An exploratory study for bladder dysfunction in atypical antipsychotic-emergent urinary incontinence

Abstract

Introduction:This is an exploratory study, which aimed to analyze urodynamic findings in patients who are on atypical antipsychotics and present with urinary incontinence (UI) in order to understand the mechanisms of antipsychotic-emergent UI.Patients and Methods:Eight patients (34 ± 7.6 years; five males and three females) diagnosed with schizophrenia or other psychotic disorders, who were on risperidone, olanzapine, or clozapine monotherapy and having UI were recruited. Urodynamic study was performed in all patients.Results:Six out of eight (75%) patients had abnormal urodynamic findings. Three of them had detrusor overactivity (DO) without detrusor-sphincter dyssynergia (DSD); two had DO with DSD; and one had hypoactive detrusor with nonrelaxing sphincter during void phase. The common urinary symptoms were urgency, enuresis, and straining to void urine. Significant postvoid residual urine was found in two patients.Conclusion:The evidence of bladder dysfunction in atypical antipsychotic-emergent UI is similar to that present in patients with neurological disorders. Urinary complaints in patients on antipsychotics thus need to be evaluated and managed systematically using the protocol followed for neurological conditions.

The association of lower urinary tract symptoms with schizophrenia and its treatments: A narrative review

“…Three papers made no mention of the current status of schizophrenia 9,32,33 . Sixten papers mentioned some current symptoms of schizophrenia 6,18,19,28,30,34,35,37,40,42,44,46,48,49 or stated that the patient was in remission 27,36 .…”

“…Thirteen papers detailed the current antipsychotics the patient was prescribed, 6,8,14–19,26–31,33–42,44–49 and of these, 26 papers stated the current antipsychotic doses 8,14,15,17,18,26–31,33–42,44–46,48,49 …”

“…In terms of LUTS‐specific terminology, 14 papers mentioned only urinary incontinence, 8,9,14,16,18,28–30,32,34–37,42 while 13 papers mentioned only (nocturnal) enuresis/bedwetting/nocturnal incontinence 15,17,19,38,39,41,43–49 . Seven papers included other LUTS in addition to the above, 6,7,26,27,31,33,40 but only one of these papers used the phrase “lower urinary tract symptoms.” 27 Of the 20 papers that mentioned urinary incontinence, 6–9,14–16,18,26–32,34–37,42 six subcategorized it 6,7,26,27,30,31 . Of these six papers, two did not detail how they subcategorized urinary incontinence, 7,30 three used urodynamics 6,26,31 and one used direct questioning 27 …”

“…Three papers included an evaluation of the patient by a urologist 36,40,42 . Seven papers performed urodynamics 6,14,26,31,33,35,42 . Three of these papers described the urodynamic tests performed in detail 6,31,33 .…”

“…Despite this, 24 papers attributed the apparent association between LUTS and schizophrenia to antipsychotics, 8,14–19,27–30,34–41,44–46,48,49 while 10 papers attributed the association to the disease of schizophrenia itself 6,7,9,26,31–33,42,43,47 . Of these 10 papers, three demonstrated that the prevalence of LUTS in schizophrenia is higher than in other patient populations, 7,9,32 while four reported abnormal urodynamic findings in patients with schizophrenia 6,26,31,33 . Three papers reported a general association between schizophrenia and LUTS 42,43,47 …”