Book contents
- The Clozapine Handbook
- The Clozapine Handbook
- Copyright page
- Additional material
- Contents
- Foreword
- Introduction
- 1 The Efficacy Story: Treatment-Resistant Schizophrenia, Psychogenic Polydipsia, Treatment-Intolerant Schizophrenia, Suicidality, Violence, Mania and Parkinson’s Disease Psychosis
- 2 Addressing Clozapine Positive Symptom Nonresponse in Schizophrenia Spectrum Patients
- 3 Initiating Clozapine
- 4 Discontinuing Clozapine and Management of Cholinergic Rebound
- 5 Binding Profile, Metabolism, Kinetics, Drug Interactions and Use of Plasma Levels
- 6 Understanding Hematologic Monitoring and Benign Ethnic Neutropenia
- 7 Managing Constipation
- 8 Managing Sedation, Orthostasis and Tachycardia
- 9 Managing Sialorrhea
- 10 Managing Seizure Risk and Stuttering
- 11 Managing Metabolic Adverse Effects
- 12 Fever, Myocarditis, Interstitial Nephritis, DRESS, Serositis and Cardiomyopathy
- 13 Managing Enuresis and Incontinence, Priapism, Venous Thromboembolism, Neuroleptic Malignant Syndrome, Tardive Dyskinesia and Obsessive Compulsive Disorder
- 14 Eosinophilia, Leukocytosis, Thrombocytopenia, Thrombocytosis, Anemia, Hepatic Function Abnormalities
- 15 Special Topics: Child and Adolescent Patients, Elderly Patients, Patients With Intellectual Disability, Pregnancy and Risk for Major Congenital Malformation, Lactation, Overdose, Postmortem Redistribution
- Index
- References
13 - Managing Enuresis and Incontinence, Priapism, Venous Thromboembolism, Neuroleptic Malignant Syndrome, Tardive Dyskinesia and Obsessive Compulsive Disorder
Published online by Cambridge University Press: 19 October 2021
Book contents
- The Clozapine Handbook
- The Clozapine Handbook
- Copyright page
- Additional material
- Contents
- Foreword
- Introduction
- 1 The Efficacy Story: Treatment-Resistant Schizophrenia, Psychogenic Polydipsia, Treatment-Intolerant Schizophrenia, Suicidality, Violence, Mania and Parkinson’s Disease Psychosis
- 2 Addressing Clozapine Positive Symptom Nonresponse in Schizophrenia Spectrum Patients
- 3 Initiating Clozapine
- 4 Discontinuing Clozapine and Management of Cholinergic Rebound
- 5 Binding Profile, Metabolism, Kinetics, Drug Interactions and Use of Plasma Levels
- 6 Understanding Hematologic Monitoring and Benign Ethnic Neutropenia
- 7 Managing Constipation
- 8 Managing Sedation, Orthostasis and Tachycardia
- 9 Managing Sialorrhea
- 10 Managing Seizure Risk and Stuttering
- 11 Managing Metabolic Adverse Effects
- 12 Fever, Myocarditis, Interstitial Nephritis, DRESS, Serositis and Cardiomyopathy
- 13 Managing Enuresis and Incontinence, Priapism, Venous Thromboembolism, Neuroleptic Malignant Syndrome, Tardive Dyskinesia and Obsessive Compulsive Disorder
- 14 Eosinophilia, Leukocytosis, Thrombocytopenia, Thrombocytosis, Anemia, Hepatic Function Abnormalities
- 15 Special Topics: Child and Adolescent Patients, Elderly Patients, Patients With Intellectual Disability, Pregnancy and Risk for Major Congenital Malformation, Lactation, Overdose, Postmortem Redistribution
- Index
- References
Summary
Along with metabolic problems, there are a number of other adverse effects not unique to clozapine, but which present unique treatment considerations given the absence of alternatives to clozapine for many patients. An important part of prescribing clozapine is developing patient rapport, and conveying the message that embarrassing adverse effects such as nocturnal enuresis and incontinence can occur in up to 40% of patients, and will be addressed, especially if persistent. Normalizing the experience through education and elucidation of a prior history of such problems is a helpful means of initiating the discussion, and imparting to patients that this is not an unusual issue, and that there are standard approaches to these problems. Nonetheless, direct inquiry is the best method for elucidating complaints about enuresis or incontinence. Large studies of clozapine treatment discontinuation often cite “patient preference” when no specific reason is provided. Given the high prevalence of enuresis early in treatment, and the fact that it may persist in 20% of patients, the absence of this complaint from the literature on clozapine discontinuation suggests a lack of communication with providers.
- Type
- Chapter
- Information
- The Clozapine HandbookStahl's Handbooks, pp. 242 - 257Publisher: Cambridge University PressPrint publication year: 2019
References
Harrison-Woolrych, M., Skegg, K., Ashton, J., et al. (2011). Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: Comparative cohort study. British Journal of Psychiatry, 199, 140–144.Google Scholar
Nielsen, J., Correll, C. U., Manu, P., et al. (2013). Termination of clozapine treatment due to medical reasons: When is it warranted and how can it be avoided? Journal of Clinical Psychiatry, 74, 603–613.Google Scholar
Legge, S. E., Hamshere, M., Hayes, R. D., et al. (2016). Reasons for discontinuing clozapine: A cohort study of patients commencing treatment. Schizophrenia Research, 174, 113–119.Google Scholar
Kashyap, G. L., Nayar, J., Bashier, A., et al. (2013). Treatment of clozapine-induced priapism by goserline acetate injection. Therapeutic Advances in Psychopharmacology, 3, 298–300.Google Scholar
Citrome, L., McEvoy, J. P. and Saklad, S. R. (2016). Guide to the management of clozapine-related tolerability and safety concerns. Clinical Schizophrenia & Related Psychoses, 10, 163–177.CrossRefGoogle Scholar
Manu, P., Lapitskaya, Y., Shaikh, A., et al. (2018). Clozapine rechallenge after major adverse effects: Clinical guidelines based on 259 cases. American Journal of Therapeutics, 25, e218–e223.Google Scholar
Meyer, J. M. (2016). Forgotten but not gone: New developments in the understanding and treatment of tardive dyskinesia. CNS Spectrums, 21, 13–24.CrossRefGoogle Scholar
Grillault Laroche, D. and Gaillard, A. (2016). Induced obsessive compulsive symptoms (OCS) in schizophrenia patients under atypical antipsychotics (AAPs): Review and hypotheses. Psychiatry Research, 246, 119–128.CrossRefGoogle ScholarPubMed
Bonney, W. W., Gupta, S., Hunter, D. R., et al. (1997). Bladder dysfunction in schizophrenia. Schizophrenia Research, 25, 243–249.CrossRefGoogle ScholarPubMed
Sinha, P., Gupta, A., Reddi, V. S., et al. (2016). An exploratory study for bladder dysfunction in atypical antipsychotic-emergent urinary incontinence. Indian Journal of Psychiatry, 58, 438–442.Google Scholar
Lin, C. C., Bai, Y. M., Chen, J. Y., et al. (1999). A retrospective study of clozapine and urinary incontinence in Chinese in-patients. Acta Psychiatrica Scandinavica, 100, 158–161.Google Scholar
Yusufi, B., Mukherjee, S., Flanagan, R., et al. (2007). Prevalence and nature of side effects during clozapine maintenance treatment and the relationship with clozapine dose and plasma concentration. International Clinical Psychopharmacology, 22, 238–243.Google Scholar
Callegari, E., Malhotra, B., Bungay, P. J., et al. (2011). A comprehensive non-clinical evaluation of the CNS penetration potential of antimuscarinic agents for the treatment of overactive bladder. British Journal of Clinical Pharmacology, 72, 235–246.Google Scholar
Foo, K. T. (2010). Decision making in the management of benign prostatic enlargement and the role of transabdominal ultrasound. International Journal of Urology, 17, 974–979.CrossRefGoogle ScholarPubMed
Hecht, S. L. and Hedges, J. C. (2016). Diagnostic work-up of lower urinary tract symptoms. Urology Clinics of North America, 43, 299–309.CrossRefGoogle ScholarPubMed
Syan, R. and Brucker, B. M. (2016). Guideline of guidelines: Urinary incontinence. BJU International, 117, 20–33.Google Scholar
Shigehara, K. and Namiki, M. (2016). Clinical management of priapism: A review. World Journal of Men’s Health, 34, 1–8.CrossRefGoogle ScholarPubMed
Doufik, J., Otheman, Y., Khalili, L., et al. (2014). [Antipsychotic-induced priapism and management challenges: a case report]. Encephale, 40, 518–521.Google Scholar
Donizete da Costa, F., Toledo da Silva Antonialli, K. and Dalgalarrondo, P. (2015). Priapism and clozapine use in a patient with hypochondriacal delusional syndrome. Oxford Medical Case Reports, 2015, 229–231.Google Scholar
Raja, M. and Azzoni, A. (2006). Tardive priapism associated with clozapine. A case report. Pharmacopsychiatry, 39, 199–200.CrossRefGoogle ScholarPubMed
de Nesnera, A. (2003). Successful treatment with clozapine at higher doses after clozapine-induced priapism. Journal of Clinical Psychiatry, 64, 1394–1395.Google ScholarPubMed
Barbui, C., Conti, V. and Cipriani, A. (2014). Antipsychotic drug exposure and risk of venous thromboembolism: A systematic review and meta-analysis of observational studies. Drug Safety, 37, 79–90.CrossRefGoogle ScholarPubMed
Jonsson, A. K., Schill, J., Olsson, H., et al. (2018). Venous thromboembolism during treatment with antipsychotics: A review of current evidence thromboembolism during treatment with antipsychotics: a review of current evidence. CNS Drugs, 32, 47–64.CrossRefGoogle ScholarPubMed
Allenet, B., Schmidlin, S., Genty, C., et al. (2012). Antipsychotic drugs and risk of pulmonary embolism. Pharmacoepidemiology and Drug Safety, 21, 42–48.CrossRefGoogle ScholarPubMed
Maly, R., Masopust, J., Hosak, L., et al. (2008). Assessment of risk of venous thromboembolism and its possible prevention in psychiatric patients. Psychiatry and Clinical Neurosciences, 62, 3–8.CrossRefGoogle ScholarPubMed
Khorana, A. A. and Weitz, J. I. (2018). Treatment challenges in venous thromboembolism: an appraisal of rivaroxaban studies. Thrombosis and Haemostasis, 118, S23–S33.Google Scholar
Hollenhorst, M. A. and Battinelli, E. M. (2016). Thrombosis, hypercoagulable states, and anticoagulants. Primary Care, 43, 619–635.Google Scholar
Gurrera, R. J., Caroff, S. N., Cohen, A., et al. (2011). An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. Journal of Clinical Psychiatry, 72, 1222–1228.CrossRefGoogle ScholarPubMed
Gurrera, R. J., Mortillaro, G., Velamoor, V., et al. (2017). A validation study of the International Consensus Diagnostic Criteria for Neuroleptic Malignant Syndrome. Journal of Clinical Psychopharmacology, 37, 67–71.CrossRefGoogle ScholarPubMed
Pope, H. G., Jr., Cole, J. O., Choras, P. T., et al. (1986). Apparent neuroleptic malignant syndrome with clozapine and lithium. Journal of Nervous and Mental Disorders, 174, 493–495.CrossRefGoogle ScholarPubMed
Cheng, M., Gu, H., Zheng, L., et al. (2016). Neuroleptic malignant syndrome and subsequent clozapine-withdrawal effects in a patient with refractory schizophrenia. Neuropsychiatric Disease and Treatment, 12, 695–697.Google Scholar
Simpson, G. M. and Meyer, J. M. (1996). Dystonia while changing from clozapine to risperidone. Journal of Clinical Psychopharmacology, 16, 260–261.Google Scholar
Ryu, S., Yoo, J. H., Kim, J. H., et al. (2015). Tardive dyskinesia and tardive dystonia with second-generation antipsychotics in non-elderly schizophrenic patients unexposed to first-generation antipsychotics: A cross-sectional and retrospective study. Journal of Clinical Psychopharmacology, 35, 13–21.CrossRefGoogle ScholarPubMed
Bhidayasiri, R., Fahn, S., Weiner, W. J., et al. (2013). Evidence-based guideline: Treatment of tardive syndromes: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 81, 463–469.CrossRefGoogle Scholar
Dykema, L. R. (2018). Abrupt improvement in obsessive-compulsive symptoms upon discontinuation of clozapine. Journal of Clinical Psychopharmacology, 38, 88–89.Google Scholar
Fuller, M. A., Borovicka, M. C., Jaskiw, G. E., et al. (1996). Clozapine-induced urinary incontinence: Incidence and treatment with ephedrine. Journal of Clinical Psychiatry, 57, 514–518.Google Scholar
Hanes, A., Lee Demler, T., Lee, C., et al. (2013). Pseudoephedrine for the treatment of clozapine-induced incontinence. Innovations in Clinical Neuroscience, 10, 33–35.Google ScholarPubMed
Sarma, S., Ward, W., O’Brien, J., et al. (2005). Severe hyponatraemia associated with desmopressin nasal spray to treat clozapine-induced nocturnal enuresis. Australian and New Zealand Journal of Psychiatry, 39, 949.Google Scholar