Cichon Gregory J, Qadri Syed F
Psychiatry, Creighton University School of Medicine, Omaha, USA.
Cureus. 2023 Feb 23;15(2):e35357. doi: 10.7759/cureus.35357. eCollection 2023 Feb.
Treatment-emergent sexual dysfunctions are a common and distressing adverse effect of antipsychotic medication, particularly risperidone, which can result in medication noncompliance among patients with psychiatric disorders. In this case report, we present a 55-year-old male patient with a history of bipolar disorder type 1 who was admitted to an inpatient psychiatric facility due to a severe manic episode with psychotic features. The patient reported having previously taken risperidone for his bipolar symptoms but stopped taking it two months prior to hospitalization due to sexual side effects, including reduced libido and anejaculation. Comprehensive medical and psychiatric evaluations were performed during the patient's hospitalization, and his symptoms were treated with lurasidone instead of resuming risperidone. The patient's symptoms improved, and he was discharged with close outpatient follow-up for six months without symptoms of sexual dysfunction, depressive or manic symptoms, or adverse medication effects. This case adds to the growing body of literature on the adverse effects of risperidone, which is known to stimulate prolactin and contribute to sexual dysfunction in as many as 50-70% of patients, and highlights the potential benefits of switching to lurasidone, which has limited literature but as of this publication has not been associated with sexual dysfunction in clinical trials. However, more research is needed to fully understand the impact of antipsychotic switching on sexual side effects and the reluctance of patients to switch medications due to discomfort discussing these sensitive issues.
治疗中出现的性功能障碍是抗精神病药物常见且令人苦恼的不良反应,尤其是利培酮,这可能导致精神疾病患者不遵医嘱服药。在本病例报告中,我们介绍了一名55岁的男性患者,他有1型双相情感障碍病史,因伴有精神病性特征的严重躁狂发作入住一家精神病住院机构。患者报告曾服用利培酮治疗双相情感症状,但因包括性欲减退和射精障碍在内的性副作用,在住院前两个月停药。在患者住院期间进行了全面的医学和精神科评估,用鲁拉西酮治疗其症状,而非恢复使用利培酮。患者症状改善,出院时进行为期六个月的密切门诊随访,期间无性功能障碍、抑郁或躁狂症状,也无药物不良反应。该病例补充了关于利培酮不良反应的越来越多的文献,已知利培酮会刺激催乳素分泌,在多达50%至70%的患者中导致性功能障碍,并突出了改用鲁拉西酮的潜在益处,关于鲁拉西酮的文献有限,但截至本出版物发表时,在临床试验中尚未发现其与性功能障碍有关。然而,需要更多研究来充分了解抗精神病药物换药对性副作用的影响,以及患者因不愿讨论这些敏感问题而不愿换药的情况。