(P7) the role of therapeutic drug monitoring in managing sexual dysfunctions related to pharmacological drugs

Abstract Background Sexual dysfunctions are common among psychiatric patients, and they may be influenced by a variety of social, environmental, and cultural factors, as well as psychopathology-pharmacotherapy interaction. Medical professionals underestimate the prevalence of sexual dysfunctions among psychiatric patients treated with different psychopharmacological drugs, which may result in noncompliance with treatment. The quantification and interpretation of drug concentrations in blood is known as therapeutic drug monitoring (TDM), and it is a useful tool for optimizing pharmacotherapy. The aim of this lecture to summarize the current status of TDM for psychopharmacological drugs and its beneficial role in decreasing the sexual dysfunctions emerging from pharmacological treatment of affective disorders: 1. To understand the bidirectional addiction between affective disorders and sexual dysfunction, 2. To know the different types of SD among patients with affective disorders, 3. To recognize the concept of Therapeutic drug monitoring and its role in the management of psychiatric disorders, and to 4. To understand the current evidence related to the use of therapeutic drug monitoring and the limitations of the state of the literature in this domain. Methods Patients suffering from a depressive episode of any affective disorder were recruited in the period from the beginning of September 2019 to the end of July 2020. They were admitted as inpatients to the Department of Psychiatry, Psychosomatics and Psychotherapy of the University Hospital of Würzburg in Germany. A correlation study was designed to evaluate the link between sexual dysfunction caused by the psychopharmacological drugs and their doses together with their serum concentration. Severity of sexual side effects were assessed at admission and then biweekly by trained raters using the Arizona Sexual Experience Scale (ASEX). Therapeutic drug monitoring (TDM) was assessed by measuring the plasma serum concentrations of the psychopharmacological drugs at admission and then biweekly by trained laboratory personnel. Results 50 patients were included in the study in the 1st week and 44 patients (88%) continued to the end of the 7th week. 37 patients (74%). showed sexual dysfunction according to the ASEX scale in the 1st week and 28 (63.6%) patients continued to have SD by the end of the 7th week. There were only statistically significant correlations in only 3 psychopharmacological drugs. In Amitriptyline, there was a statistically significant negative correlation (r = 0.77, P = 0.043) in the 5th and the 7th week (r = 0.82, P = 0.024) respectively. Concerning Venlafaxine, there was a statistically significant positive correlation (r = 0.56, P = 0.048) in the 3rd week only. While Quetiapine showed a weak positive significant correlation (r = 0.53, P = 0.028) by the 3rd week. Conclusion From these results, we concluded that exposure and response to psychotropic medication is better correlated with serum levels of medication than with total daily dose. Clinician should be encouraged to use TDM for psychotropic medications in the clinical practice, this may help to identify non-adherence, treatment resistance and the likelihood of safety and efficacy.