There was also no history of urinary tract symptom. Neurological examination did not reveal any relevant findings and urine cultures were negative. To address the issue, the authors reduced the nightly doses of quetiapine changing it to 50 mg in the morning, mg at noon, and mg at night. In both of the cases outlined above, quetiapine was the most likely cause of urinary incontinence, since UI symptoms started after the patients started to take quetiapine and disappeared shortly after the dosage reduction.
Urinary incontinence is a rarely reported side effect of quetiapine. Interestingly, some articles have stated that replacement of risperidone with a low potent peripheral a-1 adrenergic antipsychotic like quetiapine and olanzapine is a potentially good therapeutic strategy for dealing with risperidone-induced urinary incontinence 7 , Quetiapine-induced urinary incontinence seems to be as rare as urinary incontinence caused by other neuroleptics. In , a study compared the prevalence of nocturnal enuresis in patients treated with clozapine against those treated with risperidone, olanzapine, or quetiapine.
The pathophysiology of antipsychotic-induced urinary incontinence is still unclear, yet several mechanisms have been proposed. One of these suggested mechanisms is associated with anticholinergic effects of atypical antipsychotic on the bladder, which leads to inhibition of detrusor contraction with consequent overflow of urine A general explanation for neuroleptic-induced urinary incontinence is that it is caused mostly by alpha—adrenergic blockade, moderately by dopamine blockade, and minimally by cholinergic effects on the bladder Urinary incontinence and enuresis associated with alpha-adrenergic blockade causes urinary sphincter relaxation in anatomically predisposed patients 1.
The absence of other systemic hypo adrenergic effects such as hypertension shows that alpha-adrenergic blockade cannot accurately explain urinary incontinence. The early speculations about neuroleptic-induced UI leads to a centrally mediated mechanism 2. An experimental study on animals has shown that the olanzapine and to a lesser extent risperidone, effect a number of voiding parameters, which collectively lead to reduced micturition volume, increased residual volume of the bladder, and decreased activity of external urethral sphincter. The study elucidated that the mechanism of these effects may be more central rather than peripheral In a study on participants, who experienced UI after treatment with an atypical antipsychotic, urodynamic examinations showed that one-third of participants had detrusor over-activity, while another one-third had reduced bladder compliance It was then suggested that neuroleptics may cause UI through several mechanisms, and there may be different individual susceptibilities.
In support of this belief, case reports and case series have shown that clozapine-induced enuresis could be successfully treated with anticholinergics trihexyphenidyl and oxybutynin , alpha-1 agonists ephedrine , antidepressants amitriptyline , desmopressin, or by adding a second antipsychotic to clozapine aripiprazole 16 - As postulated in a case report, central dopaminergic—serotonergic activity combined with peripheral alpha—adrenergic blockade may act synergistically and predispose a patient to urinary dysfunction.
The lower urinary tract is controlled by several neurotransmitter pathways, to which antipsychotics have affinity.
- Interval Semigroups.
- Adults & Bedwetting?
- Caught You Watching!: Voyeurs Who End Up Joining In (Unusual Encounters: Special Ops/Sex With Strangers)?
- Some Of My People.
- Ready to Trust?
- Not My Problem.
These neurotransmitters include serotonin which facilitates urine storage and inhibits voiding , dopamine blockade in the basal ganglia, which may cause involuntary enuresis , acetylcholine which has a direct effect on bladder contractility and adrenergic which has significant impact on the regulation of bladder outlet function, especially in males.
The sedative effects of antipsychotics may lead to the inability of the patients to wake-up, leading to enuresis Quetiapine is also sedative, and it can therefore be argued that some patients may enjoy a deeper sleep, thus failing to notice the need for voiding. This hypothesis cannot properly explain this urinary incontinence because deep sleep is not exclusively sedation-induced, and is by no means strongly associated with enuresis 6.
In the cases reported in this paper, the improvement of urinary incontinence after administration of lower nightly doses of quetiapine and shifting the dose to day hours may support the hypothesis of the sedative role of these drugs in developing urinary incontinence. Urinary incontinence is a stressful and awkward side effect of antipsychotics. Once left untreated, it may lead to noncompliance of patients undergoing distress.
The prevalence of urinary incontinence and enuresis may be under-reported.
This side effect has a profound impact on both patients and their caregivers. The ignominious and uncomfortable nature of this symptom, coupled with constant need for cleaning and laundering the bed linens and the ongoing concern about the cause of symptoms, may lead to mental exhaustion and subjective burden.
This can leave significantly adverse effects on the quality of life of a patient. Mental health clinicians and personnel should directly ask patients about this issue, explain it to them, and discuss the options available to patients for managing symptoms. Complications of chlorpromazine therapy in mental-hospital patients.
Urinary incontinence in patients receiving neuroleptics. J Clin Psychiatry. Shapiro AK. Pimozide-induced enuresis. Am J Psychiatry. Enuresis and incontinence occurring with neuroleptics. Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: comparative cohort study. Br J Psychiatry. Nocturnal enuresis with antipsychotic medication. Ghanizadeh A, Kianpoor M. Cessation of risperidone-induced incontinency by valproate in a child with pervasive developmental disorder.
Prim Psychiatry. Olanzapine-induced double incontinence.
Bed wetting (Nocturnal Enuresis)
Indian J Med Sci. Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic. Clark N. Conventional antipsychotic and clozapine-induced urinary incontinence.
What can I as a parent do to help stop bedwetting?
J Coll Psychiatr Neurolog Pharma. Bozkurt H, Abali O. Aripiprazole-induced enuresis in a child with autistic disorder. Arch Neuropsy. Three cases of risperidone-induced enuresis. Schizophr Res. Clozapine and urinary incontinence. Int Clin Psychopharmacol. Effects of two atypical neuroleptics, olanzapine and risperidone, on the function of the urinary bladder and the external urethral sphincter in anesthetized rats. Voiding dysfunction: What can radiologists tell patients and pediatric urologists? Pediatric urinary incontinence: Classification, evaluation, and management.
Afr J Urol ; Lettgen B. Differential diagnoses for nocturnal enuresis. Scand J Urol Nephrol Suppl ; Nocturnal Enuresis. Differential Diagnosis. Nocturnal enuresis: Current concepts. Colley W. Use of frequency volume charts and voiding diaries. Nurs Times ; Kanitkar M, Ramamurthy HR. Bed wetting — Silent suffering: An approach to enuresis and voiding disorders in children.
Kanitkar M. Practical approach to nocturnal enuresis and voiding dysfunction. Indian J Pract Pediatr ; Predictors for a positive outcome of adapted clinical dry bed training in adolescents and adults with enuresis.
Bagga A. Management of enuresis. Bulletin of Indian pediatric nephrology group. Night diuresis stimulation increases efficiency of alarm intervention.
Simple behavioural interventions for nocturnal enuresis in children. Management of nocturnal enuresis. BMJ ;f Efficacy of acupuncture in children with nocturnal enuresis: A systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med ; Alarm interventions for nocturnal enuresis in children.
Parent-administered modified dry-bed training for childhood nocturnal enuresis: Evidence for superiority over urine-alarm conditioning when delivery factors are controlled. Behav Intervent ; High initial efficacy of full-spectrum therapy for nocturnal enuresis in children and adolescents.
BJU Int ; The Canadian Enuresis Study and Evaluation — Short- and long-term safety and efficacy of an oral desmopressin preparation. Scand J Urol Nephrol ; The efficacy and safety of oral desmopressin in children with primary nocturnal enuresis.
Adults & Bedwetting
Oral desmopressin: A randomized double-blind placebo controlled study of effectiveness in children with primary nocturnal enuresis. J Urol ; 3 Pt 2 Comparison of effects of treatment of primary nocturnal enuresis with oxybutynin plus desmopressin, desmopressin alone or imipramine alone: A randomized controlled clinical trial. Desmopressin melt improves response and compliance compared with tablet in treatment of primary monosymptomatic nocturnal enuresis.
Primary monosymptomatic nocturnal enuresis: Monotherapy versus combination therapy. Urology ; Lottmann H. Comparison of two sublingual types of desmopressin in 6-year-old and more children with primary nocturnal enuresis.
Desmopressin for bedwetting | Medicines for Children
About an international randomized cross-over study. Prog Urol ; Does structured withdrawal of desmopressin improve relapse rates in patients with monosymptomatic enuresis? Safety profile of desmopressin tablet for enuresis in a prospective study. Adv Ther ; Predictive parameters of response to desmopressin in primary nocturnal enuresis. Daytime functional bladder capacity as a predictor of response to desmopressin in monosymptomatic nocturnal enuresis.
Eur Urol ;33 Suppl The influence of urine osmolality and other easily detected parameters on the response to desmopressin in the management of monosymptomatic nocturnal enuresis in children. Minerva Urol Nefrol ; Plasma vasopressin and response to treatment in primary nocturnal enuresis. Arch Dis Child ; Spina bifida occulta: Not to be overlooked in children with nocturnal enuresis.
Related Stop Bedwetting in 24 hours
Copyright 2019 - All Right Reserved