Effects of cigarette smoking on priapism induced by quetiapine: a case report

The etiology of priapism may be idiopathic, drug-induced, or related to some medical problems like sickle cell disease or leukemia [1]. Priapism has been notenoted as an adverse effect of both first- and second-generation anti psychotic medications [2]. Peripheral alpha-1 adrenergic blockade has been considered as the main cause of priapism [3]. Trazodone with its alpha-1 antagonistic properties, has been reported to induce priapism [4]. Antipsychotics are accounted for 15-26% of priapism cases that are induced by medications [5]. Previous case reports of priapism associated with quetiapine were those with a total daily dose of 600mg or greater [4,6-9]. One case involved a single overdose of 675mg [8]. Presently, we report a case of priapism associated with 25mg use of quetiapine [10].A 30 year old single unemployed man was presented to our out-patient psychiatry clinic because of a recurrence of the psychotic episode. The patient did not have any comorbidity with medical diseases or substance abuse disorders in the past. Recurrence of the psychotic episode was due to the self-discontinuation of quetiapine secondary to recurrent priapism. He was diagnosed with paranoid schizophrenia since 10 years ago. His main symptoms included delusions of control, persecutory delusion, and auditory hallucination. His symptoms were relatively controlled. He had several recurrences and all of them were associated with drug discontinuation due to the patient's lack of compliance. He did not have any major stressors before recurrences. He was under treatment of first- and second-generation antipsychotics. He developed drug-induced Parkinsonism several times which was resolved with dose-adjustment and anti cholinergic therapy. The patient experienced priapism secondary to use of some antipsychotic medications like risperidone, olanzapine, clozapine and finally quetiapine. The diagnosis of priapism was confirmed by a urologic consult. All medical causes of priapism were ruled-out by a