A Case of Hypersexuality Probably Associated With Lurasidone

Reddy, Balaswamy; Das, Soumitra; Ali, Mustafa

doi:10.1097/jcp.0000000000000934

Cited by 10 publications

(6 citation statements)

References 12 publications

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“…Disproportionalities were significant for all TGAs, satisfying strength, consistency, coherence, and exclusion of bias criteria. The lower but significant intraclass ROR supported the existence of a disease-related susceptibility to ICDs not sufficient to explain the disproportionality of TGAs, lurasidone [a recent antipsychotic for which a case of hypersexuality has already been recorded ( Reddy et al, 2018 )], and olanzapine and ziprasidone (limited to hyperphagia). The high proportion of aripiprazole-related ICD cases in which the primary indication for use was a mood disorder is in line with the hypothesis that depression may be a synergistic risk factor for impulsive-compulsive behaviors ( Cao et al, 2021 ).…”

Section: Discussionmentioning

confidence: 93%

Impulse Control Disorders by Dopamine Partial Agonists: A Pharmacovigilance-Pharmacodynamic Assessment Through the FDA Adverse Event Reporting System

Fusaroli

Raschi

Giunchi

et al. 2022

International Journal of Neuropsychopharmacology

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Background The dopaminergic partial agonism of the so-called third-generation antipsychotics (TGAs: aripiprazole, brexpiprazole, cariprazine) is hypothesized to cause Impulse Control Disorders (ICDs). Relevant warnings by the Food and Drug Administration (FDA) were posted on aripiprazole (2016) and brexpiprazole (2018). Our study investigated the FDA Adverse Event Reporting System (FAERS) and the pharmacodynamic CHEMBL database to further characterize TGA-induced ICDs. Methods We downloaded and pre-processed the FAERS up to December 2020. We adapted Bradford Hill criteria to assess each TGA’s –and secondarily other antipsychotics’– causal role in inducing ICDs (pathological gambling, compulsive shopping, hyperphagia, hypersexuality), accounting for literature and disproportionality. ICDs clinical features were analyzed, and their pathogenesis investigated using receptor affinities. Results 2708 reports of TGA-related ICDs were found, primarily recording aripiprazole (2545 reports, 94%) among the drugs, and gambling (2018 reports, 75%) among the events. Bradford-Hill criteria displayed evidence for a causal role of each TGA, consistent across subpopulations and when correcting for biases. Significant disproportionalities also emerged for lurasidone with compulsive shopping, hyperphagia, and hypersexuality, and olanzapine and ziprasidone with hyperphagia. Time to onset varied between days and years, and positive dechallenge was observed in 20% cases. Frequently co-reported events were economic (50%), obsessive-compulsive (44%), and emotional conditions (34%). 5-HT1A emerged as an additional plausible pathogenetic mechanism. Conclusions We detected an association between TGAs and ICDs and identified a new signal for lurasidone. ICD characteristics are behavior-specific and may impact heavily on life. The role of 5-HT1A-agonism should be further explored.

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Section: Discussionmentioning

confidence: 93%

Impulse Control Disorders by Dopamine Partial Agonists: A Pharmacovigilance-Pharmacodynamic Assessment Through the FDA Adverse Event Reporting System

Fusaroli

Raschi

Giunchi

et al. 2022

International Journal of Neuropsychopharmacology

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“…As there are only a few reported clinical cases of second-generation antipsychotic (SGA)-induced hypersexuality in the medical literature, there are yet no neurobiological or imaging correlates of SGA-induced hypersexuality [ 34 , 39 ]. Nevertheless, an SGA-mediated increase in dopaminergic neurotransmission, a blockade of serotoninergic neurotransmission, or a combined effect, have been suggested as possible pathways for SGA-induced hypersexuality.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Difficulties and Treatment Challenges of a Young Patient With Severe Acute Psychosis and Complete Recovery

Siembida¹,

Mohammed²,

Chishty³

et al. 2022

Cureus

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First break psychosis in young adults is sometimes presented as a dichotomous model of organic or substance-induced etiology or a primary psychiatric disorder on the schizophrenia spectrum and related disorders. In this case of a young adult with a typical age of onset for psychotic symptoms also presenting with cannabis use, excessive vaping, history of COVID-19 illness, pineal cyst, and extreme elevation of blood pressure, the diagnostic certainty decreases. Increased risk of progression to schizophrenia in individuals with cannabis use disorder and genetic loading has been extensively reported in the literature. Clinicians may face significant diagnostic and treatment challenges when managing a patient with severe psychotic symptoms. For the clinicians acutely managing such patients facing these exact questions of unknown certainty in progression to full-blown schizophrenia, we highlight a case of severe acute psychosis and complete recovery on a first-generation antipsychotic and mood stabilizer.

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“…Secondary drug-induced hypersexuality, which is a well-established complication of dopamine-enhancing medications (e.g., antiparkinsonian drugs) (30,31), has also been associated with enhanced activation in similar regions, including the ventral striatum, cingulate, and orbitofrontal cortices (32). As only few clinical cases of SGA-induced hypersexuality have been reported in the medical literature, no evidence on neurobiological or imaging correlates of SGA-induced hypersexuality exists (10)(11)(12)(13)(14)(15)(16)(17). Nevertheless, an SGA-mediated increase in dopaminergic n e u r o t r a n s m i s s i o n , a b l o c k a d e o f s e r o t o n i n e r g i c neurotransmission or a combined effect, have been suggested as possible pathways for SGA-induced hypersexuality (17).…”

Section: Discussionmentioning

confidence: 99%

“…As only few clinical cases of SGA-induced hypersexuality have been reported in the medical literature, no evidence on neurobiological or imaging correlates of SGA-induced hypersexuality exists (10)(11)(12)(13)(14)(15)(16)(17). Nevertheless, an SGA-mediated increase in dopaminergic n e u r o t r a n s m i s s i o n , a b l o c k a d e o f s e r o t o n i n e r g i c neurotransmission or a combined effect, have been suggested as possible pathways for SGA-induced hypersexuality (17).…”

Section: Discussionmentioning

confidence: 99%

“…The dopamine hypothesis, which proposes that a preponderance of dopaminergic activity is implicated in psychosis propagation (8), is considered a plausible model for sexual disinhibition in psychotic patients (9). Interestingly though, a growing number of published cases has recently indicated that hypersexuality may also arise in conjunction with treatment with second-generation antipsychotics (SGA) (10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Episodes of Paraphilic Behavior Possibly Associated With Olanzapine and Aripiprazole Treatment in a Patient With Schizophrenia

et al. 2020

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Background: Hypersexual and paraphilic disorders have been frequently associated with concomitant psychiatric disorders, including schizophrenia. A growing number of published cases has recently indicated that hypersexual behavior may also arise in conjunction with treatment with second-generation antipsychotics. Although hypersexuality has been acknowledged as a possible side effect of antipsychotic treatment with partial dopamine agonists, including aripiprazole, only very few cases of olanzapine-associated hypersexuality have been reported in the literature. Case Presentation: A 29-year-old man presented with delusions of persecution and reference, auditory hallucinations, and negative symptoms, and was diagnosed with paranoid-hallucinatory schizophrenia. One and a half months after initiation of antipsychotic treatment with olanzapine, he developed compulsive sexual behavior and paraphilia, without signs of akathisia. After olanzapine discontinuation, a full remission of the hypersexual behavior was noted within one week, and treatment was switched to risperidone. Due to hyperprolactinemia, adjunct treatment with low-dose aripiprazole was initiated and a severe recurrence of identical hypersexual behavior occurred. The hypersexual behavior resolved completely within a week after aripiprazole discontinuation. Conclusion: This case illustrates that hypersexuality may be a rare adverse effect of treatment with second-generation antipsychotics. Although aripiprazole is a drug with a well-established risk for hypersexuality, the question of whether a causal association between hypersexuality and olanzapine exists remains currently unresolved. As the currently limited amount of available evidence precludes any definitive conclusions, additional research is warranted to delineate the possible neurobiological substrates of hypersexual and paraphilic disorders in patients treated with second-generation antipsychotics.

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A Case of Hypersexuality Probably Associated With Lurasidone

Cited by 10 publications

References 12 publications

Impulse Control Disorders by Dopamine Partial Agonists: A Pharmacovigilance-Pharmacodynamic Assessment Through the FDA Adverse Event Reporting System

Impulse Control Disorders by Dopamine Partial Agonists: A Pharmacovigilance-Pharmacodynamic Assessment Through the FDA Adverse Event Reporting System

Diagnostic Difficulties and Treatment Challenges of a Young Patient With Severe Acute Psychosis and Complete Recovery

Recurrent Episodes of Paraphilic Behavior Possibly Associated With Olanzapine and Aripiprazole Treatment in a Patient With Schizophrenia

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