Micturition Difficulty and Urinary Retention Associated with Aripiprazole and Citalopram Treatment in a Male Adolescent with Asperger Syndrome

Abstract

[Author Affiliation]Ozhan Yalcin. Bakirkoy Mental Health, Neurology and Neurosurgery Research and Trainee Hospital, Child and Adolescent Psychiatry Clinic, Istanbul, Turkey.Address correspondence to: Ozhan Yalcin, MD, Bakirkoy Mental Health, Neurology and Neurosurgery Research and Trainee Hospital, Child and Adolescent Psychiatry Clinic, Istanbul, Turkey, E-mail: cpozhan@gmail.comTo The Editor:Urinary problems such as urinary incontinance (clozapine, risperidone) and urinary retention (olanzapine, chlorpromazine) have been reported with both typical and atypical antipsychotics, which could be very problematic, especially for older patients (Saddichha and Kumar 2009). Urinary symptoms caused by antipsychotics are hypothesized to be extrapyramidal side effects (EPS) or a result of the medications' anticholinergic effects or related to their action on the peripheral adrenergic system. As α1-adrenergic receptors are widely distributed over the smooth muscle of the trigone and detrusor muscles of the bladder, it is claimed that central dopamino-seratonergic effects along with peripheral α1-adrenergic blockade may act synergistically to cause urinary incontinance and retention (Saddichha and Kumar 2009). Other psychiatric drugs, especially tricyclic antidepresants (Hermesh et al. 1987), reboxetine (Borade et al. 2005), atomoxetine (Desarkar and Sinha 2006), and even selective serotonin reuptake inhibitors (SSRIs) may cause urinary retention (Uher et al. 2009; Garakani 2010).Case ReportA 15-year-old male adolescent patient was referred to our outpatient clinic with the complaints of tics, obsessive compulsive symptoms, and social incompetence. He was in the ninth grade. Both of his parents were high school graduates. He had a 10-year-old brother. He had been diagnosed with Asperger syndrome at the age of 11 at a university child and adolescent psychiatry clinic. He had been referred to the university clinic with the complaints of social incompetence, socially introverted behavior, monotonous and nonprosodic speech style, anxiety, perfectionism, restricted patterns of interest, and obsessive compulsive symptoms. At the psychiatric examination his nonprosodic and monotonous speech pattern was very prominent, and also he had poor and short eye contact. His memorizing was very good but he had difficullties with mathematics. He had socially phobic attitudes and obsessive compulsive symptoms (cleaning, fear of contamination and touching, continously asking the same questions, being doubtful about hurting people, perfectionism, uncertainty). Also he had had coughing (vocal tic) and multiple motor tics for 1 year. He was diagnosed with Asperger syndrome, obsessive compulsive disorder (OCD), and Tourette syndrome. His parents were informed about his psychiatric condition and citalopram 10 mg/day and aripiprazole 2.5 mg/day were initiated. Low doses were instructed to be used, bcause of his possible vulnerability to psychotropic drug side effects, as he had autism spectrum disorder. The citalopram dose was increased to 20 mg/day on the 10th day of the medical treatment. Three weeks later his OCD findings were 50-60% better, according to him and his parents. The citalopram dose was increased to 30 mg/day on the 3rd week. Three weeks later, his OCD findings and social incompetency were much better, but his tics were only slightly better; therefore, his aripiprazole dose was increased to 5 mg/day. With that dose titration, micturition difficuly and urinary retention developed. He had been admitted to the emergency room for these findings, and his urinary examination and laboratory and radiological findings had not identified any abnormality. The patient's mother thought that the increased dosage of aripiprazole might be responsible for this urinary side effect. When she had administered the dosage of 2.5 mg/day of aripiprazole, there had been no symptoms of micturition difficulty. After the dose was decreased to 2. …