two out of four patients declare to have an in-love relationship.

Table 2: The friends pay a visit to me

Patients Score
Bad

QV

Good QV

75

%

Excellent QV

100

%

0% 25% 50%
Patient 1 x
Patient 2 x
Patient 3 x
Patient 4 x
Total 0 0 3 1 0

Only one patient receives visits by the individual that is supposed to be his/her love.

Table 3: “I have a sexual life”

Patients Score
Bad

QV

Good QV

75

%

Excellent QV

100

%

0% 25% 50%
Patient 1 x
Patient 2 x
Patient 3 x
Patient 4 x
Total 2 1 0 1 0

One only declares to have sexual activities.

Table 4: I am satisfied with this sexual life

Patient Score
Bad

QV

Good QV

75

%

Excellent  QV

100

%

0% 25% 50%
Patient 1 x
Patient 2 x
Patient 3 x
Patient 4 x
Total 1 1 1 0 1

Only one has satisfaction with his/her sexual life.

Figure 1: Score (average) of the item (D5): 46.8%.

Table 5: Score of the life domain (D5); Score by item and patient by.

Under – tems

Participants

1 2 3 4 Quality of life
Patient 1 75% 50% 75% 100% 75%
Patient 2 50% 50% 0% 50% 37,5%
Patient 3 50% 50% 25% 25% 37,5%
Patient 4 75% 75% 0% 0% 37,5%
Average 62,% 56,2% 25% 43,7% 46,8%

3.2. WHOQOL-26 – 432 topics

Table  6: WHOQOL-26 ; item 5.17

Frequency Percentage Valid % accumulated
Valid 0 192 43,1 44,4 44,4
25 28 6,3 6,5 50,9
50 68 15,3 15,7 66,7
75 68 15,3 15,7 82,4
100 76 17,1 17,6 100,0
Total 432 97,1 100,0
Miss System missing 13 2,9

DISCUSSION:

The concept of life quality was developed in 1960 and was quickly adopted into the health field.  Around 1980, the concept of life of quality began to act as a basis for numerous researches in psychiatry and in psychology (7) as a desire to understand those who live with schizophrenia. With the EQVS scale, there were 4 schizophrenics (three men and a woman) who all had at least 2 hospitalizations; this shows how schizophrenia is a chronic mental illness.

Reviewing the quality of life scores of each patient, it is apparent that only one patient had a good quality of life. That patient, a woman, presents a good quality of life for some items with a score of 75%. She is the only patient that doesn’t receive visits.  She is the only one of the four patients who is satisfied with her sexual life. As for the three men, none have sexually intimate relationships. It is likely that the woman developed her illness after she had her first sexual experience.

They needed 4-5 minutes on average to answer the questionnaire; it took them the most time to answer the last two questions concerning sexual life. This suggests that sexuality particularly affects them. Their sexual activity is low with an average score of 25%, and their sexual satisfaction varies 0%-75%.  Fig. 1 (D5.Rapports socio-in love) gives us the score average of the life quality in this domain of the EQVS at 46.8%. In no item, any patient had an average of 75 (good QV).

Similarly, with the WHOQOL-26 scale, the median score is of 38,9%, and most topics are below 39,6%. Looking at the results below 75%, both with the EQVS scales (46, 8%) and WHOQOL-26 (38,9 %), it is revealed that schizophrenics’ in-love relationships are not developed and their quality of life is poor. It is necessary to note that all of these patients are neuroleptics.

Several studies demonstrate sexual activity and sexual satisfaction is essential to the quality of life of a person (Tardieu and al. 2006); others explain the impact of sexual dysfunction on the quality of life of the schizophrenics (DrGorin Lazard 2008).

A lot of authors note that schizophrenia doesn’t necessarily exclude all desire or sexual activity. It is only a fact that interest for sexuality, sexual intercourse, and sexual satisfaction is reduced, with declining age (7). The reported increase of  dysfunction sexual rate in recent studies is due especially to the increasing use of auto-questionnaires that return more elevated numbers (8).

Sexual dysfunction would be with the extra pyramidal effects and the hold of weight, one of the most deleterious factors on the quality of life of the schizophrenic patients (Smith and al. 2002; Lambert 2004). If one wants to improve their quality of life, clinicians should recognize the sexual needs of the hospitalized patients.

The important and prevalent sexual dissatisfaction among schizophrenics has been extensively underestimated by physicians, and psychiatrists in particular (2). A variance of 14%-35% of patients will talk about their sexual dissatisfaction unprovoked, while the number jumps to 58%-69% if they are sought after by a physician (Bernard 2008, p 34). Some schizophrenics seem to be indifferent to the act of sex, hence, emphasizes the classic emotional dissociation of the schizophrenic. Although some rare patients have apparently healthy relations in love, most (60% to 70%) do not get married and numerous patients have limited social contacts.  This is for many reasons: their dissatisfaction was their sexual life, leading to lack of pleasure. Hospitalization rates of men and women (young to middle-aged) increased, which revealed the effect of schizophrenia in individuals during their most productive years—the period in which most people start a family, establish their careers, and begin their lives (1). The cognitive and emotional deficits of those with the illness mark the gravity of schizophrenia. The development of the illness affects the individual’s attention, anterior grade memory, judgment, abstract thought, self-criticism, functions of abstraction and scheduling, and motor functions. The team of Fortier et al., in 2003, noted the hypo-sexuality of schizophrenics and documents an average of less than one sexual intercourse per month in the population of the schizophrenic patients. This speaks of sexuality related to risk, unwanted pregnancies, IST, sexual violence, and sexual absence that doesn’t constitute in itself a sexual dysfunction.

CONCLUSION:

Our report reveals that in-love relationships are essential to all human beings, regardless of being ill or not.  Schizophrenics do not have a good quality of life in regard to the domain of sexuality.  The results of the study show that schizophrenics’ sexualities are not well developed and result in a poor quality of life. The chronic illness, schizophrenia, alters social and sexual relations appreciably so that the individual becomes incapable of maintaining in-love relationships and a healthy sexual life.

REFERENCES:

  1. Troudi H. Sexualité et schizophrénie : évaluation de la fonction sexuelle chez les patients suivis pour schizophrénie et traités par Risperidal Constat. Université Claude Bernard Lyon I Année.U.F.R. de Biologie Humaine 3ème Année de Sexologie Médicale, 2006-2007.
  2. Bernard A. Schizophrénie et sexualité : prévalence de la dysfonction sexuelle et impact sur les soins, 2009.
  3. 3. Colson MH. La plainte sexuelle, l’analyse des symptômes ; cours DIU sexologie MARSEILLE, 2009.
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  5. Kaswa KJ. X- Manuel d’évaluation de la qualité de vie des schizophrènes. Harmattan, Paris. 55-57, 2011.
  6. Baker, F. et Intagliata, J. (1982). Quality of life in the evaluation of community support systems. Evaluation and Program Planning, 1982;5: 69-79.
  7. 7. Kaswa KJ,  Mampunza ., Kinsalaya Bassi S. UNFPA-Projet SRAJ-UNIKIN. Santé reproductive et santé mentale, Kinshasa 57-67, 2007.
  8. Messick, S. Validity of psychological assessment. American Psychologist, 1995; 741-749.
  9. WHOQOL Group. (1993). Study protocol for the World Health Organization project to develop a quality of life assessment instrument (WHOQOL). Quality of Life Research, 2, 153-159.
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