Duloxetine is a balanced and potent serotonin and noradrenaline reuptake inhibitor which is known to be effective in depression and anxiety disorders. The common adverse effects include dry mouth, nausea, insomnia, somnolence, dizziness and constipation. Reported adverse effects of the extra pyramidal symptoms (EPS) are rare. In this case, a patient who suffered from acute dystonia, after only one dose of 30 mg duloxetine is presented.
Anxiety Disorders ; Constipation ; Depression ; Dizziness ; Dystonia ; Humans ; Mouth ; Nausea ; Norepinephrine ; Serotonin ; Sleep Initiation and Maintenance Disorders ; Thiophenes ; Duloxetine Hydrochloride

Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients' compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.
Acetylcholine ; Amitriptyline ; Antipsychotic Agents ; Cholinergic Antagonists ; Compliance ; Deamino Arginine Vasopressin ; Dopamine ; Ephedrine ; Epinephrine ; Follow-Up Studies ; Humans ; Mass Screening ; Neural Pathways ; Neurotransmitter Agents ; Schizophrenia ; Serotonin ; Trihexyphenidyl ; Urinary Incontinence* ; Paliperidone Palmitate

Objective: Several immunological factors are emphasized in the etiology of autoimmune thyroid diseases and obsessivecompulsive disorder. Obsessive-compulsive symptoms (OCS) are commonly seen in patients with autoimmune thyroid diseases. This study aims to evaluate the relationship between OCS and antithyroid antibodies. Methods: The study included 145 patients with Hashimoto thyroiditis or Graves’ disease and 42 healthy controls. Thyroid function tests and serum thyroid autobody levels (anti-thyroglobulin [TG], anti-thyroid peroxidase [TPO], and anti-thyroid stimulating hormone [TSH]) of the patients were measured. The socio-demographic data and OCS of the participants were evaluated with Dimensional OCS (DOCS). Results: DOCS scores were higher in patients than in the control group. There was not found a significant relationship between free T3, free T4, and TSH levels and DOCS scores. Anti-TG positivity in females was associated with lower DOCS scores. Anti-TPO positivity in males had a positive correlation with DOCS scores. There was no correlation between sex and the presence of anti-TSH in terms of OCS severity. Univariate analysis found the highest OCS scores in anti-TPO positive, anti-TG, and anti-TSH negative patients. The group with the lowest OCS scores was found to be anti-TG positive, anti-TPO, and anti-TSH negative patients. Conclusion OCS severity could be affected by different thyroid autoantibody profiles in patients with autoimmune thyroid diseases. While anti-TG serves a protective role against OCS in females, the presence of anti-TPO may worsen the OCS in men. Additionally, the co-existence of different antithyroid antibodies may affect the severity of OCS differently according to sex.