A case of enuresis with use of Risperidone in a patient with Schizoaffective Disorder |
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Poster |
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Yes |
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Clinical Case Studies |
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Terry McMahon |
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terry.mcmahon@ttuhsc.edu |
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Risperidone is one of the most commonly prescribed antipsychotic worldwide due to its broad clinical applications. Generally well tolerated, side effects such as, hyperglycemia, weight gain, dyslipidemia, metabolic syndrome, hyperprolactinemia and its consequences are commonly reported. Although enuresis is not one of the more frequently discussed side effects of Risperidone, it can be distressing and disruptive to the patient's overall functioning. There are many causes of enuresis; it could be psychological, medical, or pharmaceutical in its origin. A comparative cohort study of patients from New Zealand found that 6.2% of participants taking Risperidone experienced enuresis, a much lower percentage than other antipsychotics. It is plausible that individuals who experience Risperidone-induced enuresis will have similar effects with similar antipsychotics; therefore, becoming non compliant with their medications and suffering from a lower quality of life. Other atypical antipsychotics such as, Clozapine are known to carry a significantly higher risk of causing nocturnal enuresis, occurring at a rate of 20.7%; Olanzapine, Quetiapine, and Risperidone were found to have an incidence of 9.6, 6.7, and 6.2%, respectively. Risperidone is known to have lower risk of enuresis when compared to other atypical antipsychotics, but the underlying mechanisms are yet to be completely understood. Although generally well tolerated, side effects such as, fatigue, difficulty concentrating, difficulty remembering things, restlessness, weight gain, and depression are commonly reported. An animal study has suggested that Risperidone impacted the urination response through a variety of mechanisms. Several pharmacologic interventions for Risperidone-induced enuresis such as, anticholinergics, alpha-1 agonists, and desmopressin have been tried and varied in their success. Many cases of Risperidone-induced enuresis have been reported to occur in those taking SSRI’s. Various treatments have been effective in treating antipsychotic induced enuresis. Clozapine-induced enuresis has been effectively treated with anticholinergic agents, antidepressants, desmopressin, and alpha-1 adrenergic agonists. Reboxetine, a selective noradrenaline reuptake inhibitor antidepressant, has been used to treat risperidone-induced enuresis, suggesting a central noradrenergic cause of pathologic enuresis. Various genetic polymorphisms in dopaminergic transmission and in proteins involved in crosstalk with serotonergic receptors have shown to be important in risk of developing schizophrenia and responsiveness to anti-psychotics. Likewise, these polymorphisms could explain the varied rates of adverse effects seen from antipsychotic treatment. Here we present a case of enuresis in a 32 year old man with a history of Schizoaffective disorder who endorsed significant enuresis after being initiated on Risperidone. His enuresis promptly disappeared after a switch to Quetiapine was made. |
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1. Correll, C. U., & Schooler, N. R. (2020). Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatric disease and treatment, 16, 519–534. https://doi.org/10.2147/NDT.S225643 2. Kloosterboer, SM, de Winter, BCM, Reichart, CG, et al. Risperidone plasma concentrations are associated with side effects and effectiveness in children and adolescents with autism spectrum disorder. Br J Clin Pharmacol. 2020; 1– 13. https://doi.org/10.1111/bcp.14465 3. Madaan, V., Bestha, D. P., Kolli, V., Jauhari, S., & Burket, R. C. (2011). Clinical utility of the risperidone formulations in the management of schizophrenia. Neuropsychiatric disease and treatment, 7, 611–620. https://doi.org/10.2147/NDT.S14385 4. Julie Thiel; Second generation antipsychotics & nocturnal enuresis in children. Mental Health Clinician 1 May 2013; 2 (11): 370–374. doi: https://doi.org/10.9740/mhc.n146896 |
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Psychopharmacology |
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Biological Psychiatry |
Submitter Only
Ashish | |
K | |
Sarangi | |
MD | |
ashish.sarangi@ttuhsc.edu |
Ashish | |
K | |
Sarangi | |
MD | |
ashish.sarangi@ttuhsc.edu |
Daniel | |
Cho | |
dcho78@gmail.com |