clozapine and Sexual-Dysfunction--Physiological

The recognition, management, and if possible prevention, of major cardiovascular, central nervous system, haematological, and metabolic adverse effects, including diabetes mellitus and weight gain, of antipsychotics and some other drugs used to treat mental illness is a topic of much debate. However, a wide range of other adverse effects, some of which may be life-threatening, may also be encountered. Side-effects reviewed here include: gastrointestinal-associated effects (constipation, hypersalivation, oropharyngeal lesions, nasal congestion, nausea, nocturnal enuresis, and urinary retention), metabolic effects (obesity, insulin resistance, dyslipidemia, impaired glucose tolerance, and hypertension), neuromuscular effects (extrapyramidal side effects, myoclonus, and neuroleptic malignant syndrome, and pleurothotonus), thermoregulatory effects, effects on the liver, pancreas, and kidney, sexual side effects, and effects on skin and bone. Metabolic factors affecting the incidence of adverse effects to clozapine especially are also discussed. The increasing use of atypical (second generation) antipsychotics and indeed of selective serotonin reuptake inhibitors has led to a greater appreciation of not only the benefits of these drugs, but also of the spectrum of toxicity that may occur in clinical practice. The adverse effects of antipsychotics are a major factor in promoting poor adherence to, and even discontinuation of, antipsychotic treatment on the one hand, and increasing the risk of cardiovascular and metabolic disease on the other. As such they merit recognition and either harm minimization strategies (use of the minimum effective dose, or use of lower doses of combinations of antipsychotics), or in extreme cases discontinuation of the offending drug(s).

Topics: Animals; Antipsychotic Agents; Body Temperature Regulation; Bone Diseases; Clozapine; Digestive System Diseases; Dose-Response Relationship, Drug; Humans; Metabolic Diseases; Neuromuscular Diseases; Risk Assessment; Risk Factors; Sexual Dysfunction, Physiological; Skin Diseases

Prolactin levels are elevated to varying degrees by antipsychotics. Prolactin elevations may result in sexual and other adverse effects, and they may be related to antipsychotic effects. We used the data collected in a trial of antipsychotics to study the differential effect of these drugs on prolactin level, to explore the relation between clinical effects and prolactin level, and to determine the relationship between plasma levels of antipsychotics and prolactin level.. Treatment-resistant patients (133 men, 24 women) diagnosed with DSM-IV schizophrenia or schizoaffective disorder participated in a double-blind, randomized, 14-week trial comparing clozapine (N = 40), olanzapine (N = 39), risperidone (N = 41), and haloperidol (N = 37). Plasma levels of prolactin and antipsychotics were determined at baseline and at weeks 5, 8, 10, 12, and 14 during the trial. Clinical effects were measured with the Positive and Negative Syndrome Scale and the Extrapyramidal Symptom Rating Scale. Statistical analyses were limited to the 75 men for whom repeated prolactin levels were available. Data were gathered from June 1996 to December 1999.. Risperidone caused significant elevation of prolactin levels (p <.05) that appeared to be dose-dependent. Clozapine and olanzapine were associated with decreases of prolactin, whereas haloperidol led to a minor, nonsignificant increase. Plasma olanzapine and prolactin levels were correlated. Prolactin levels were not related to clinical improvement or extrapyramidal side effects.. Antipsychotics show major differences in their effects on prolactin, and risperidone has clearly the most robust effect.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Dose-Response Relationship, Drug; Double-Blind Method; Female; Haloperidol; Humans; Male; Olanzapine; Prolactin; Risperidone; Schizophrenia; Sexual Dysfunction, Physiological

Schizophrenia treatment needs to cover several psychological interventions and pharmacological treatment for stabilizing the disease course and decreasing relapses. Sexual side effects are a major hindrance to patients and lead to decreased adherence to therapy and reduced quality of life. Recently, several studies outlined that sexual dysfunction is one of the most distressing side effects of antipsychotics and a major cause of a poor quality of life. We hereby report a case of hypersexuality probably associated with clozapine in a middle-aged woman with schizoaffective disorder.. 45-year-old female diagnosed as a case of schizoaffective disorder, was initiated on quetiapine 150 mg, risperidone 4 mg, lithium 900 mg for her psychotic and maniac symptoms, and lorazepam 2 mg for insomnia. Due to non-compliance and relapse of symptoms, she was started on clozapine 450 mg which was further increased to 650 mg along with an injectable antipsychotic zuclopenthixol 400 mg. After 3 months of treatment with an increased dose of clozapine, patient exhibited unprovoked and increased sexual urges towards male relatives, exhibitionism and an increased libido compared to normal days. A complete physical examination ruled out any extrapyramidal signs. Clozapine was tapered to 400 mg and stopped. Upon cessation of clozapine, her symptoms of hypersexuality gradually reduced.. Clozapine's dopaminergic agonistic effects at the mesolimbic circuit may be responsible for this hypersexuality phenomenon. Poor understanding of the condition by the patient could lead to marital discord and suffering. WHO scale indicates clozapine as the probable cause of sexual dysfunction in our patient.

Topics: Antipsychotic Agents; Clozapine; Female; Humans; Libido; Middle Aged; Psychotic Disorders; Sexual Behavior; Sexual Dysfunction, Physiological

To examine the frequency of hyperprolactinemia and the socio-demographic, clinical, and quality of life (QOL) correlates. The frequency of prolactin-related side effects and associated subjective experiences were also examined.. A cohort of 1364 psychiatric inpatients were consecutively recruited and evaluated. Basic socio-demographic and clinical data were collected. Psychopathology, prolactin-related side effects were measured using standardized instruments. QOL was assessed using the Medical Outcomes Study Short Form 12.. The frequency of hyperprolactinemia was 61.3% in the whole sample; 61.6% in female and 60.8% in male patients. There was no significant association between hyperprolactinemia and any QOL domain. In the whole sample, 15.1% of patients reported moderately severe breast symptoms and lactation, and 53.9% reported moderate or severe discomfort. Nearly a third of female patients (30.4%) reported at least moderate menstrual changes and 50.2% moderate or severe discomfort, while 24.2% of male patients reported at least moderate erectile dysfunction and 52.6% moderate or severe discomfort. Multiple logistic regression analysis revealed that patients with hyperprolactinemia were less likely to be married, diagnosed with mood disorders, or treated with clozapine, aripiprazole, or antidepressants but more likely to receive risperidone.. Effective measures to lower the frequency of hyperprolactinemia and the related side effects should be considered in Chinese psychiatric facilities.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Aripiprazole; Case-Control Studies; China; Clozapine; Female; Humans; Hyperprolactinemia; Male; Mental Disorders; Quality of Life; Risperidone; Sexual Dysfunction, Physiological; Young Adult

Clozapine is associated with non-neurological side effects that can be subjectively unpleasant and/or clinically serious. We sought to: (i) assess the nature and prevalence of side effects experienced by patients receiving maintenance treatment with clozapine and (ii) explore the relationship between clozapine plasma concentration and side effect burden. Patients were receiving clozapine maintenance treatment. Open questioning followed by systematic enquiry using the Antipsychotic Non-neurological Side Effects Rating Scale were used to assess side effects. Trough plasma clozapine and norclozapine concentrations were measured. One hundred and three patients participated. On open questioning, 61 patients reported a total of 117 side effects, whereas systematic enquiry identified an additional 649 side effects, with each patient reporting at least one. Clozapine plasma concentrations were significantly but weakly correlated with total Antipsychotic Non-neurological Side Effects Rating Scale score (Pearson correlation=0.29, P<0.004). Patients with a plasma clozapine concentration >0.25 mg/l were significantly more likely to have moderate/severe side effects than patients with lower plasma concentrations (63/76 vs. 12/23, chi=9.07, d.f.=1, P<0.01). The side-effect burden associated with maintenance clozapine treatment is high and the true extent can only be ascertained by systematic inquiry. The use of target plasma concentrations below those used for acute treatment should be explored as a strategy for minimizing side effects.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Clozapine; Disorders of Excessive Somnolence; Female; Humans; Male; Middle Aged; Prevalence; Psychotic Disorders; Schizophrenia; Sexual Dysfunction, Physiological; Sialorrhea

To examine the possible association of neuropsychiatric symptoms and pallidal surgery for Parkinson disease (PD).. Parkinson disease may be accompanied by a variety of psychiatric symptoms. It is important to distinguish these from psychiatric syndromes that are associated with the treatment of PD.. Case description of a patient with PD and a history of right pallidotomy who developed a psychiatric syndrome, including prominent hypersexuality, after surgical implantation of a deep brain stimulator electrode in the left globus pallidus.. This case demonstrates that patients receiving antiparkinson medication may be at risk for the development of psychiatric sequelae after pallidal surgery.

Topics: Antiparkinson Agents; Antipsychotic Agents; Clozapine; Electric Stimulation Therapy; Electrodes, Implanted; Globus Pallidus; Humans; Male; Middle Aged; Neuropsychological Tests; Neurosurgical Procedures; Parkinson Disease; Sexual Dysfunction, Physiological; Tomography, X-Ray Computed

Topics: Antipsychotic Agents; Clozapine; Female; Haloperidol; Humans; Male; Risperidone; Schizophrenia; Sexual Dysfunction, Physiological