Abstract
Case Report
A 10-year-old boy was referred to the child and adolescent psychiatry department of a tertiary health care facility for side-effects associated with risperidone treatment. Autism was diagnosed in the patient, and the psychiatric examination revealed restricted interests, diminished social interaction, lack of verbal communication, and gestures along with abnormal eye contact and stereotypic behaviors. The patient was continuing a behavioral special education program for the last 6 years and was on risperidone 1 mg/day (0.03 mg/kg) treatment for the last 1 year to control agitation. Three weeks before his admission to the child and adolescent psychiatry department, urinary and fecal incontinence began when the patient was on this treatment regimen. Parents described urgency along with incontinence. Risperidone was stopped, and the symptoms remitted in a couple of days. However, due to behavioral problems, risperidone 0.5 mg/day was initiated again, and after a single dose, urinary and fecal incontinence along with urgency returned. These complaints remitted after the treatment had been stopped again. Risperidone was prescribed for the third time; this was at 0.25 mg/day dose to control agitation. After a single dose, there was urinary incontinence without fecal incontinence; however, the parents described fecal urgency. Risperidone was stopped, and olanzapine 5 mg/day was initiated without these side-effects.
Discussion
In the present case, risperidone treatment was strongly associated with double incontinence due to several reasons. First of all, there was a temporal relationship between drug use and the symptoms (Kantrowitz et al. 2006). Remission of the incontinence with discontinuation, and return with the initiation of the drug at each time, indicates that double incontinence was clearly related to risperidone treatment. Second, it seemed like there was a dose-response relationship. With the highest dose, there was double incontinence with urgency feeling; in the lowest dose, there was no fecal incontinence but only fecal urgency. Third, there is biological plausibility. Risperidone is an alpha antagonist, and this may cause relaxation in smooth muscles including urethral and anal sphincters (Vera et al. 2001). Therefore, the cause-effect relationship between risperidone use and double incontinence seems to be straight-forward. There may be differences in the sensitivity of urethral and anal sphincters to risperidone, as urinary incontinence is much more common than fecal incontinence with risperidone use. The present case also supports this by showing that with the lowest dose, there was only urinary incontinence.
Footnotes
Disclosures
None of the authors have any affiliation with pharmaceutical companies. None of the authors have any institutional affiliations and funding sources that supported the study.