Priapism associated with iloperidone: a case report

Priapism is a known side effect of antipsychotics. The causal mechanism seems to be mediated through α1-adrenergic receptor blockade which many antipsychotics are known to possess. We present the first detailed case of iloperidone-induced priapism in a patient with bipolar disorder with psychotic features. His case highlights some of the important risk factors clinicians should consider when using iloperidone, as it may be the highest-risk antipsychotic for causing priapism given it is a very potent blocker of the alpha-adrenergic receptor.     

Priapism associated with risperidone treatment

Priapism is the occurrence of sustained and painful erection that does not result from sexual desire and fails to subside despite orgasm. It is often accompanied by pain and tenderness. The aetiologies are idiopathic, alcohol abuse, drug therapy, perinatal trauma and sickle-cell anaemia. It is a very rare adverse effect of psychotropic medications, due to alphaadrenergic receptor blockade. Priapism is reported in a 19-year-old physically healthy mental patient after 4 days of risperidone treatment 2 mg/day. ( Int J Psych Clin Pract 2000; 4: 237 - 239)     

氟西汀和曲唑酮的抗焦虑作用

目的　观察氟西汀 (fluoxetine)和曲唑酮 (trazodone)对焦虑症状的改善作用。方法　选择符合CCMD II R抑郁症诊断标准、伴有焦虑或单纯广泛性焦虑的病例共 148例 ,按就诊顺序随机分为 4组。一组单用氟西汀2 0mg/d ,一组用氟西汀 2 0mg/d加曲唑酮 50～ 10 0mg/d ,一组用氟西汀 2 0mg/d加罗拉 1 5mg/d ,一组用安慰剂加少量安定或 10g/dL水化氯醛。观察 8周。结果　氟西汀能有效的改善焦虑症状 ,但疗效出现较晚 ,第 6周才显示抗焦虑效果。加用曲唑酮或罗拉能加强氟西汀的抗焦虑作用 ,同时能缓解氟西汀在用药早期加重焦虑和影响睡眠的副作用。结论　氟西汀有抗焦虑疗效。用氟西汀抗焦虑的早期加用曲唑酮或罗拉有利于病情的缓解和提高患者的治疗依从性。     

Priapism Associated with Risperidone: A Case Report

Background & objective: Priapism is a rare but serious adverse effect of psychotrpic drugs where antipsychotic agents were implicated in 15% to 26% of priapism associated with medications. Among atypical antipsychotic, clozapine, risperidone and olanzapin have been reported to be associated with the condition. Case report: The patient was a 24 years old man referred to the OPD clinic with symptoms of delusion of control, delusion of persecution, delusion of somatic and auditory hallucination, and since last year had progressive non-sexual stimulation and painful erection. Conclusion: Physicians who prescribe serotonine–dopamine antagonist (SDA) should be careful about this rare yet serious complication, especially in cases with previous history of priapism following the use of psychotropic drugs.     

Trazodone for aggression in an adolescent with hydrocephalus

Abstract A case of 19 year old male with hydrocephalus is reported whose aggressive self-injurious behaviors were resistant to conventional pharmacotherapy but successfully treated by trazodone. In addition to the self-injurious behaviors, this patient displayed withdrawal and eating refusal, which initially resulted in his admission to a psychiatric ward. Various conventional treatments with pharmacotherapy (e.g., tricyclic antidepressants, antipsychotics, anxiolytics and anticonvulsants) in combination with psychotherapy and family therapy proved not to be effective for 15 months. Neither was electroconvulsive therapy successful. Administration of trazodone for 5 months after tapering of the above agents improved his aggressive behaviors. A survey of previous cases with organic brain syndromes who had aggressive behaviors and responded well to trazodone revealed that most of the cases were aged individuals and that cases in adolescence are rare.     

Trazodone. A comparative clinical and predictive study

The clinical efficacy and tolerability of trazodone and amitriptyline were compared in 74 hospital patients suffering from depressive illness. The daily doses of trazodone and amitriptyline were 150-300 mg and 75-225 mg, respectively, with half-strength capsules for patients over the age of 65 years. Twenty-five and 29 patients receiving trazodone and amitriptyline, respectively, completed the 6 week treatment period. Antidepressant activity was measured using the Hamilton Depression Rating Scale (HDRS), the Zung Scale of Depression, visual analogue scales and a Global Assessment Scale. Trazodone and amitriptyline were both effective but not statistically different from each other in terms of antidepressant action. Moreover, patients with neurotic or endogenous depression responded equally well on either treatment. Trazodone was less troublesome in respect of the persistent dry mouth and severe adverse psychiatric reactions which occurred with amitriptyline. Patients should be advised to take trazodone after meals.     

A Case Report of Priapism Caused by Ziprasidon

Priapism is defined as having prolonged (more than 6 h), and usually painful penile erection that occurs without a sexual desire or arousal. Only a very few priapism cases caused by ziprasidone are reported in the literature. In this case report we aimed to present a prolonged penile erection due to use of ziprasidone.     

Priapism and cannabism: A case report and review of the literature

Priapism is classically defined as a partial or complete erection, abnormally prolonged in the absence of desire or sexual stimulation. Several classes of drugs as well as certain psychoactive substances (e.g. alcohol, cocaine, cannabis, etc.) are accused in the occurrence of priapism. In this article, we report a case of priapism in a 37-year-old adult admitted to the emergency department after cannabis use. The patient received emergency aspiration of blood by puncturing the corpora cavernosa, followed by intra-cavernous injection of ephedrine. The evolution has been good. This case relates a rare side effect resulting from the consumption of cannabis, which requires a rapid assessment and management to avoid complications.     

Prior Cocaine Use Alters the Normal Evolution of Information Coding in Striatal Ensembles during Value-Guided Decision-Making

Substance use disorders (SUDs) are characterized by maladaptive behavior. The ability to properly adjust behavior according to changes in environmental contingencies necessitates the interlacing of existing memories with updated information. This can be achieved by assigning learning in different contexts to compartmentalized “states.” Though not often framed this way, the maladaptive behavior observed in individuals with SUDs may result from a failure to properly encode states because of drug-induced neural alterations. Previous studies found that the dorsomedial striatum (DMS) is important for behavioral flexibility and state encoding, suggesting the DMS may be an important substrate for these effects. Here, we recorded DMS neural activity in cocaine-experienced male rats during a decision-making task where blocks of trials represented distinct states to probe whether the encoding of state and state-related information is affected by prior drug exposure. We found that DMS medium spiny neurons (MSNs) and fast-spiking interneurons (FSIs) encoded such information and that prior cocaine experience disrupted the evolution of representations both within trials and across recording sessions. Specifically, DMS MSNs and FSIs from cocaine-experienced rats demonstrated higher classification accuracy of trial-specific rules, defined by response direction and value, compared with those drawn from sucrose-experienced rats, and these overly strengthened trial-type representations were related to slower switching behavior and reaction times. These data show that prior cocaine experience paradoxically increases the encoding of state-specific information and rules in the DMS and suggest a model in which abnormally specific and persistent representation of rules throughout trials in DMS slows value-based decision-making in well trained subjects.SIGNIFICANCE STATEMENT Substance use disorders (SUDs) may result from a failure to properly encode rules guiding situationally appropriate behavior. The dorsomedial striatum (DMS) is thought to be important for such behavioral flexibility and encoding that defines the situation or “state.” This suggests that the DMS may be an important substrate for the maladaptive behavior observed in SUDs. In the current study, we show that prior cocaine experience results in over-encoding of state-specific information and rules in the DMS, which may impair normal adaptive decision-making in the task, akin to what is observed in SUDs.     

Rural African-American Women Who Use Cocaine: Needs and Future Aspirations Related to Their Mothering Role

The overall purpose of this ethnographic study was to understand the culture of rural African-American women who use cocaine, with this report focusing on their perceived mothering needs and future aspirations. Three semi-structured interviews and participant observations were conducted over four years with 30 respondents, of which 24 were mothers. Data for this article were derived from the 21 mothers who cared for dependent children. Four mothering-related needs (escape from boredom, others to help mother for them, not having others’ children to mother, and having children to “keep them going”) and two categories of mothering-related aspirations (child-focused or self-focused) were identified. Given the limited resources in the area, an unexpected finding was the absence of some needs and aspirations. Theoretical explanations for the themes identified as well as those not identified are posited, and practice and research implications are presented.Emma J. Brown Ph.D., R.N. and Frances B. Smith Ed.D., R.N. are affiliated with the School of Nursing College of Health and Public Affairs in the University of Central Florida     

Trace Amines and Cocaine Abuse

Cocaineaddiction remains a clinical challenge with no effectivepharmacotherapy available. Trace amine associated receptor (TAAR)1 represents a promising drug target for the modulation of dopaminergicsystem and stimulant abuse. This Viewpoint discusses the emergingdata which strongly suggest that TAAR 1 functions as a molecular “brake”that controls the addiction-related effects of cocaine and could bea novel drug target for the development of efficacious pharmacotherapyto treat cocaine addiction.     

Characteristics of Cocaine Dependent Patients Who Attempt Suicide

There have been few studies examining risk factors for attempting suicide among cocaine dependent patients. Therefore, a large group of 406 abstinent cocaine dependent patients had a psychiatric interview and completed the Childhood Trauma Questionnaire. Patients who had or had never attempted suicide were compared on putative suicide risk factors. The results showed that 43.5% of the patients had attempted suicide. Attempters were younger; more were female; more reported childhood trauma, a family history of suicidal behavior, a history of aggression, treatment with antidepressant medication, and comorbidity with alcohol and opiate dependence. Logistic regression revealed that childhood physical abuse, childhood emotional negelect, comorbidity with alcohol dependence, and treatment with antidepressant medication were significant predictors of attempting suicide. Thus these results suggest that attempting suicide is common among cocaine dependent patients and that both distal and proximal risk factors may play a role.     

Cocaine increases ryanodine receptors via dopamine D1 receptors

For review there are little available data on regulatory mechanisms of ryanodine receptor (RyR) expression with cocaine treatment, though methamphetamine was reported to up-regulate RyRs in mouse brain. This study attempted to investigate regulatory mechanisms of RyR expression using the cerebral cortical neurons in primary culture intermittently exposed to a psychostimulant, cocaine. Intermittent exposure to cocaine (10 μM) significantly enhanced RyR 1 and 2 proteins and their mRNA, but not RyR 3 expression in the neurons. These cocaine-induced increases of RyR proteins and their mRNA were dose-dependently blocked by a dopamine D1 receptor antagonist (SCH23390), but not by a dopamine D2 receptor antagonist (sulpiride). These results indicate a regulatory role of dopamine D1 receptors in RyR expression bycocaine.