BACKGROUND: Patients with schizophrenia frequently encounter challenges related to sexuality and intimacy; however, the underlying causes of these difficulties remain unknown and unexplored. AIM: This narrative review aims to explore how the biological/hormonal and psychological/behavioral developmental trajectories in schizophrenia patients deviate from the normal course and to examine their connection to difficulties in sexual and romantic functioning. METHODS: A comprehensive literature search was conducted using PubMed and Google Scholar, with key terms related to schizophrenia and sexual development without restriction on publication year. Articles discussing behavioral, sexual, or psychological/behavioral development before the onset of schizophrenia were included. Articles were divided into biological/hormonal and psychological/behavioral precursor categories. Additional searches were conducted to explore the broader sociocognitive context of schizophrenia, such as deficits in empathy, emotional processing, and theory of mind. OUTCOMES: The review highlights deviations in both biological/hormonal and psychological/behavioral development in schizophrenia that contribute to difficulties in romantic and sexual relationships. RESULTS: This narrative review addresses the extent to which biological, psychological, and social factors in schizophrenia may be closely intertwined. Abnormalities in the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-adrenal axes have been documented in individuals with schizophrenia, potentially impairing sociosexual competencies and leading to behavioral challenges in forming sexual relationships. Deficits in theory of mind, emotional processing, and empathy may further hinder the ability to form and sustain intimate relationships, amplifying the social difficulties associated with schizophrenia. Additionally, early life traumas, especially sexual abuse, can contribute to sexual difficulties and worsen the disorder. CLINICAL TRANSLATION: Understanding the deviations from the normal developmental course in schizophrenia patients may offer valuable insights for potential intervention strategies and remediation approaches and contribute to improvements in sexual/romantic functioning and overall sexual health in schizophrenia patients. STRENGTHS AND LIMITATIONS: This review provides an overview of the developmental precursors of schizophrenia-related sexual/romantic difficulties. Further research is needed to elucidate the specific mechanisms underlying these difficulties, particularly in determining the emotional and motivational salience of sexual stimuli and the capacity to engage in and maintain communication of sexual interest. The reader should bear in mind that narrative reviews lack systematic methods for selecting and evaluating studies, which can lead to author bias in choosing or interpreting sources. CONCLUSION: The narrative review identified deviations in the biological/hormonal and psychological/behavioral developmental trajectories of schizophrenia patients, linking these abnormalities to difficulties in sexual and romantic functioning, and highlighting the need for sexological remediation strategies to improve sociosexual competencies and overall sexual health.

• Klíčová slova
• gonadal steroid hormones, psychosexual development, schizophrenia, sexual behavior, sexual dysfunction, sexual trauma,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Schizophrenia is associated with numerous abnormalities, including imbalances in all hormonal axes, among which steroids play a major role. Steroidomic studies therefore represent a promising tool for early diagnosis and appropriate treatment of schizophrenia. A total of 51 adult male schizophrenics aged 27 (22, 34) years (shown as median with quartiles) and 16 healthy controls (HCs) aged 28 (25, 32) years were enrolled into this study. Our results showed the effective differentiation of men with schizophrenia from controls based on steroidomic profiles. We also found an altered metabolic pathway from pregnenolone and its sulfate (PREG/S) to cortisol in schizophrenics with several metabolic bottlenecks such as lower PREG levels due to increased PREG sulfation and/or suppressed PREGS desulfation and attenuated conversion of 17-hydroxy-PREG to 17-hydroxy-progesterone, as well as the results suggestive of suppressed CYP11B1 activity. In contrast, steroid molar ratios suggested two counterregulatory steps involving increased conversion of PREG/S to 17-hydroxy-PREG/S and decreased conversion of cortisol to cortisone, which may maintain unchanged basal cortisol levels but may not ensure a sufficient cortisol response to stress. Our data also indicated a trend to higher 7α-, 7β-, and 16α-hydroxylation that may counteract the autoimmune complications and proinflammatory processes accompanying schizophrenia. Finally, a possible suppression of HSD17B3 activity was suggested, resulting in decreased circulating testosterone levels with increased androstenedione levels.

• Klíčová slova
• GC-MS/MS, differential diagnostics, multivariate statistics, schizophrenia, steroidomics,
• MeSH
• dospělí MeSH
• hydrokortison metabolismus   krev   MeSH
• lidé MeSH
• mladý dospělý MeSH
• pregnenolon metabolismus   krev   MeSH
• schizofrenie * metabolismus   MeSH
• steroidy metabolismus   MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• hydrokortison MeSH
• pregnenolon MeSH
• steroidy MeSH