Kristina Vickutė1, Marius Žiemininkas2
1Vilnius University, Faculty of Medicine, Vilnius, Lithuania
2Vilnius University, Faculty of Medicine, Department of Pathology, Forensic Medicine and Pharmacology, Vilnius, Lithuania
Background. To prevent relapses and disease progression, most patients with schizophrenia must take antipsychotic drugs indefinitely. In addition to extrapyramidal symptoms, these drugs can cause acute urinary retention and constipation through their antagonistic effect on acetylcholine, serotonin or histamine receptors. These medication side effects can be severe and require urgent medical interventions. Olanzapine is an atypical antipsychotic drug that may disrupt urethral detrusor contractions and slow duodenal motility by blocking muscarinic acetylcholine receptors. By blocking serotonin receptors and reducing myosin light chain kinase, secretory, sensory, motor function of digestive tract may be disturbed.
Case report. A 55-year-old woman presented with diarrhea and abdominal pain. Suffered from paranoid schizophrenia, primary arterial hypertension, dyslipidemia. The patient has been taking Olanzapine 20 mg/day for the past two months. An ultrasound examination showed an intestinal tumor and a full bladder. An urgent CT scan showed that the rectum was 10 cm diameter and full of feces, the bladder was completely overfilled. Olanzapine 20 mg/day was changed to Quetiapine 100 mg/day, enemas, laxatives administered, catheterized with Foley catheter. In 2 weeks the patient completely recovered.
Conclusions. In order to avoid serious complications of urinary retention or constipation, we should pay attention to the group of patients who are elderly, female, non-smokers, have more co-morbidities, and receive polytherapeutic treatment. When treating patients with antipsychotic drugs, we should prescribe the lowest effective dose of the drug, avoid treatment combinations with typical and atypical antipsychotic drugs, and if necessary, prescribe prophylactic laxatives.
Keywords: olanzapine, urinary retention, constipation.