Risperidone-induced hypersexuality

Abstract

We report hypersexuality in three people with schizophrenia after starting risperidone, with evidence suggesting a possible link between risperidone and the hypersexuality. Mrs X, 71 years old, married once and widowed for 20 years, with no known history of hypersexuality, was started on risperidone 25 mg intramuscular (IM) injection three times weekly. Two months later, she complained of 'having to' masturbate two to three times daily without being able to orgasm, lactating and losing 'too much fluids' vaginally. She became fixated on an imagined romantic relationship, took off her old wedding ring and attempted to hire a tourist boat for a wedding reception she planned for herself. Risperidone was stopped after 6 months and switched to pipotiazine 25 mg IM injection, three times weekly, after a washout period of 5 days. Features of hypersexuality waned and resolved 10 days later, with no recurrence. A 53-year-old man, Mr Y, took clozapine for 14 years before it was stopped due to neutropenia. He was started on oral risperidone 2 mg twice daily and developed thoughts fixated on masturbation, erections and needing a sexual partner. Risperidone was stopped and olanzapine initiated, with no disclosed sexual content in his thoughts from the next day. Hypersexual thoughts recurred on overnight leave. During the second overnight leave, he behaved indecently towards two young women in a park and was charged with indecent assault. A 23-year-old man, Mr Z, was re-titrated on risperidone after a period of non-adherence. From the day after oral risperidone was titrated up to 5 mg daily, when risperidone 50 mg IM injection was also administered, ten episodes of hypersexual behaviour were documented in a period of 10 days, including sexually disinhibited speech, propositioning and exhibitionism. Risperidone was tapered and stopped, and Mr Z was started on flupentixol 20 mg IM injection. There were no further episodes of hypersexual behaviour other than one episode of disinhibited speech when the risperidone was 3 mg daily. Mr Z was later readmitted and maintained on flupentixol 20 mg IM injection. No hypersexual behaviour occurred during this admission. None of these people were hypomanic. Bipolar disorder was excluded. Prolactin levels on risperidone were 2737 IU/l for Mrs X, and 468 IU/l for Mr Y. A review of the literature showed similar case reports. 1,2 Antagonism of 5-HT 2A receptors by risperidone, which increases dopamine release in the prefrontal cortex, and antagonism of alpha-2 adrenergic receptors, which disinhibits noradrenergic neurons and plays a role in genital stimulation, 3,4 could explain this effect. A similar mechanism of alpha-2 adrenergic blockade has been postulated for yohimbine. The expression of these receptors in individuals may affect vulnerability. Conventional

Sexuelle Enthemmung bei Therapie mit Aripiprazol

“…ejakulierendes Verhalten führte [21]. Dies allerdings dazu kontrastierend, dass bei dem beschriebenen Fall einer Hypersexualität unter Risperidon der 5-HT 2A -Antagonismus dafür verantwortlich gemacht wird, dass die Hypersexualität aufgetreten ist, da durch den 5-HT 2A -Rezeptoren-Antagonismus die präfrontal erhöhte Dopaminausschüttung in die-sem Fall für die Hypersexualität verantwortlich gemacht wird [1]. Zusammenfassend scheint der in Anbetracht des wiederholt aufgetretenen pathologischen Spielens bzw.…”

“…Davidson et al berichten über Fälle von Hypersexualität, die durch Risperidon induziert wurden, bei einem 23-jährigen Mann, einem 53-jährigen Mann sowie einer 71 Jahre alten Frau. Sie vertreten dabei die These, dass der ausgeprägte 5-HT 2A -Rezeptoren-Antagonismus des Risperidon bezüglich der Hypersexualität eine kausale Rolle spielt in der Form, dass es bedingt dadurch zu einem Dopaminanstieg präfrontal kommen würde, zudem würde der Antagonismus am Alpha2-Rezeptor dazu führen, dass adrenerge Neuronen enthemmt werden, welche wiederum eine Rolle bei genitaler Stimulation spielen würden [1]. Gomez berichtet zudem über das Auftreten einer Hypersexualität bei 2 Männern im Alter von 25 und 28 Jahren, die Fluphenazindecanoat als Depotmedikament erhalten haben [2].…”

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

“…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).…”

“…On the other hand, only very few cases of risperidoneinduced hypersexuality have been reported in the medical literature (16), while results from a randomized clinical trial showed less sexual dysfunction in patients treated with olanzapine compared to risperidone (38). Moreover, accumulating epidemiological evidence suggests that among the currently available antipsychotics, risperidone is the antipsychotic most frequently related to hyposexuality, amenorrhoea, and galactorrhoea, and is closely followed by haloperidol (39,40).…”

“…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).…”