Urinary obstruction with citalopram and aripiprazole combination in an elderly patient

Urological adverse drug reactions of psychotropic medication in psychiatric inpatients - A drug surveillance report from German-speaking countries

Urological adverse drug reactions (UADR) are common during treatment with psychotropic medication. The aim of this study was to provide a systematic description of the differential profile of UADR of psychotropic drugs in a large naturalistic population. Data stems from psychiatric hospitals collected by AMSP (Arzneimittelsicherheit in der Psychiatrie), a continuous multi-center pharmacovigilance program in Austria, Germany, and Switzerland. 171 cases of severe UADR (0.037%) among a total population of 462 661 inpatients treated with psychotropic drugs in 99 psychiatric hospitals between 1993 and 2016 were examined. Urinary retention (129 cases, 0.028%) was the most common UADR followed by incontinence (23 cases, 0.005%) and nocturnal enuresis (16 cases, 0.003%). Risk of UADR was higher in patients with mania than in other diagnostic groups. Promethazine and haloperidol were the antipsychotics with the highest rate of UADR. Tricyclic antidepressants had a higher and selective serotonin reuptake inhibitors a lower risk for UADR than the respective other antidepressants. Amitriptyline and clomipramine were the most common causes of urinary retention and clozapine of urinary incontinence. This research improves our knowledge of the urological risk profiles of psychotropic drugs in inpatients and highlights compounds associated with higher or lower risk.

Tools for Managing Feline Problem Behaviours Psychoactive medications

PRACTICAL RELEVANCE

When a cat is presented for evaluation of a problem behaviour, it is likely that the cat's wellbeing is negatively affected by the condition. In addition, the owners and any other animals around the cat may also be experiencing negative consequences. When managing these cases, it is important to consider all options (including behaviour modification, environmental changes, medications) that can help to reach an optimal solution. Medication cannot teach the cat how to behave or change a particular behaviour; it can, however, reduce arousal, excitability, reactivity and anxiety.

RATIONALE

The rationale for using psychoactive medications in behavioural medicine, or veterinary psychiatry, is to increase the wellbeing of the animal and to aid the owner and practitioner in managing problem behaviours. Medications should always be used as an adjunct to behavioural and environmental modification.

CLINICAL CHALLENGES

Many psychoactive medications cannot be used in the face of certain physical illnesses or concurrently with other medications. Some medications may also have side effects, not be effective at the recommended dose or have a paradoxical effect. Furthermore, success is reliant on the owner being able to administer the medication.

AIMS

This article aims to guide practitioners by discussing questions such as how to choose the appropriate medication, how to dose it and how long to use it. The psychoactive medications most commonly used in feline medicine are reviewed, as well as some that are newer or less common.

EVIDENCE BASE

Data for the use of medications in cats is limited, with just a small number of clinical-, species- and problem-directed studies available, and a few more case series and case reports. Where feline-specific research is not available, the authors have drawn upon research published in other species, such as humans, dogs and rats, as well as anecdotal reports and expert opinions.

Linking the evidence between urinary retention and antipsychotic or antidepressant drugs: A systematic review

AIMS

Urinary retention (UR) occurs in patients on antipsychotic and antidepressant medication despite no apparent underlying urological cause. This review was undertaken to ascertain which of these medications are associated with UR and how often.

METHODS

A systematic literature search for evidence on antipsychotic and antidepressant medications and UR was completed in June 2015 using Scopus, Pubmed, Web of Science, and the Cochrane library. Search terms included urinary retention, antidepressants and antipsychotics as well as individual drug names. Filters used were: humans and English language. PRISMA guidelines were employed.

RESULTS

Out of 614 articles initially identified, one meta-analysis, five RCT's, five cohort studies and 27 case reports were finally included. There was a wide range of definitions of UR. Studies which appropriately defined UR revealed it occurred in 1/21 patients on ziprasidone (an atypical antipsychotic), 17.6% of those on imipramine but only 0.1% of those on all tricyclic antidepressants analysed together. It was not reported in any of the 1,139 patients given duloxetine (a combined serotonin and noradrenaline reuptake inhibitor). It was reported in 0.025% of patients on selective serotonin reuptake inhibitors. UR was also reported in patients on typical antispychotics, selective noradrenaline reuptake inhibitors but the studies did not define UR. The majority of case reports reported an improvement in UR on discontinuation or dose reduction.

CONCLUSION

Antipsychotics and antidepressants interact with the urinary system in many ways. Clinicians treating acute UR need to keep in mind the role of antipsychotic and antidepressants as a precipitating cause. Neurourol. Urodynam. 35:866-874, 2016. © 2015 Wiley Periodicals, Inc.

Aripiprazole associated urine retention in a male schizophrenia patient

Urine retention and voiding dysfunction are infrequent adverse effects in second generation antipsychotics. We present a male patient who developed voiding difficulties after aripiprazole treatment. Close follow-up of a patient after initiating aripiprazole treatment is critical. Lowering the dosage of aripiprazole or changing the antipsychotic medication might be helpful in this situation.

Aripiprazole augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a 10-week open-label study

INTRODUCTION

Studies investigating the aripiprazole augmentation treatment of serotonin reuptake inhibitor (SRI)-resistant obsessive-compulsive disorder (OCD) are insufficient. The aim of the present pilot study was to investigate the efficacy and tolerability of flexible doses of aripiprazole as an augmenting agent in SRI-resistant OCD patients.

METHODS

OCD patients who met the criteria of this study were followed up with flexible doses of aripiprazole augmentation over a 10-week period. Effectiveness of treatment was evaluated via the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales. At the end of the 10-week follow-up period, patients who showed an improvement of ≥30% for the Y-BOCS total score from baseline were considered responders.

RESULTS

Thirty patients met the study inclusion criteria; three patients did not agree to participate, and four patients dropped out of the study. The differences between baseline and scores at 10 weeks for the parameters studied were as follows: Y-BOCS scores: 32.0±6.3-24.0±8.1 (Z=4.2, P<0.05); Y-BOCS compulsion subscore: 15.0±4.2-11.5±4.3 (Z=4.01, P<0.05); Y-BOCS obsession subscore: 17.0±2.6-12.4±4.0 (Z=4.1, P<0.05); and CGI-S scores: 4.8±0.8-3.1±1.2 (Z=3.9, P<0.05). Patients showed a significant improvement over the 10-week study period; however, only seven of 23 patients (30.4%) who completed the study met the criteria determined for treatment response.

CONCLUSION

Despite the limited number of cases and open-label design of this study, results support the notion that adding aripiprazole to SRIs could be a valid strategy for treatment-resistant OCD patients.

Antipsychotic-induced urinary dysfunction: anticholinergic effect or otherwise?

Although urinary difficulties such as incontinence (UI) and retention (UR), reported with both typical and atypical antipsychotics, have been hypothesised as being a form of extrapyramidal side effects or due to anticholinergic side effects, we believe this may not be the case. We report here a male patient with bipolar disorder who developed urinary difficulties with antipsychotics, both typical and atypical, and in whom only aripiprazole seemed to work. We also hypothesise on the possible mechanisms of adverse urinary effects of antipsychotics.