SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Poster Presentations
Case: A 32 year old single man, who has not been a soldier, presented with aggressive, contamination, sexual, need for symmetry, somatic
obsessions; checking, washing, counting, need for confession compulsions; thinking he was followed by the secret service, sense of anal
burning, and inability to sleep. His mood and affect were anxious, speech increased, and associations were dispersed. He had a history
of sexual abuse by his brother. Obsessive symptoms started at the age of 12, feeling some problems about his gender, anxiety about
his future, sleeplessness and not talking to people at 16. After 15 days he had talked about the sexual abuse with her mother, who died
because of a myocardial infarction and he started to blame himself. He lost 15 kg in 6 months and started to experience auditory and
visual hallucinations. He was treated with many antipsychotics, SRIs, TCAs, and benzodiazapines. He had a hypomanic attack under the
treatment of aripiprazole. In the Rorschach test he showed schizoid reactions and dissociation in 2003. He was hospitalized 2 times. At his
last visit his treatment was sertraline 200 mg/day and olanzapine 5 mg/day. The appearance of the psychotic symptoms occurred, when
the depressive symptoms started. Olanzapine was increased to 10 mg/day after sleeplessness and psychotic symptoms flared up. The last
Rorschach test assessed the patient as being in pregenital organization and requiring close control of affective and psychotic symptoms.
Discussion: The clinical observations emphasize the interest in OCD patients with psychosis, who are neglected often. The shift from
an obsession to delusion is triggered by stress and is generally transient (2). The strong association between psychotic features and
depressive features in OCD may also have important implications in the treatment strategies (3). OCD represents a psychopathological
spectrum varying along a continuum of insight and requires careful clinical observation and treatment.
Key words: Obsesive compulsive disorder, psychosis, sexual trauma
References:
1. Eisen JL, Rasmussen SA. Obsessive-compulsive disorder with psychotic features. J Clin Psychiatry1993; 54(10):373-379.
2. Özerdem A. Obsesif-Kompulsif Bozukluk ve Psikoz Üzerine Bir Gözden Geçirme. Klinik Psikiyatri 1998;2:98-102
3. Khess CDJ, Das J, Parial A et. al. Obsesive Compulsive Disorder with psychotic features.Hong Kong J Psychiatry1999;9(1): 21-25
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S166-7
[PP-077] Ref. No: 304
Priapism associated with zuclopenthixol treatment: A case report
Alparslan Asil Budaklı, Mehmet Alpay Ateş, Ayhan Algül
GATA Haydarpasa Education Hospital, İstanbul, Turkey
E-mail: asil.budakli@gmail.com
Background: Priapism is pathologically prolonged and painful penis erection, usually without sexual desire or stimulation. Priapism is
classified as veno occlusive low flow (ischemic) and arterial high flow (non ischemic). The low flow–ischemic type is the most common
type of priapism and if it is untreated, leads to irreversible ischemic cavernosal tissue changes. The causes include generally certain
medications, although the mechanism for drug-induced priapism is unknown (1-4).
Here we discuss, in light of the literature, a 62-year-old- male paranoid schizophrenic patient, who had been treated with oral
zuclopenthixol since 1995 and developed an acute and painful erection.
Case: It was revealed that the patient, who presented with priapism, that hadcontinued for a week, took zuclopenthixol 20 mg a day for
2 days prior to the veno occlusive priapism.
After emergency urological treatment, the psychiatric examination revealed paranoid psychosis. Zuclopenthixol was stopped and
risperidone 6 mg/day and biperiden 4 mg/day were prescribed. A week later he was discharged from hospital.
Discussion: In many cases it has been reported that psychotropic drugs may cause priapism. Some of them are trazadone, chlorpromazine,
haloperidol, zuclopenthixol, olanzapine, ziprasidone, and clozapine (3). Although the mechanism of priapism associated with antipsychotics is not
clear, it is thought to be related to blockage that is mediated by the alpha receptors in the corpora cavernosa of the penis (3). Similarly, the capacity
of zuclopenthixol to induce priapism is thought to be due to its antagonist activity on alpha-1 adrenergic receptors (1,3).
Therefore it is important that clinicians must take notice of side effects of antipsychotics, including rarely seen ones.
Key words: Zuclopenthixol, priapism, side effect, drug induced, antipsychotics
References:
1. J Salado, A Blazquez, R Diaz-Simon, F Lopez-Munoz, C Alamo and GG Rubio Priapism associated with zuclopenthixol: Ann Pharmacother June 1, 2002 vol. 36 no. 6 1016-1018
2. Brichart N, DElavierre D, Peneau M, İbrauhim H, Mallek A. Priapism induced with antipsychotic medications: a series of four patients. Prog.Urol. 2008 Nov; 18 (10):
699-73.Epub 2008 Jun 10.
3. Sood S, James W and Bailon MJ. Priapism associated with atypical antipsychotic medications. a review. Int Clin Psychopharmacol 2008; 23: 9-17
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