Reduction in Retinal Ganglion Cell Layer, Inner Plexiform Layer, and Choroidal Thickness in Children With Autism Spectrum Disorder.

PURPOSES: The aim of this study was to evaluate the retinal nerve fiber layer (RNFL), choroidal layer, inner plexiform layer (IPL), and ganglion cell layer (GCL) in patients with autism spectrum disorder (ASD). METHODS: In this study, we measured the thickness of the RNFL, GCL, IPL, and choroidal thickness using a spectral optical coherence tomography (OCT) device and we compared the results between the children diagnosed with ASD and healthy controls. Correlation between the Childhood Autism Rating Scale (CARS) and the OCT data was evaluated. RESULTS: Both ASD and control group consisted of 40 subjects (30 males and 10 females). Of the children in the ASD group, 29 had normal intelligence and 11 had mild intellectual disability (MID). The mean age of patients in the ASD group and control groups were 9.77 ± 3.37 years and 9.85 ± 3.97 years (p = 0.928). There was a statistically significant difference between the ASD group and the control group in the nasal and nasal-superior sectors of the RNFL layers in the left eye when all the lower layers of RNFL were assessed. In both eyes, the children with ASD had considerably lower mean choroidal thicknesses than the controls. When compared to the controls, the GCL and IPL volumes in the individuals with ASD were considerably lower in both eyes. Compared to the MID group, the left GCL volume of the nasal-inferior group was noticeably higher. A significant correlation was found between CARS scores and left GCL left IPL. CONCLUSIONS: In contrast to RNFL in the ASD group, significant reductions in IPL, GCL, and choroidal thickness were observed in both eyes. It is thought that GCL may be a much more important biomarker than RNFL in terms of representing the structural deterioration in the brain. In addition, these results may form the basis for a new perspective on the use of OCT for the diagnosis and clinical course of autism.

Retinal nerve fiber layer decrease and choroidal layer increase after four weeks of buprenorphine/naloxone maintenance treatment in opioid use disorder

Background and Objectives: Spectral-domain optical coherence tomography (SD-OCT) findings in substance use disorders have been investigated in recent years. In this study, we compared the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), the inner plexiform layer (IPL), and the choroid thickness (CT) of OUD and control groups before and after buprenorphine/naloxone maintenance treatment (BN-MT).MethodsThe OUD group consisted of 46 male subjects and the control group consisted of 49 male subjects. Patients with chronic opioid use and opioid positivity in their urine during the initial SD-OCT application were included in the study. At the end of the fourth week of BN-MT, SD-OCT was repeated and BN positivity was detected in the urine of the patients at this time.ResultsThere was a significant difference between OUD and control groups in terms of nasal superior and CT values of both eyes (p<0.05) before BN use. The values of RNFL sectors and CT of both eyes before and after BN-MT differed significantly (p<0.05); CT increased and RNFL sectors decreased. After BN-MT, psychometric scales differed significantly in favor of the patients (p<0.05). The SD-OCT values of the OUD group after BN-MT were compared with the control group: the right IPL (p=0.003), the left IPL (p=0.023), the right N (p=0.001) and the left N (p<0.001) values were significantly lower in the OUD group.ConclusionThis is the first study to show the SD-OCT findings of patients with OUD before and after BN-MT. The findings of this study may indicate possible effects of chronic opioid use in patients and/or possible effects of exogenous opioid or BN present in the body during SD-OCT applications. However, based on our findings, it is not possible to distinguish between the two possible outcomes. The fact that the use of BN acting through opioid receptors has different effects from exogenous opioids may be due to different receptor profiles. (AU)

Acute opioid use may cause choroidal thinning and retinal nerve fiber layer increase.

The number of optical coherence tomography (OCT) examinations in substance use disorders is gradually increasing. However, OCT findings in opioid use disorder (OUD) have not yet been investigated. In this study, we compared the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), the inner plexiform layer (IPL), and choroid thickness (CT) of OUD and control groups. We included 43 male patients and 43 healthy male controls of similar age (p = 0.296) in the study, prospectively. On the day of OCT application, urine toxic screening test results of all OUD patients were positive for opioid use. There was a significant difference between OUD and control groups in terms of CT (p < 0.05), nasal superior (NS), and nasal (N) sectors of the RNFL (p < 0.05) values of both eyes. According to the binary logistic regression analysis, the sensitivity of mean NS (p = 0.001) and mean CT (p = 0.007) related to the diagnosis of OUD was 72.1 percent, and the specificity was 65.1 percent. Receiver operating characteristic (ROC) analysis revealed that the sensitivity and specificity of mean CT for the diagnosis of OUD were 18.6% and 97.7%, respectively. This is the first study to investigate the OCT findings in OUD. Our findings are important in terms of showing thinning in the choroidal layer and an increase in the volume of the NS and N sectors of RNFL while detecting opioids in the body/urine. Further studies are needed to clarify whether these differences are due to the acute and/or chronic effects of opioids.

Comparison of OCT findings of schizophrenia patients using FGA, Clozapine, and SGA other than Clozapine

ABSTRACT Objective: The effect of antipsychotic (AP) drugs on optical coherence tomography (OCT) findings in schizophrenia has not yet been fully elucidated. In this study, we aimed to investigate the effects of APs (the first generation antipsychotic group [FGAG], the second generation antipsychotic group [SGAG], the clozapine group [CG]) on OCT findings in schizophrenia. Methods: The thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and choroidal thickness were measured using a spectral OCT device. Results: No significant difference was found between FGAG, SGAG, CG (p > 0.05) while there was a significant difference between the control group and the patients group in terms of RNFL, GCL, and IPL (p < 0.05). A significant difference between SGAG and CG, FGAG (p < 0.05); between control group and FGAG (p < 0.05) were found in terms of choroidal thickness. Conclusion: These findings suggested the deterioration of the metabolic parameters due to the SGA use. Thinner choroidal layer thickness in the CG compared to the SGAG and control group was thought to be related to the patients using clozapine had a resistance to the treatment.

Long-Term Substance Use Can Cause Irreversible Photopic Vision Changes in Substance Use Disorder in Remission.

OBJECTIVE: Substance use has such effects on pupil diameter. Although there is knowledge about the acute effects of substances on pupils, studies showing their chronic effects are limited. The aim of the present study was to evaluate the effect of long-term substance use on scotopic, mesopic, and photopic vision. METHODS: The present study with cross-sectional desgn was conducted at the Adiyaman Training and Research Hospital for Psychiatry in Adiyaman. This study involved 110 substance use disorder (SUD) patients and 46 healthy volunteers as the control. The parameters were measured and recorded automatically by a device. RESULTS: The mean age was 23.44±5.53 years in the SUD group and 24.26±5.38 years in healthy controls (p=0.420). The mean age of onset of the substance was 17.74±3.89 years and the mean duration of substance use was 3.54±2.9 years. It was determined that the patients had not used any substance for a mean of 121.73±117.49 days. There was no significant difference between patient and control groups in terms of scotopic and mesopic measurements of both eyes (p>0.05). Photopic measurements were significantly higher in the patient group than in the control group (p<0.05). Photopic measurements were significantly higher in the opioid, cannabis, ecstasy, and multiple substance use groups than in the control group (p<0.05). CONCLUSION: The most important topic of this study is that photopic vision is permanently impaired in patients with a history of chronic substance use. This was attributed to disrupted sympathetic-parasympathetic hierarchy.

Increases in retinal nerve fiber layer thickness may represent the neuroprotective effect of cannabis: an optical coherence tomography study.

Although optical coherence tomography (OCT) has been used in many neuropsychiatric disorders, data on substance use disorders (SUD) are not available. The aim of this study was to evaluate ganglion cell layer (GCL), inner plexiform layer (IPL), retinal nerve fiber layer (RNFL), and choroidal layer thickness in patients diagnosed with SUD especially cannabis use disorder (CUD). RNFL, GCL, IPL, and the choroidal layers of 111 patients diagnosed with SUD and 45 healthy controls were retrospectively analyzed. Fifty patients were diagnosed with CUD and 50 patients had multiple drug use (MDU). The mean age of the patient and control groups were 23.39 ± 5.53 and 28.48 ± 5.21 years, respectively. The mean duration of substance use was 3.53 ± 2.95 years. The patients had not used any substance for a mean of 121.45 ± 116.99 days. When the RNFL values of the SUD, MDU, and control groups were compared, no significant difference was found except for such components. However, there were significant differences in terms of right naso-superior (p = 0.020), right temporo-inferior (p = 0.024), right temporo-superior (p = 0.002), left naso-superior (p = 0.005), left naso-inferior (p = 0.043), and left temporo-superior (p = 0.008) between CUD and control groups. That is, RNFL values were higher in the CUD group than in the control group. Cannabis has medical uses because of its possible neuroprotective properties. Our study supports the possible neuroprotective effects associated with cannabis through RNFL data. According to our best knowledge, this is the first study investigating the association between RNFL and drugs, particularly cannabis.

Decreases in retinal nerve fiber layer thickness correlates with cumulative alcohol intake.

Alcohol and illicit drugs affect neurons through various mechanisms and are detected by neuroimaging techniques. The optical coherence tomography device has just been used in research on substance use disorders. In this study, we compared the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), the inner plexiform layer (IPL), and choroid layer of alcohol use disorder (AUD) and healthy subjects. We included 38 male patients and 38 male healthy controls of similar age (p = .714) in the study, prospectively. Monthly income (p = .001) and stable employment (p = .001) were lower in the patient group. There was a significant difference between patient and control groups in terms of RNFL sectors, choroid, GCL, IPL values of both eyes were significantly different (p < .05). When the effect of age and liver damage was controlled in the patient group, a correlation was found between alcohol unit/year and nasal superior (r = -0.474, p = .004), temporal (r = -0.402, p = .015) sectors of the RNFL. The regression analysis indicated that the sensitivity and specificity of mean N (p = .060), mean choroidal thickness (p < .001), mean GCL (p = .013), and mean IPL (p = .017) related to the diagnosis of AUD were 78.9% and 81.6% (-2 Log likelihood = 57.57, Nagelkerke R2=0.622), respectively. Alcohol has neurotoxic effects, either directly or indirectly, with withdrawal. Our study results suggest that RNFL, the non-myelinated white matter tissue, can be a follow-up marker of neuronal damage due to cumulative alcohol intake.

Investigation of neurodegenerative and inflammatory processes in sleep bruxism.

Objective: The present study aimed to evaluate the anxiety and optical coherence tomography (OCT) findings in patients with sleep bruxism (SB) and to develop objective measurements to assess the neurodegenerative and inflammatory processes associated with this disease. Methods: A group of 40 SB patients were compared with a control group consisting of 40 healthy individuals (without SB). Anxiety results and the OCT measurements of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and choroidal thickness were assessed in both groups. Results: Anxiety values in the bruxism group were significantly higher than those in the control group. The measurements of RNFL, IPL, and GCL in the bruxism group were significantly lower than the control group, whereas the choroidal thickness was significantly higher. Conclusion: According to literature, this is the first study that analyzed the changes in the retinal structures in bruxism, which revealed that SB is a neurodegenerative and inflammatory process.

Comparison of nitric oxide level in Behçet's disease patients with or without psychiatric comorbidity.

Both Behçet's disease (BD) and major depressive disorder (MDD) are diseases associated with nitric oxide (NO). We hypothesized that the comorbidity of MDD affects the levels of NO in BD. In this study, we investigate whether there was a difference in NO levels among BD patients with accompanying MDD, BD patients with no depressive symptoms and healthy control group. There was a significant difference in NO levels among BD and control group (P < 0.05). Also, there was a significant difference between the BD group with MDD and BD group without psychiatric comorbidity in terms of NO levels (P < 0.05). This study is interesting as it demonstrates that accompanying psychiatric comorbidity puts an additional NO burden on the shoulders of BD patients.

Evaluation of Optical Coherence Tomography Results and Cognitive Functions in Patients with Restless Legs Syndrome.

INTRODUCTION: The aim of this study was to evaluate whether retinal neural network was impaired and cognitive functions were disturbed in restless legs syndrome (RLS) considering the hypothesis that there may be a dysfunction in dopaminergic pathways in RLS like in Parkinson's disease. Therefore, we evaluated retinal neural network with optical coherence tomography (OCT) and presence of cognitive impairment with Montreal Cognitive Assessment (MOCA). METHODS: OCT evaluations were performed for 30 RLS patients and 30 healthy controls. Ganglion cell complex was segmented to retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) automatically by the device, and recorded. Additionally, all the patients and the controls were evaluated using MOCA. RESULTS: No statistically significant difference was detected between RLS and controls in RNFL, GCL, IPL, and choroidal thicknesses. However, total MOCA score and all of its subscale scores were significantly lower in the RLS patients compared with the controls. No significant correlation was detected between OCT and MOCA parameters. CONCLUSION: No degeneration was detected in retinal neurons (RNFL, GCL, and IPL) of RLS patients. However, impairments were seen in MOCA total and subscale scores of these patients. On the other hand, no significant correlation was detected between MOCA scores and RNFL, GCL, or IPL thicknesses. These findings suggest decrease in cognitive functions of RLS patients probably due to dopaminergic dysfunction regardless of anatomical neural degeneration. Longitudinal follow-up studies are warranted to evaluate whether neuronal degeneration will develop.

Optical coherence tomography findings in conversion disorder: are there any differences in the etiopathogenesis of subtypes?

Abstract Background: Optical coherence tomography is a contactless and fast neuroimaging method. Previous Studies have observed thinning of the ganglion cell layer and inner plexiform layer in many neurodegenerative diseases. Objective: The aim of this study was to compare the layers of ganglion cell complex in conversion disorder. Methods: This study involved 50 conversion disorder patients and 50 healthy volunteers as the control. The parameters were measured and recorded automatically by a spectral optical coherence tomography device. Results: There was no difference in the retinal nerve fiber layers between the conversion disorder group and the control group (p > 0.05). The left and right choroid layer thickness acquired from three regions of the choroid layer was higher in patients compared with controls (p < 0.05). The ganglion cell layer and inner plexiform layer volumes were also significantly lower in the patient group (p < 0.05). Discussion: These ganglion cell layer and inner plexiform layer findings suggest that neurodegeneration occurs during the course of conversion disorder especially in subtype involved motor component. The choroid seems to be more related to the sensory component and it may be used to determine the active stage of the disease and to monitor inflammatory process like other inflammation markers used in systemic inflammatory diseases.

Complete blood count alterations due to the opioid use: what about the lymphocyte-related ratios, especially in monocyte to lymphocyte ratio and platelet to lymphocyte ratio?

This study was designed to compare the complete blood count values of opioid users (N = 61) and healthy subjects (N = 61), particularly monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR). PLR, MLR, and percentage of monocyte (MONO%) were significantly lower in opioid use disorder (OUD) group (P = 0.012, P = 0.005, P = 0.000). The area under the ROC curve of MLR and PLR levels for OUD was 0.349 and 0.368. MONO% correlated with substance use duration. Measurements like lymphocyte-related ratios and MONO% in opioid use can be important in substance monitoring, detection, and differentiation of acute and chronic conditions.

Successful treatment of olfactory reference syndrome with clomipramine / Tratamiento eficaz del síndrome de referencia olfativo con clomipramina

Subjective halitosis is a chronic disorder, and cannot be easily identified or measured by objective methods. The patients who are complaining with subjective halitosis usually refer to dentists, yet they reject to psychiatric consultations. One of the causes is olfactory reference syndrome (ORS) which is accepted as delusional or obsessive thoughts. ORS patients are usually refer to others’ behaviours; people who are closing their mouth, coughing and touching their nose, opening window, turning faces to another side to protect themselves. These are the signs as to emitting malodour which patients misinterpret. This paper illustrates a 51-old male who suffers from halitosis since 30 years which is diagnosed as ORS and treated with clomipramine

La halitosis subjetiva es un trastorno crónico y no es fácilmente identificable o cuantificable con métodos objetivos. Los pacientes que se quejan de halitosis subjetiva por lo general consultan al dentista, pero evitan la consulta psiquiátrica. Una de las causas es el síndrome de referencia olfativo (SRO), que se reconoce como pensamientos delirantes u obsesivos. Los pacientes con SRO generalmente hacen referencia a los comportamientos de los demás, personas que cierran la boca, tosen y se tocan la nariz, abren la ventana o giran la cara hacia otro lado para protegerse. Estos son los signos del hecho de desprender mal aliento que los pacientes malinterpretan. Este artículo expone el caso de un varón de 51 años que sufre halitosis desde hace 30 años, que se diagnostica como SRO y se trata con clomipramina

[Augmentation of Clozapine With Paliperidone in Schizophrenia Patients With Partial Response to Treatment: A Case Series]. / Tedaviye Kismi Yanit Veren Sizofreni Hastalarinda Klozapine Eklenen Paliperidon Sizofreninin Negatif Belirtilerinde Iyilesme Saglayabilir mi? Bir Olgu Serisi.

Clozapine is the only antipsychotic which has definitely shown to be effective in refractory schizophrenia. Clozapine treatment is usually preferred in schizophrenia patients with a partial response to treatment and augmentation strategies are tried when clozapine also fails to provide full treatment response. In treatment resistant schizophrenia patients addition of a second antipsychotic is a frequently preferred augmentation method. With previous augmentation strategies consistent positive results could not be obtained. Paliperidone is a risperidone metabolite and it has proven effectiveness in schizophrenia treatment. Although most effects of paliperidone on central nervous system are similar with risperidone, there are some differences. In this case series treatments of 5 schizophrenia patients who still had symptoms despite clozapine treatment were augmented with paliperidone during 6 months of follow up. This augmentation was tolerated well by the patients, and caused improvements in both positive and negative symptoms. Particularly, improvement in negative symptoms after addition of paliperidone was remarkable in our patients. Evaluation of paliperidone's effects on negative symptoms in schizophrenia patients with partial response to clozapine treatment using randomized, placebo controlled studies may provide an important treatment choice.

Optic coherence tomography shows inflammation and degeneration in major depressive disorder patients correlated with disease severity.

BACKGROUND: Previous research has consistently detected inflammation in the etiology of depression and neuroimaging studies have demonstrated gray matter abnormalities implying a neurodegenerative process in depression. The aim of this study was to compare ganglion cell layer (GCL), and inner plexiform layer (IPL) volumes and retinal nerve fiber layer (RNFL) thickness between first episode and recurrent major depressive disorder (MDD) patients and controls using optic coherence tomography (OCT) in order to detect findings supporting a degenerative process. Also choroid thicknesses of the same groups were compared to examine effects of inflammation on MDD. METHODS: This study included 50 recurrent MDD patients, 50 first episode MDD patients and 50 controls. OCT measurements were performed by a spectral OCT device. GCL and IPL volumes and RNFL and choroid thicknesses were measured automatically by the device. RESULTS: GCL and IPL volumes were significantly smaller in recurrent depression patients than first episode patients and in all MDD patients than controls. Also there were significant negative correlations between their volumes and disease severity parameters such as Ham-D and CGI scores, and disease duration. RNFL thicknesses were also lower in recurrent MDD patients than first episode patients and all MDD patients than controls but statistical significance was achieved only for global RNFL and temporal superior RNFL. Mean choroid thickness was higher in MDD patients than controls and in first episode MDD patients than recurrent MDD patients. LIMITATIONS: Cross-sectional design of our study limits conclusions about progressive degeneration during the course of MDD. Lack of a control neuroimaging method like magnetic resonance imaging makes it hard to draw firm conclusions from our results. CONCLUSIONS: OCT finding of decreased GCL and IPL volumes supports previous research suggesting degeneration in MDD. OCT may be an important tool to track neurodegeneration in patients with major depression. Considering RNFL to be the latest layer that will be affected during course of degeneration, GCL and IPL volumes appear to be better parameters to follow. In addition, choroid may be an important structure to detect acute attack period and to follow inflammatory process in MDD like in systemic inflammatory diseases.

Can the retinal ganglion cell layer (GCL) volume be a new marker to detect neurodegeneration in bipolar disorder?

PURPOSE: The aim of this study was to compare the ganglion cell layer (GCL) volume and retinal nerve fiber layer (RNFL) thickness in bipolar patients and controls using optic coherence tomography to demonstrate neurodegeneration in bipolar disorder. METHODS: This study involved 43 euthymic bipolar I patients who were being followed by the Psychiatry Department of Adiyaman University Medical School and 43 healthy volunteers as controls. Optic coherence tomography (OCT) measurements were performed for both groups. The RNFL thickness and GCL volumes were measured and recorded automatically by a spectral OCT device. FINDINGS: No differences in sociodemographics were detected between groups, except for unemployment status, which was significantly higher in the patient group. The RNFL thickness was lower in patients compared with controls at all measured regions, and this decrease was statistically significant for the global RNFL measurement. The GCL volume was also significantly lower in the patient group. There was a significant negative correlation between the disease parameters, such as the disease duration, YMRS score, CGI score, and number of hospitalizations, and GCL volume. DISCUSSION: These findings suggest that neurodegeneration occurs during the course of bipolar disorder. This degeneration may be demonstrated by decreased GCL at early stages, and as the disease progresses, involvement of other retinal layers, such as the RNFL and IPL, may be observed.

[Effect of Continuous Positive Airway Pressure Treatment on Depression, Anxiety and Perceived Stress Levels in Patients with Obstructive Sleep Apnea Syndrome]. / Obstrüktif Uyku Apne Sendromu Olan Hastalarda Sürekli Pozitif Havayolu Basinci Tedavisinin Depresyon, Kaygi ve Algilanan Stres Düzeylerine Etkisi.

OBJECTIVE: The aim of this study is to determine the effects of continuous positive airway pressure (CPAP) treatment on depression, anxiety, and perceived stress levels and to identify factors predictive of treatment efficacy in patients with obstructive sleep apnea syndrome (OSAS). METHOD: This study included 51 patients admitted to the Adiyaman University Medical School Otorhinolaryngology Department or Eskisehir Yunus Emre State Hospital between January and September 2014 with one or more complaints including snoring, excessive daytime sleepiness, or apnea witnessed by the partner. Diagnosis of OSAS was made by polysomnography and CPAP treatment was initiated. Depression levels were assessed in all study subjects using the Hospital Anxiety and Depression Scale (HADS) at the start of treatment and at 3 months. Anxiety levels were assessed using both the HADS and the State and Trait Anxiety Inventory (STAI), and perceived stress level was assessed using the Perceived Stress Questionnaire (PSQ). RESULTS: After CPAP treatment, we observed significant decreases in both the Depression and Anxiety Subscales of the HADS, in the Trait Anxiety subscale of the STAI, and in the PSQ. An evaluation of the initial parameters that predict improvements in these scales revealed that snoring time predicted decreases in all scale scores. CONCLUSION: In OSAS patients CPAP treatment has positive effects on psychological parameters like depression, anxiety, and perceived stress. We suggest that possible psychogenic benefits should be considered when deciding to start CPAP treatment, particularly in patients with pronounced and extended snoring who may also have social problems.

Copycat Suicides Without an Intention to Die After Watching TV Programs: Two Cases at Five Years of Age.

Suicide is an intentional self-destructive act. As conceptualization of death as an irreversible end occurs at approximately 8-10 years, attempted and completed suicides are rare before 7 years of age. Studies have suggested that media may contribute to increased suicides in adolescents through social learning. Effects of media on suicides were thoroughly evaluated in children and adolescents who committed suicide after identifying with the subject of a TV program, movie, or book. We present 2 cases at 5 years of age who committed suicide by hanging themselves after watching a TV program. These cases differed from copycat suicides reported in the literature that are performed mostly by adolescents because victims are very young children and because they died without an actual intent to die while they were imitating suicides. By presenting these cases, we want to emphasize that destructive effects of media may involve not only adults and adolescents but also very young children who do not have a completely developed concept of death.

Spontaneous Ejaculations Associated with Aripiprazole.

Sexual side effects are common with antipsychotic use. Spontaneous ejaculations without sexual arousal have been previously described with several typical and atypical antipsychotics. We report the case of a man who had spontaneous ejaculations after stopping risperidone and starting 30 mg/day aripiprazole. Spontaneous ejaculations ceased 3 days after decreasing the aripiprazole dose to 15 mg/day. He denied sexual fantasies or increased sexual desire during the period in which he had spontaneous ejaculations. The partial agonistic effect of aripiprazole on D2 receptors may have augmented the mesolimbic dopaminergic pathway, which was suppressed by risperidone, causing spontaneous ejaculations in this patient. Serotoninergic effects of aripiprazole should also be considered. This unusual side effect should be questioned, particularly in patients who recieve aripiprazole after D2-blocking antipsychotics; otherwise, this side effect may cause embarrassement and noncompliance.