A Case Report of Priapism Caused by Ziprasidon
A 43-year-old male patient was admitted to the emergency department of our hospital due to insomnia, irritability, aggression, self-talk, and complaints of non-compliance with his psychiatric medications over the previous two weeks. During his psychiatric examination, he did not make eye contact, was unwilling to communicate, and exhibited decreased self-care, poor speech content, dysphoric mood, and increased psychomotor activity. His thought content could not be assessed due to his irritability and dissimulative attitude. According to information received from his family and from clinical observations, he suffered persecution, reference, and grandeur delusions. Additionally, it was noted that there had been no use of psychostimulants other than irregular alcohol intake for five years, which had stopped two years previously, and he smoked a pack of cigarettes per day.\nThe patient had been followed up for nearly 20 years following a diagnosis of chronic schizophrenia, for which he had been hospitalized in a psychiatric institution 17 times. Examination of his past hospital files revealed that he had been prescribed various typical and atypical antipsychotics: haloperidol (20-30 mg/day), sulpiride (800 mg/day), pimozide (4 mg/day), clozapine (600 mg/day), risperidone (6 mg/day), olanzapine (20 mg/day), quetiapine (100-900 mg/day), chlorpromazine (200 mg/day), and amisulpride (800 mg/day). The patient did not describe any involuntary prolonged erections when questioned during his follow-ups or during his former psychiatric hospital admissions. He had been diagnosed with diabetes mellitus type 2 in 2006 and had been receiving antidiabetic treatment since that time.\nAfter his hospitalization, the patient continued to use metformin (2000 mg/day) in conjunction with ziprasidone (40 mg/day) and, as he had gastric ulcers, ranitidine (50 mg/day). The patient's total Positive and Negative Symptom Scale (PANSS) score was 131 (positive: 27; negative: 30; general psychopathology: 72). On the seventh day of treatment, a continuous painful penile erection was observed. The patient felt uncomfortable and stated that this condition had lasted for nearly 8 h and was not associated with sexual stimulation or desire. Following urologic consultation, no medical disorder or trauma that might have caused priapism was found in the patient's history, and laboratory values [complete blood count, biochemical parameters, activated partial thromboplastin time (aPTT), and International Normalized Ratio (INR)] were within the normal range. As it was thought that the antipsychotic medications might be the cause of the prolonged painful penile erection, ziprasidone treatment was discontinued but no emergency urological intervention was undertaken. The antipsychotic treatment regimen of the patient was reorganized and continued with amisulpride (800 mg/day) and quetiapine (600 mg/day). The priapism ameliorated without surgical intervention 8 h after discontinuation of ziprasidone and did not recur during the clinical monitoring of the patient.