Kawahara Saki, Watanabe Kazuyuki, Inazumi Kazuhiko, Kimura Makoto, Hirose Yuki, Koishikawa Hiraki
Department of Psychiatry, Kisarazu Hospital, Kisarazu, Chiba, Japan.
Department of Pharmacy, Kameda Medical Center, Kamogawa, Chiba, Japan.
Neuropsychopharmacol Rep. 2024 Dec;44(4):863-866. doi: 10.1002/npr2.12501. Epub 2024 Nov 3.
Ischemic priapism is a rare pathological condition, and delayed intervention can result in irreversible sequelae. Most cases are attributed to the use of antipsychotics. The blockade of α1-adrenergic receptors is thought to be associated with the disease onset, although data supporting this hypothesis are lacking. No consensus regarding the optimal choice of medication is available.
A 59-year-old man with schizophrenia, who had been receiving long-acting injections of risperidone, developed ischemic priapism after receiving paliperidone treatment. Following improvement in ischemic priapism, we administered a combination of aripiprazole and olanzapine, which improved his psychiatric symptoms. We did not observe any recurrence of ischemic priapism.
Switching the antipsychotic drug causing ischemic priapism to patients having a relatively low affinity for α1-adrenergic receptors may enable the treatment of schizophrenia without recurrence of ischemic priapism. In addition to the affinity for α1-adrenergic receptor, differences in metabolic enzyme types and antipsychotic doses may be involved in the occurrence of ischemic priapism. Accumulating evidence is necessary to establish guidelines for selecting medication of patients with ischemic priapism.
缺血性阴茎异常勃起是一种罕见的病理状况，延迟干预可导致不可逆的后遗症。大多数病例归因于抗精神病药物的使用。尽管缺乏支持这一假说的数据，但α1肾上腺素能受体的阻断被认为与该病的发病有关。关于药物的最佳选择尚无共识。
一名59岁的精神分裂症男性患者，长期接受利培酮长效注射治疗，在接受帕利哌酮治疗后发生了缺血性阴茎异常勃起。缺血性阴茎异常勃起改善后，我们给予阿立哌唑和奥氮平联合治疗，改善了他的精神症状。我们未观察到缺血性阴茎异常勃起的复发。
将导致缺血性阴茎异常勃起的抗精神病药物换成对α1肾上腺素能受体亲和力相对较低的药物，可能使精神分裂症得到治疗且缺血性阴茎异常勃起不再复发。除了对α1肾上腺素能受体的亲和力外，代谢酶类型和抗精神病药物剂量的差异可能也与缺血性阴茎异常勃起的发生有关。需要积累更多证据来制定缺血性阴茎异常勃起患者的用药选择指南。
