Neuroleptic-induced priapism, hepatotoxicity and subsequent impotence in a patient with depressive psychosis

Management of patients presenting with acute psychotic episodes of schizophrenia

The initial management of patients with schizophrenia presenting to psychiatric emergency departments with an acute psychotic episode requires rapid decisions to be made by physicians concerning the treatment of individuals who are likely to be relatively uncooperative, agitated and lacking insight. The treatment decision must be adapted to the individual characteristics and needs of each patient. This article reviews the issues from the perspective of the initial management of acute psychosis as it is currently practised in Europe, and discusses the pragmatic implications for initial treatment decisions and the elaboration of a long-term treatment plan. Initially, administration of antipsychotics to control psychotic symptoms and benzodiazepines to control agitation represents the cornerstone of treatment. Oral medication is preferable to injectable forms wherever possible, and atypical antipsychotics are to be preferred over conventional agents because of their lower risk of extrapyramidal adverse effects, which are a major determinant of poor adherence to treatment. Whatever antipsychotic is chosen by the physician during the initial period, it is likely that it will need to be continued for many years, and it is thus important to take into account the long-term safety profile of the drug chosen, particularly in relation to extrapyramidal adverse effects, metabolic complications and quality of life. Building a therapeutic alliance with the patient and his/her family or carers is an important element that should be included in the initial management of psychosis. The long-term goal should be to minimize the risk of psychotic relapse through adequate treatment adherence.

Priapism associated with zuclopenthixol

OBJECTIVE

To present a single case of zuclopenthixol-induced priapism and a literature review.

CASE SUMMARY

We report the case of a 31-year-old patient hospitalized due to behavioral alterations and treated with oral zuclopenthixol, an antipsychotic from the thioxanthene family, who developed an acute, painful erection.

DISCUSSION

The occurrence of priapism in our patient was related to zuclopenthixol. This adverse reaction is reported for the first time in a patient not concomitantly treated with other drugs associated with the appearance of priapism. The capacity of zuclopenthixol to induce priapism is thought to be due to its antagonist activity on alpha-adrenergic receptors.

CONCLUSIONS

Priapism is an uncommon but potentially serious adverse effect of zuclopenthixol that practitioners, as with many other antipsychotics, should be aware of.

Antipsychotic induced priapism in a man with an intellectual disability

Priapism is a rare urological emergency, which can be associated with the use of psychotropic medication. The authors were able to find only one brief report of this condition in people with an intellectual disability. A case is reported in a man with moderate intellectual disability, who was receiving antipsychotic medication to manage extreme challenging behaviour. We discuss the condition and its implications for pharmacological treatments of behavioural disturbance in susceptible individuals.