At the same time,

however, clozapine can cause serious side effects such as priapism, an embarrassing condition which is a urological emergency potentially leading to severe complications as well as lifelong sexual problems. It is very difficult for patients to discuss this in the open ward round settings, especially in the presence of female staff or large numbers of staff Selleckchem Autophagy inhibitor members. We have to be aware and mindful of this uncommon, unusual and rare side effect of clozapine which if not severe, might go unnoticed due to the hesitancy of a patient in revealing it. We may have to ask the patients specifically about priapism. It can Inhibitors,research,lifescience,medical be a dilemma for doctors to rechallenge with clozapine, and the literature suggests that there have been patients who never redeveloped priapism. At the same time, there can be cases such as ours where Inhibitors,research,lifescience,medical the patient developed stuttering (recurrent) priapism whenever he was rechallenged with clozapine, as evidenced by a clear temporal relationship of the occurrence

of priapism with initiations of clozapine, and its disappearance with the discontinuation of clozapine. In cases such as these where every other antipsychotic has failed, the clinician has to give due consideration to spending time in discussion with the patient and giving them Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical all of the relevant necessary information regarding clozapine (or, for that matter, any other antipsychotic) including information about rare but serious side effects such as priapism

and treatments including injectable goserline acetate (and its side effects) which may also affect the natural sexual erection in Inhibitors,research,lifescience,medical a sexually viable adult patient. We have to thoroughly check the patient’s capacity to help them make a decision regarding these issues, to empower the patient with knowledge and information, to discuss with them the delicate balance between mental health and sexual health, and to provide them with as much support as possible to make an informed decision. With our patuent, we discussed the side effects of clozapine, the use of goserline acetate, checked his capacity and he willingly agreed to continue the treatment. Recognition and acknowledgement of the patient’s Edoxaban distress are essential, and the issue is a sensitive one requiring time, patience and relevant support for resolution. Footnotes Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflict of interest statement: The author declares that there is no conflict of interest. Contributor Information Gursharan Lal Kashyap, SEPT, Weller Wing, Ampthill Road, Bedford, Bedfordshire, UK. Jitendra Nayar, SEPT, Weller Wing, Ampthill Road, Bedford, Bedfordshire, UK.