Eğilmez Oğuzhan, Çelik Mustafa, Kalenderoğlu Aysun
Department of Psychiatry, Adıyaman University School of Medicine, Adıyaman, Turkey.
Noro Psikiyatr Ars. 2016 Mar;53(1):85-86. doi: 10.5152/npa.2015.9896. Epub 2016 Mar 1.
Sexual side effects are common with antipsychotic use. Spontaneous ejaculations without sexual arousal have been previously described with several typical and atypical antipsychotics. We report the case of a man who had spontaneous ejaculations after stopping risperidone and starting 30 mg/day aripiprazole. Spontaneous ejaculations ceased 3 days after decreasing the aripiprazole dose to 15 mg/day. He denied sexual fantasies or increased sexual desire during the period in which he had spontaneous ejaculations. The partial agonistic effect of aripiprazole on D2 receptors may have augmented the mesolimbic dopaminergic pathway, which was suppressed by risperidone, causing spontaneous ejaculations in this patient. Serotoninergic effects of aripiprazole should also be considered. This unusual side effect should be questioned, particularly in patients who recieve aripiprazole after D2-blocking antipsychotics; otherwise, this side effect may cause embarrassement and noncompliance.
抗精神病药物治疗常出现性功能副作用。先前已有多种典型和非典型抗精神病药物导致无性欲唤起的自发性射精的报道。我们报告一例男性患者，在停用利培酮并开始每日30毫克阿立哌唑治疗后出现自发性射精。将阿立哌唑剂量减至每日15毫克后3天，自发性射精停止。他否认在出现自发性射精期间有性幻想或性欲增强。阿立哌唑对D2受体的部分激动作用可能增强了被利培酮抑制的中脑边缘多巴胺能通路，从而导致该患者出现自发性射精。还应考虑阿立哌唑的5-羟色胺能效应。这种不寻常的副作用应引起关注，尤其是在使用D2受体阻断型抗精神病药物后改用阿立哌唑的患者中；否则，这种副作用可能会导致尴尬和治疗依从性下降。
