Extremely Rare Side Effects From Psychiatric Medications

I’ve actually had 2 of these: Stevens Johnson Syndrome and Diabetes Insipidus. Aren’t I lucky?!

Diabetes insipidus

Info

Most common drug to cause this: Lithium

Occurrence: 5-20%

Nephrogenic diabetes insipidus (NDI) occurs when the kidney tubules do not respond to a chemical in the body called antidiuretic hormone (ADH), also called vasopressin. ADH normally tells the kidneys to make the urine more concentrated.

As a result of the defect, the kidneys release an excessive amount of water into the urine, producing a large quantity of very dilute urine. This makes you produce large amounts of urine.

Diagnosis: A physical exam may reveal:

  • Low blood pressure
  • Rapid pulse
  • Shock
  • Signs of dehydration

Testing may reveal:

  • High serum osmolality
  • High urine output, regardless of how many fluids you drink
  • Kidneys don’t concentrate urine when the person is given ADH
  • Low urine osmolality
  • Normal or high ADH levels

Symptoms: You may have intense or uncontrollable thirst, and crave ice water. You will produce large amounts of urine, usually more than 3 – 15 liters per day.

If you do not drink enough fluids, dehydration can result. Symptoms may include:

  • Dry mucous membranes
  • Dry skin
  • Sunken appearance to eyes
  • Extreme thirst
  • Urinating a lot

Treatment: The goal of treatment is to control the body’s fluid levels. Patients will be given a large amount of fluids. The amount of fluids given should be about equal to the amount of urine produced.

If the condition is due to a certain medication, stopping the medicine may improve symptoms. Never stop taking any medication without first talking to your doctor.

A medicine called hydrochlorothiazide may improve symptoms.

diabetesinipidus

Agranulocytosis

Info 1 Info 2

Most common med to cause this: Clozapine

Occurrence: 5%

Agranulocytosis is a rare condition that occurs when the bone marrow does not make enough neutrophils, the white blood cells needed to fight infections

Diagnosis: Blood test

Symptoms: The early symptoms of agranulocytosis include a sudden fever, chills, a sore throat, and weakness in the limbs. The mouth and gums may be sore, mouth ulcers can develop, and gums might begin to bleed.

Other signs of agranulocytosis can include:

  • fast heart rate
  • rapid breathing
  • low blood pressure
  • skin abscesses

Treatment: If the agranulocytosis is caused by a drug needed for another condition, a substitute treatment will be offered. For anyone taking several different drugs, it may be necessary to stop taking them. This could be the only way to find which one(s) may be the cause of the problem.

Antibiotics or antifungal drugs may be given to treat any infections.

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Stevens Johnson Syndrome

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Most common med to cause this: Lamictal

Occurrence: 0.8%

Stevens-Johnson Syndrome is the most severe form of erythema multiforme and is characterized by ulcerated lesions on the skin and mucous membranes.

It is a serious, sometimes fatal inflammatory disease. It is also known as erythema multiforme major.

Diagnosis: The diagnosis of Stevens-Johnson Syndrome is usually based on the clinical appearance and distribution of the skin and mucosal lesions. A skin biopsy may be performed.

Symptoms: Typically, Stevens-Johnson syndrome affects the mucous membranes of the oral cavity, nostril, eyes, and both the anal and genital regions. It may or may not be associated with skin lesions elsewhere on the body. Oropharyngeal (mouth) lesions may be so intolerable as to prevent eating, and there may be recurring oral ulcers. Often, the skin lesions may look like a target-lesion (3 concentric zones of color change) or as bullae (bubble-like).

A painful conjunctivitis may occur in the eye, frequently with a pus discharge, and can lead to corneal scarring and loss of vision. In addition to the mucous membrane lesions, fever and exhaustion are usual.

Approximately one-third of patients have pulmonary involvement with cough and patchy infiltrates (material that has permeated into the tissues) on chest x-ray. In fatal cases, renal failure and pneumonia may occur.

Treatment: Every attempt should be made to identify a precipitating agent, and to remove it if possible. Antibiotics are appropriate if superinfection (a fresh infection added to one of the same nature already present) is suspected, or if bacterial disease, such as mycoplasma, is suspected to be the cause. Intensive supportive care is important in severe cases, including specialized care in a burn unit.

Fluid replacement is often required, and meticulous oral hygiene is necessary to prevent superinfection. Examination by an ophthalmologist is recommended for patients with eye lesions so that precautions can be taken to avoid permanent eye damage. Oral and topical corticosteroids are often used.

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Priapism

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Most common med to cause this: Typical (old) antipsychotics

Diagnosis: Your doctor will review your medical history and perform a thorough physical exam to determine the cause of priapism. This will include checking the rectum and the abdomen for evidence of unusual growths or abnormalities that may indicate the presence of cancer.

Symptoms: Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

Treatment:

  • Ice packs: Ice applied to the penis and perineum may reduce swelling.
  • Surgical ligation: Used in cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing the priapism in order to restore normal blood flow.
  • Intracavernous injection: Used for low-flow priapism, during this treatment drugs known as alpha-agonists are injected into the penis. This causes the veins to narrow, reducing blood flow to the penis and easing swelling to the area. Oral alpha-agonists have also been used for the acute treatment of priapism.
  • Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.
  • Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

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