title: Quetiapine-induced diabetes with metabolic acidosis.
abstract: Medication adherence with antipsychotics is adversely impacted by the burden of untoward adverse effects. In particular, sexual side-effects may interfere with compliance, but are often underreported by patients. Sexual dysfunction related to hyperprolactinemia is commonly described, but ejaculatory disturbance due to potent alpha1 adrenergic antagonism may also occur, and has been reported frequently with certain typical antipsychotics such as thioridazine, but rarely with atypical antipsychotics. Presented here is the case of a 51 year old male with schizophrenia who developed retrograde ejaculation on high dose risperidone therapy (8 mg/day) with prompt resolution of symptoms upon dose reduction. The absence of decreased libido or erectile dysfunction indicates that alpha1 adrenergic antagonism and not low serum testosterone due to hyperprolactinemia is the etiology for this side-effect. This case illustrates another mechanism for sexual adverse effects, and the need for routine inquiry into sexual dysfunction during atypical antipsychotic therapy.
authors.affiliation: Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California, USA. jmmeyer@ucsd.edu
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Meyer
authors.forename: Susan G
authors.initials: SG
authors.lastname: Leckband
authors.forename: Catherine
authors.initials: C
authors.lastname: Loh
authors.forename: Christine Y
authors.initials: CY
authors.lastname: Moutier
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects*; D003922:Diabetes Mellitus, Type 1 / Q000139:chemically induced*; D016883:Diabetic Ketoacidosis / Q000139:chemically induced*; D003987:Dibenzothiazepines / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069348:Quetiapine Fumarate; D012559:Schizophrenia / Q000188:drug therapy
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate