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

Abstract

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.

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

“…The interaction between brain monoaminergic (i.e., adrenergic and serotoninergic) receptors and sex hormones (i.e., testosterone) is considered pivotal for sexual responses and behaviors. Enhanced dopaminergic neurotransmission is typically associated with sexual excitation, while enhanced serotonergic neurotransmission with sexual inhibition [ 34 - 36 ].…”

“…Secondary drug-induced hypersexuality due to dopamine-enhancing medications like antiparkinsonian drugs is well-known and has been associated with enhanced activation of the ventral striatum, cingulate, and orbitofrontal cortices, which are similar to those areas of the brain that are related to primary hypersexual disorders [ 34 , 37 ].…”

“…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.…”

A Case of Hypersexuality in a Patient Receiving Aripiprazole for Schizophrenia

“…Olanzapine has also been reported to cause hypersexuality in individuals and with return to baseline once the medication has been discontinued [ 7 ]. It is interesting to note that the patient presented here took olanzapine previously for four years without any complaints of hypersexuality.…”

“…Aripiprazole, however, has an agonist activity at the dopamine receptor which can induce compulsive behaviors such as gambling, shopping, and hypersexuality [2]. There are case reports in the literature of hypersexuality following aripiprazole treatment [2][3][4][5][6][7]. In these cases, hypersexuality symptoms arose days to weeks after administration of the medication.…”