Risperidone-Induced Enuresis in Two Children with Autistic Disorder

Abstract

Although the pathophysiology of antipsychotic-induced enuresis remains unclear, a number of mechanisms including alpha(1)-adrenergic blockade, dopamine blockade, and antimuscarinic effects has been proposed. Olanzapine has lower alpha(1)-adrenergic and dopaminergic blockade properties, thus changing risperidone to olanzapine may be an alternative modality in risperidone-induced enuresis when antipsychotic treatment is crucial. Clinicians should be more vigilant about screening for this side effect, especially in younger population with developmental disabilities.

Tolerability, Safety, and Benefits of Risperidone in Children and Adolescents with Autism: 21-Month Follow-up After 8-Week Placebo-Controlled Trial

“…We did observe more excessive appetite (42.1% vs. 20.0%) and more enuresis/urinary problems (19.6% vs. 0.0%) among the subjects taking risperidone. The higher percentage of children with excessive appetite (42%) is consistent with the literature and with weight gain findings in other studies (Martin et Case reports have noted enuresis with risperidone (both daytime and nocturnal) in children with PDDs (Hergüner and Mukaddes 2007;Ghanizadeh et al 2008;Cop et al 2011), and there is at least one report of enuresis associated with aripiprazole as well (Bozkurt and Abali 2011). The frequency of this associated event (especially in patients with developmental disabilities) suggests that clinicians should anticipate the possibility, discuss it with parents, and monitor explicitly for such changes.…”

Desmopressin Use in the Treatment of Aripiprazole-Induced Nocturnal Enuresis in a Child Diagnosed with Autistic Disorder

“…A great number of cases in the past have reported clozapineinduced (Frankenburg et al 1996;Praharaj and Arora 2007), risperidone-induced (Hergüner and Mukaddes 2007), and olanzapineinduced (Vernon et al 2000) nocturnal enuresis. The occurrence mechanism of antipsychotic-induced enuresis has not yet been fully presented (Fuller et al 1996).…”

“…The occurrence mechanism of antipsychotic-induced enuresis has not yet been fully presented (Fuller et al 1996). Possible mechanisms for antipsychotic-induced enuresis are a-1 adrenergic blockers (Hergüner and Mukaddes 2007), decreased dopaminergic activity in the basal ganglia (Ambrosini 1984), overflow incontinence following urinary retention with antimuscarinic (M4) effect (Barnes et al 2012), pudendal reflex blockage with 5 HT2 and 5 HT3 antagonism (et al 2006), activity increase in detrusor muscle with 5 HT4 antagonism (Tonini and Candura 1996), and sedation effect that increases the deepness of sleep (Ambrosini 1984). In addition, nocturnal enuresis induced by diabetes mellitus polyuria caused by long-term antipsychotic use has been presented as another possible mechanism (Ambrosini 1984).…”

Prevalence of enuresis in a community sample of children and adolescents referred for outpatient clinical psychological evaluation: Psychiatric comorbidities and association with intellectual functioning

“…Given the reported association between enuresis and low self esteem (Butler 2004, Heap 2004), treatment of enuresis may reduce or alleviate disturbances of mood, which were found to be the highest comorbid diagnoses in this study. Furthermore, recent case reports have suggested that enuresis in children may be induced by resperidone (Herguner and Mukaddes 2007) and serotonin-selective re-uptake inhibitors , psychotropic medications commonly prescribed to ameliorate psychological disturbances. Literature is lacking concerning the potential negative side effects and interactions of other medications prescribed for the management of psychiatric symptoms in children and adolescents, particularly the various psychostimulants utilised in the treatment of ADHD.…”