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Guest Editorial
Highlighting Bipolar II Disorder
Gordon Parker, MD, PhD, DSc, FRANZCP
(PDF)

In Review
Neurobiological Findings in Bipolar II Disorder Compared With Findings in Bipolar I Disorder
Brent M McGrath, BSc, MSc, Phillip H Wessels, MD, FRCPC, Emily C Bell, BSc, MSc, Michele Ulrich, BSc, Peter H Silverstone, MB, BS, MD, MRCPsych, FRCPC
(PDF)

Bipolar II Disorder: An Overview of Recent Developments
George Hadjipavlou, MA, MD, Hiram Mok, MA, MB, BCh, BAO, FRCPC, Lakshmi N Yatham, MBBS, MRCPsych, FRCPC3 (PDF)

Review Paper
Bipolar Disorder: It’s All in Your Mind? The Neuropsychological Profile of a Biological Disorder
Gin S Malhi, BSc, MB, ChB, MRCPsych, FRANZCP, Belinda Ivanovski, Ssc Psychol, M Clin Psychol, Viktoria Szekeres, BSc,Psychol
(PDF)

Original Research
Impact of Culture on Depressive Symptoms of Elderly Chinese Immigrants
Glenda MacQueen, MD, PhD, FRCPC
Daniel WL Lai, PhD
(PDF)

Development and Reliability of a Pictorial Mental Disorders Screen for Young Adolescents
Nicole Smolla, PhD, Jean-Pierre Valla, MD, MSc, Lise Bergeron, PhD, Claude Berthiaume, MSc, Marie St-Georges, MPs
(PDF)

Command Hallucinations Among Asian Patients With Schizophrenia
Theresa MY Lee, MBBS, MMed, Siow Ann Chong, MBBS, MMed, Yiong Huat Chan, PhD, Gangaharan Sathyadevan, MBBS, MRCPsych
(PDF)

The Centre for Addiction and Mental Health Concurrent Disorders Screener
Juan C Negrete, MD, FRCPC, Jane Collins, MSc, Nigel E Turner, PhD, Wayne Skinner, MSW
(PDF)

Validation de la version française du questionnaire de Sociotropie-Autonomie de Beck et collègues
Mathilde M Husky, MSc, Olivier S Grondin, MSc, Philippe D Compagnone, PhD
(PDF)

Brief Communication
Depressive Symptoms and Alcohol Consumption Among Nonalcoholic Depression Patients Treated With Desipramine
Benjamin I Goldstein, MD, PhD, Ayal Schaffer, MD, FRCPC, Anthony Levitt, MD, FRCPC, Ari Zaretsky, MD, FRCPC, Russell T Joffe, MD, FRCPC, Virginia Wesson, MD, R Michael Bagby, PhD
Pierre Bleau, MD, FRCPC
(PDF)

Letters to the Editor
(PDF)

Safety of Clozapine in 2 Successive Pregnancies

Revisiting the Diagnostic Challenges of Secondary Mania and Bipolar Disorder in a Patient With Borderline Hyperthyroidism

Dyslipidaemia and Psychiatric Patients

Dream Contents in Patients With Major Depressive Disorder

Sensory Deprivation and Disorders of Perception

Re: The Internet’s Impact on the Practice of Psychiatry

Response: The Internet’s Impact on the Practice of Psychiatry

Denial and Avoidance in an Unusual Case of Death From Breast Cancer

Interferon-Induced Mania

Drug-Induced Psychosis After Long-Term Treatment With Levetiracetam

Priapism

An Ounce of Prevention: “COPEing with Toddler Behaviour”

Internet Gaming Addiction

Letters to the Editor

Priapism

Dear Editor:
Priapism is a rare but serious side effect of antipsychotic medication. Cases of ischemic priapism have been reported with most atypical antipsychotics (ATPs) (1). Priapism, which has both ischemic and high-flow subtypes, can also be associated with hematologic and vascular abnormalities, as well as spinal cord injury, neoplasms, and prostatitis. We present the case of a man who developed ischemic priapism on 3 occasions, while on 3 different ATPs.

Mr A is aged 44 years with a 23-year history of schizophrenia. He was taking risperidone 4 mg orally twice daily and trazodone 150 mg orally at bedtime when he first developed priapism. He received saline and phenylephrine cavernosal irrigation in emergency after having the priapism for 7 hours. We changed his treatment to quetiapine up to 600 mg daily. He developed ischemic priapism 24 days after starting quetiapine. Again, he required cavernosal irrigation to resolve a 10-hour period of priapism. We then treated him with olanzapine up to 20 mg daily. He developed ischemic priapism 53 days after starting olanzapine. This episode responded to phenylephrine 60 mg orally. Following this episode, we discovered that his fasting blood sugars were consistently greater than 15 mmol/L. His hemoglobin was 120 g/L. During the previous 2 years, his fasting blood sugars had ranged from 4.6 to 8.5 mmol/L. Further workup, including a CT scan of his pelvis, was negative. He was started on insulin and loxapine, and his fasting blood sugars normalized. We chose loxapine because it has minimal alpha 1 adrenoceptor blockade (2). He had no further episodes of priapism.

The patient had previously been on risperidone up to 8 mg daily with trazodone 50 to 100 mg daily for 2 years. He then had a 4-month trial of quetiapine up to 700 mg daily with trazodone 50 to 100 mg daily. He had no documented episodes of priapism during this period. His blood sugars were normal at that time. This case illustrates the potential risk of ischemic priapism from a range of ATPs aggravated by diabetes. The capacity for each of the pharmacologic agents to induce alpha 1 adrenoceptor blockade is likely the common denominator for the drug-induced priapism. All ATPs block alpha 1 adrenoceptors (3). Olanzapine has little action on alpha 2 adrenoceptors (3). Blockade of the sympathetic nervous system prevents its normal inhibitory influence on corpus cavernosal smooth muscle and on penile vascular inflow resistance. Both are required in mediating detumescence or maintaining a flaccid state. The high blood sugars likely facilitated the development of priapism by altering the normal status of the sympathetic nervous system systemically.

References

1. Compton MT, Miller AH. Priapism associated with conventional and atypical antipsychotic medication: a review. J Clin Psychiatry 2001;62:362–6.

2. Richelson E. Pharmacology of neuroleptics in use in the United States. J Clin Psychiatry 1985;46(2):8–14.

3. Richelson E, Souder T. Binding of antipsychotic drugs to human brain receptors: focus on the newer generation compounds. Life Sciences 2000;68:29–39.

Regina M du Toit, MD;
Richard C Millson, MD;
Jeremy P Heaton, MD;
Michael A Adams, PhD
Kingston, Ontario