Successful switch to olanzapine after rhabdomyolysis caused by water intoxication and clozapine use.

We report on a case of rhabdomyolysis induced by the correction of hyponatremia after psychogenic polydipsia and clozapine use, where the switch to a high dose of olanzapine resulted in the non-recurrence of rhabdomyolysis. The 46-year-old patient with the diagnosis of schizophrenia paranoid type, who had been on clozapine treatment for the previous 4 years, was admitted with the symptoms of generalized seizure and vomiting, and as severe hyponatremia was proved, its correction with the parallel use of clozapine treatment was done. CK concentrations increased to 48 120 U/L without any symptom of neuroleptic malignant syndrome. To prevent acute renal insufficiency, high-volume alkaline diuresis was initiated and clozapine was tapered and stopped. On the day 12 of treatment, olanzapine was started and was elevated to 30 mg/day. CK concentration began to fall returning to the normal concentration on day 20. Six months after the switch to olanzapine no recurrence of rhabdomyolysis was detected; clinical and laboratory findings were normal. We suggest that after a benzodiazepine-type antipychotic-induced rhabdomyolysis, a switch to another atypical antipsychotic can be a cautious clinical strategy.

Sexual dysfunction among patients treated with antidepressants--a Hungarian retrospective study.

The authors have investigated the incidence and several aspects of sexual problems in Hungarian outpatients (N = 637) treated by antidepressive medication. In this multicentre epidemiological survey the sexual dysfunctions (SD) was assessed by psychiatrists using structured interviews. Seventy-eight of the sample has sexual problems, more than half of them mentioned SD after starting antidepressive medication. Comparing various groups of antidepressants, patients taking a RIMA compound reported the occurrence of SD not so often as in TCA or SSRI groups, where the rate of SD was very high. Authors pointed out that physicians have to pay special attention to this problem in everyday clinical practice, since the recognition and treatment of sexual dysfunction is critical for the patient's satisfaction, medication compliance and the quality of life.