Ziprasidone Associated Sexual Hyperarousal: A Case Report Hanife
1 KOCAKAYA ,
Zekiye
1 ÇELİKBAŞ ,
Mesut
2 YILDIZ ,
Emrah
2 SONGUR ,
Sedat
2 BATMAZ
1 MD,
Psychiatry Resident, Gaziosmanpasa University, School of Medicine, Department of Psychiatry, Tokat, Turkey. 2 MD, Assistant Professor of Psychiatry, Gaziosmanpasa University, School of Medicine, Department of Psychiatry, Tokat, Turkey.
Background:
Sexual dysfunction is a common condition in patients taking antipsychotic medication, with a reported prevalence of 45-80% in males, and 30-80% in females (1). Ziprasidone is an atypical antipsychotic with low rates of side effects. Ziprasidone induced spontaneous orgasm (2) and priapism (3) were reported in the literature. Here, we report a case of increased sexual arousal after ziprasidone treatment.
Case:
A twenty-three-year old, single, female patient was admitted to our clinic with reference and persecutory delusions (e.g. being followed by others, her thoughts withdrawn of her mind by others), and auditory and visual hallucinations (e.g. images that men want to be with her). Her complaints had been persisting for about one month. Her mental status examination revealed the following findings: attention and concentration were diminished, speech was slow, delusions of reference and other Schneiderian first-rank symptoms (e.g. thought withdrawal), and auditory and visual hallucinations were present, reality testing was impaired, judgment and abstract thinking skills partially preserved. Olanzapine 10 mg/day was started with a provisional diagnosis of schizophreniform disorder. Yet, the patient was not able to tolerate this olanzapine treatment due to side effects, i.e. sedation, dry mouth and weakness. Therefore, her treatment was changed to risperidone 2 mg/day after one week. The patient complained of psychomotor slowing and dysarthria after one month of treatment with risperidone. Subsequently, risperidone was switched to aripiprazole 10 mg/day, and the dose was increased to 20 mg/day afterwards. The aripiprazole treatment caused an exacerbation in psychotic symptoms, and had to be stopped. The patient was then started on ziprasidone 40 mg/day and the dosage was increased gradually. After increasing the ziprasidone dose to 60 mg/day, her psychotic symptoms diminished progressively, but she complained about increased sexual arousal; which was more prominent at nights. No other symptoms suggestive of a manic / hypomanic episode were present, and no other medical causes relevant for a hormonal change were detected. The patient also said the she had never expressed this type of sexual side effect with her previous antipsychotics, or that she never had a similar period in her life previously. Ziprasidone was tapered slowly, and quetiapine 300 mg/day was started. Unfortunately, the patient stopped taking quetiapine as well due to weight gain, i.e. 9 kg in a month. She indicated that increased sexual arousal disappeared after the cessation of ziprasidone. The treatment was changed to haloperidol 10 mg/day and biperiden 4 mg/day. There was significant improvement in the patient's psychotic symptoms after this treatment.
Discussion:
Ziprasidone has been reported to cause sexual dysfunction at a much lower rate than other antipsychotics. A case of spontaneous orgasm and a case of priapism were reported with the clinical use of ziprasidone. To the best of our knowledge, this is the first case report of increased sexual arousal with ziprasidone. Ziprasidone has the potential to cause sexual side effects. Psychiatrists should be cautious about the sexual side effects of ziprasidone.
References:
[1] Yeon Won Park, Yooseok Kim, and Jun Ho Lee. Antipsychotic-Induced Sexual Dysfunction and Its Management. World J Mens Health. Dec 2012; 30(3): 153–159. [2] Boora K, Chiappone K, Dubovsky S, Xu J. Ziprasidone-induced spontaneous orgasm. J Psychopharmacol. 2010 Jun;24(6):947-8. [3] Karamustafalioglu N, Kalelioglu T, Tanriover O, Gungor FC, Genc A and Ilnem C. A Case Report of Priapism Caused by Ziprasidone. Psychiatry Investig 2013;10:425-427.
Conflict of interest: None.
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