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Schofield E, Taylor N, Drake MJ. The association of lower urinary tract symptoms with schizophrenia and its treatments: A narrative review. Neurourol Urodyn 2024; 43:114-125. [PMID: 37916430 DOI: 10.1002/nau.25320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND A higher incidence of lower urinary tract symptoms (LUTS) in people with schizophrenia compared to the general population is often suggested. However, it is not clear whether this is a genuine association, and whether it is a direct result of schizophrenia itself, or a side-effect of certain antipsychotics. METHODS We undertook a narrative review evaluating how the published literature reports the relationship between LUTS and schizophrenia and its treatments. We searched Embase, Ovid Emcare, and Ovid MEDLINE(R) ALL to August 2022, limited to the English language. We selected the following search terms: schizophrenia, schizophrenic, LUTS, overactive bladder, urinary urgency, urinary incontinence, overactive bladder, enuresis, nocturnal enuresis, and voiding dysregulation. We identified seven domains for assessment in advance of commencing the review. These were the categorization, description, and treatment status of schizophrenia; evaluation of LUTS; categorization of LUTS confounders; recapturing of the disease states of both schizophrenia and LUTS after therapies; assessment of the association between LUTS and schizophrenia and/or antipsychotics. RESULTS The association between LUTS and schizophrenia was poorly described. The evidence was low quality and focused predominantly on urinary incontinence as an antipsychotic side effect, neglecting other LUTS. The status of schizophrenia was often incompletely characterized, and no papers made use of a bladder diary or LUTS-specific questionnaires to assess symptoms. No papers collected information about LUTS in patients not on antipsychotics, nor did any thoroughly evaluate the influence of confounding variables. Despite the tendency of symptoms and severity of both conditions to fluctuate over time, no studies fully assessed the status of both schizophrenia and LUTS at baseline, therapy initiation, and follow-up. CONCLUSIONS It is not possible to state whether there is an association between LUTS and schizophrenia or its treatments. This review highlights the need to improve research and clinical management of the urinary tract in schizophrenia, with meticulously designed longitudinal studies.
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Affiliation(s)
| | | | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College, London, UK
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Eliezer DD, Lam C, Smith A, Coomarasamy JM, Samnakay N, Starkey MR, Deshpande AV. Optimising the management of children with concomitant bladder dysfunction and behavioural disorders. Eur Child Adolesc Psychiatry 2023; 32:1989-1999. [PMID: 35767104 PMCID: PMC10533605 DOI: 10.1007/s00787-022-02016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 05/26/2022] [Indexed: 11/03/2022]
Abstract
Bladder dysfunction and behavioural disorders in children are commonly concomitant; hence, it is difficult to treat each in isolation. Pharmacotherapy is common treatment for behavioural disorders, and these medications may have intended or unintended positive or negative bladder sequelae. This review identifies the literature regarding the effects of behavioural pharmacotherapy on bladder functioning and possible bladder management strategies in children with concomitant behaviour and bladder disorders to enable clinicians to better manage both conditions. A PROSPERO registered PRISMA-guided review of three major databases was performed. After an initial scoping study revealed significant heterogeneity, a narrative approach was undertaken to discuss the results of all relevant cases relating to children being treated with pharmacotherapy for behaviour disorders and outcomes related to bladder function. Studies were screened to identify those that described effects of commonly prescribed medications in children with behavioural disorders such as stimulants, alpha 2 agonists, tricyclic antidepressants (TCA), serotonin and noradrenergic reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI) and antipsychotics, and the findings and implications were summarised. The review identified 46 studies relevant to behavioural pharmacotherapy and bladder function (stimulants (n = 9), alpha 2 agonists (n = 2), TCAs (n = 7), SNRIs (n = 8), SSRIs (n = 8) and antipsychotics (n = 6). Six studies focused specifically on bladder management in children with behavioural disorders with concurrent behavioural pharmacotherapy. This review identifies useful factors that may assist clinicians with predicting unintended bladder effects following initiation of behavioural pharmacotherapy to facilitate the best approach to the treatment of bladder dysfunction in children with behavioural disorders. With this evidence, we have provided a useful decision-making algorithm to aide clinicians in the management of these dual pathologies.
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Affiliation(s)
- Dilharan D Eliezer
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
- Urology Unit, Department of Surgery, Department of Paediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - Christopher Lam
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Angela Smith
- Hunter New England Library, New Lambton Heights, NSW, Australia
| | | | - Naeem Samnakay
- Department of Surgery, Perth Children's Hospital, Nedlands, WA, Australia
- Division of Surgery, Medical School, University of Western Australia, Crawley, WA, Australia
| | - Malcolm R Starkey
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia
| | - Aniruddh V Deshpande
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Urology Unit, Department of Surgery, Department of Paediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Low-Dose Aripiprazole-Induced Nocturnal Enuresis in a 9-Year-Old Boy: A Case Report and the Possible Underlying Mechanism. Clin Neuropharmacol 2021; 44:108-109. [PMID: 33811196 DOI: 10.1097/wnf.0000000000000450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Aripiprazole is an atypical antipsychotic commonly used in the treatment of psychiatric disorders, such as schizophrenia, bipolar disorder, and irritability associated with autism spectrum disorder. Common adverse effects associated with aripiprazole usage in children and adolescents are nausea, vomiting, extrapyramidal adverse effects, akathisia, sedation, tremor, and increased appetite. Enuresis is one of the least expected adverse effects during aripiprazole use. The pathophysiology of aripiprazole-induced enuresis has not been fully clarified. To our knowledge, our report presents enuresis related to aripiprazole use at the lowest dose in the literature. In this report, we present the case of a 9-year-old boy who developed nocturnal enuresis after the beginning of low-dose aripiprazole treatment.
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Nardello R, Guccione F, Gliubizzi C, Marino A, Capizzi M, Mangano S. Resolution of enuresis with aripiprazole in children with psychiatric disorders: two case reports. J Med Case Rep 2021; 15:209. [PMID: 33883037 PMCID: PMC8059299 DOI: 10.1186/s13256-021-02691-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aripiprazole is a third-generation atypical antipsychotic drug that acts as a stabilizer of the dopaminergic and serotonergic system. As partial agonist of the dopamine (D2) and serotonin (5-HT1A) receptors, it appears to be effective in reducing mania in patients with bipolar disorder, tics in Tourette Syndrome, aggression in schizophrenia and autism spectrum disorder. Enuresis has been reported among its side effects. Only a few studies, with conflicting results, have investigated the relationship between aripiprazole and enuresis. CASE PRESENTATION We report the disappearance of enuresis in a Caucasian girl with intellectual disability and oppositional defiant disorder and in a Caucasian boy with intellectual disability and early-onset psychosis, both following initiation of treatment with aripiprazole. CONCLUSION The aim of this study was to contribute to the literature on the use of aripripazole in subjects with enuresis. Our findings lead us to suggest that aripiprazole is less burdened with side effects, including bedwetting, than other antipsychotic drugs.
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Affiliation(s)
- Rosaria Nardello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy.
| | - Fulvio Guccione
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| | - Claudia Gliubizzi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| | - Antonio Marino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| | - Mariarita Capizzi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| | - Salvatore Mangano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
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Dikshit R, Karia S, De Sousa A. Risperidone-induced Enuresis in a 12-year-old Child. J Neurosci Rural Pract 2019; 8:122-123. [PMID: 28149096 PMCID: PMC5225694 DOI: 10.4103/0976-3147.193530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Risperidone has been documented to be effective in the management of behavior problems, aggression, and conduct disorder in children. While metabolic side effects like weight gain and obesity have been attributed to Risperidone use in children, side effects of the drug related to the urinary bladder are rare. We present a case of Risperidone-induced enuresis in a 12-year-old boy with conduct disorder that resolved completely after stopping the medication.
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Affiliation(s)
- Reetika Dikshit
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Sagar Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Ayaydın H, Bilgen Ulgar Ş. Diurnal enuresis developing in association with risperidone and aripiprazole use in a child with autism spectrum disorder: a case report. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1402497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hamza Ayaydın
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Şermin Bilgen Ulgar
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
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Aripiprazole-Related Diurnal Enuresis in Children: 2 Cases (Aripiprazole-Related Enuresis). Clin Neuropharmacol 2017. [DOI: 10.1097/wnf.0000000000000223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quetiapine-Induced Enuresis: Two Case Reports. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2017. [DOI: 10.5812/ijpbs.5154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Karslıoǧlu EH, Özalp E, Çayköylü A. Paliperidone Palmitate-induced Urinary Incontinence: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:96-100. [PMID: 26792046 PMCID: PMC4730936 DOI: 10.9758/cpn.2016.14.1.96] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/26/2015] [Accepted: 05/31/2015] [Indexed: 11/25/2022]
Abstract
Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients’ compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.
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Affiliation(s)
- Ersin Hatice Karslıoǧlu
- Department of Psychiatry, T.C.S.B. Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Elvan Özalp
- Department of Psychiatry, T.C.S.B. Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali Çayköylü
- Department of Psychiatry, T.C.S.B. Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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12
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Cop E, Oner P, Oner O. Risperidone and double incontinence in a child with autism. J Child Adolesc Psychopharmacol 2011; 21:647-8. [PMID: 22136093 DOI: 10.1089/cap.2011.0071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Esra Cop
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Pinar Oner
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Ozgur Oner
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
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Harrison-Woolrych M, Skegg K, Ashton J, Herbison P, Skegg DCG. Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: comparative cohort study. Br J Psychiatry 2011; 199:140-4. [PMID: 21653944 DOI: 10.1192/bjp.bp.110.087478] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nocturnal enuresis has been reported in patients taking clozapine, but the incidence has not been accurately established. The incidence of enuresis in patients taking risperidone, olanzapine or quetiapine is unknown. Aims To compare nocturnal enuresis in patients taking clozapine with that in patients taking risperidone, olanzapine or quetiapine. METHOD Observational cohort study using prescription event monitoring methods. Patients prescribed atypical antipsychotic medicines were followed up by questionnaires that were sent to their medical practitioner. Practitioners were asked to directly ask their patients about bed-wetting. RESULTS Nocturnal enuresis was reported by 17 of 82 (20.7%) patients taking clozapine, 11 of 115 (9.6%) taking olanzapine, 7 of 105 (6.7%) taking quetiapine and 12 of 195 (6.2%) taking risperidone. Compared with clozapine, the risk of nocturnal enuresis was significantly lower in patients taking olanzapine (odds ratio, OR = 0.43, 95% CI 0.19-0.96), quetiapine (OR = 0.33, 95% CI 0.13-0.59) or risperidone (OR = 0.27, 0.12-0.59), with odds ratios adjusted for age, gender and duration of treatment. CONCLUSIONS Approximately one in five patients prescribed clozapine experienced bed-wetting. This was significantly higher than the rate of nocturnal enuresis in patients taking olanzapine, quetiapine or risperidone.
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Affiliation(s)
- Mira Harrison-Woolrych
- Director, Intensive Medicines Monitoring Programme, Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand.
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Abstract
Parasomnias are undesirable physical or experiential events that occur in and around sleep. Treatments include reassurance in some cases, various forms of cognitive-behavioral therapy (CBT), and pharmacologic agents. Cognitive restructuring, imagery rehearsal, relaxation, hypnosis, desensitization, and anticipatory awakenings are some of the common CBT and nonpharmacologic interventions. Medications that are used belong to a wide variety of pharmacologic classes, such as alpha-blockers (prazosin), tricyclic antidepressants (imipramine and clomipramine), selective serotonin reuptake inhibitors, benzodiazepines (diazepam and clonazepam), anticonvulsants (topiramate and gabapentin), desmopressin acetate, and anticholinergic agents (oxybutynin and tolterodine). Data on efficacy are only available from randomized trials on CBT and prazosin for nightmares and on pharmacologic and alarm therapy for enuresis. No large-scale randomized trials are available to assess the efficacy of the other treatments, and most data come from anecdotal case reports, case series, or small open-label trials.
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Affiliation(s)
- Hrayr Attarian
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maguire Building, Room 2700, 2160 South First Avenue, Maywood, IL 60153, USA.
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Mendhekar DN, Andrade C. Risperidone-related reversal of primary enuresis: an unusual case report. World J Biol Psychiatry 2010; 11:514-5. [PMID: 20014956 DOI: 10.3109/15622970903369965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Occasional reports have documented treatment-emergent enuresis with medication regimens that include risperidone. In contrast to these reports, we present a 12-year-old girl with mild mental retardation and primary nocturnal enuresis who received risperidone (0.5 mg/day) for the isolated symptom of inappropriate smiling. Surprisingly, in addition to reduction in inappropriate smiling, risperidone also substantially decreased the frequency of enuresis. These benefits with risperidone were confirmed in an on-off-on treatment sequence. To our knowledge, this is the first case in literature of primary enuresis responding to low-dose risperidone. Low-dose risperidone may merit study in children with enuresis. Clinical implications and possible mechanisms are discussed.
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Lee MJ, Kim CE. Use of aripiprazole in clozapine induced enuresis: report of two cases. J Korean Med Sci 2010; 25:333-5. [PMID: 20119596 PMCID: PMC2811310 DOI: 10.3346/jkms.2010.25.2.333] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 09/19/2008] [Indexed: 11/20/2022] Open
Abstract
This report describes the efficacy of combined use of aripiprazole in the treatment of a patient with clozapine induced enuresis. Aripiprazole acts as a potential dopamine partial agonist and the dopamine blockade in the basal ganglia might be one of the causes of urinary incontinence and enuresis. We speculate that aripiprazole functioned as a D2 agonist in hypodopaminergic state of basal ganglia caused by clozapine and maintained dopamine level that would improve enuresis ultimately.
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Affiliation(s)
- Myung-Ji Lee
- Department of Psychiatry, Incheon Christian Hospital, Incheon, Korea
| | - Chul-Eung Kim
- Department of Psychiatry, Inha University Hospital and College of Medicine, Incheon, Korea
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Hergüner S, Mukaddes NM. Risperidone-induced double incontinence. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1085-6. [PMID: 18387724 DOI: 10.1016/j.pnpbp.2008.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 02/18/2008] [Accepted: 02/18/2008] [Indexed: 11/28/2022]
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Hergüner S, Mukaddes NM. Risperidone-induced enuresis in two children with autistic disorder. J Child Adolesc Psychopharmacol 2007; 17:527-30. [PMID: 17822346 DOI: 10.1089/cap.2006.0056] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Risperidone appears to be effective in treating behavioral problems in children with autistic disorder. Although increased appetite, weight gain, and sedation are among the most common side effects, risperidone-induced enuresis is rarely reported. METHOD We will present two cases with risperidone-induced enuresis, and discuss our findings in the context of current literature. RESULTS Two children aged 11 and 10 years, diagnosed with autism and mental retardation, have developed new-onset diurnal and nocturnal enuresis respectively on their first and second weeks of risperidone monotherapy (1.5 and 1 mg/day). They did not experience sedation, and their medical history and workup were unremarkable. As enuresis did not resolve spontaneously, we decided to substitute risperidone with olanzapine. Enuresis ceased rapidly after discontinuation of risperidone with no emergence when patients were treated with olanzapine 5 mg/day for a period of 6 months and 1 year, respectively. DISCUSSION Although the pathophysiology of antipsychotic-induced enuresis remains unclear, a number of mechanisms including alpha(1)-adrenergic blockade, dopamine blockade, and antimuscarinic effects has been proposed. Olanzapine has lower alpha(1)-adrenergic and dopaminergic blockade properties, thus changing risperidone to olanzapine may be an alternative modality in risperidone-induced enuresis when antipsychotic treatment is crucial. Clinicians should be more vigilant about screening for this side effect, especially in younger population with developmental disabilities.
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Affiliation(s)
- Sabri Hergüner
- Department of Child and Adolescent Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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