Use of amisulpride in treating adolescent onset schizophrenia associated with stuttering priapism induced by multiple antipsychotics

摘要

Priapism is a pathologic condition representing a true disorder of penile erection that persists beyond or is unrelated to sexual interest or stimulation (Montague et al, 2003). Priapism has been categorised into three types (Salonia et al., 2014): low flow (ischaemic), high flow (non-ischaemic) and stuttering priapism. Prolonged failure of venous outflow due to either obstructions of draining veins or failure of the sympathetic system to initiate detumescence leads to low flow priapism. High-flow priapism results from elevated unregulated flow of arterial blood into the penis without outflow obstruction. Stuttering priapism, also termed intermittent or recurrent priapism, is a distinct condition characterised by repetitive, painful episodes of prolonged erections. Erections are self-limited with intervening periods of detumescence. The aetiology of stuttering priapism is similar to that of ischaemic priapism. While sickle cell disease is considered the most common cause of stuttering priapism, other causes can be idiopathic or neurologic disorder (Salonia et al., 2014). Priapism can have serious long-term complications such as impotence that can develop in 40-50% of the patients, regardless of treatment (Sharma and Fleisher, 2009). The mechanism of priapism associated with antipsychotics is not clear but is thought to be related to alpha-adrenergic blockage that is mediated by the alpha receptors in the corpora cavernosa of the penis (Sood et al., 2008).