A Case of Risperidone-Induced Urinary Incontinence.

Schizophrenia spectrum disorders are psychiatric conditions associated with an increased risk of all-cause mortality; patients with these conditions have a shortened average lifespan compared to the general population. First-line treatment for schizophrenia spectrum illness consists of atypical antipsychotics, which are associated with well-understood side effects, including metabolic syndrome, anticholinergic effects, and extrapyramidal symptoms. We are presenting a case of a 36-year-old patient treated with the atypical antipsychotic risperidone who experienced treatment-associated urinary incontinence. In the current literature, atypical antipsychotic-induced urinary incontinence is not well-documented in patients with schizophrenia spectrum disorder. Incontinence is often a topic of societal shame for many patients, and as a side effect, it may influence medication compliance. In the treatment of schizophrenia spectrum disorders, compliance is essential to prevent psychosis relapse in patients, so prescribers must be aware of this potential side effect and how to manage it. Upon a patient presenting with incontinence suspected to be due to atypical antipsychotics, other more common causes of incontinence must first be ruled out. Then, further management can consist of stopping the offending medication or adding a medication to address the incontinence. In this case, our patient had an extended history of suboptimal treated schizoaffective disorder, and risperidone was providing significant improvement; therefore, to ensure continued improvement, we initiated oxybutynin to manage urinary incontinence.

Integrating Yoga Into Undergraduate American Medical Education.

Undergraduate medical education (UGME) is the time when doctors' attitudes toward patients and their profession are formed. It is also a period of tremendous stress for future physicians, including high levels of negative stress. Such stress can be maladaptive and may sow the seeds of burnout and long-term dissatisfaction. We believe that the introduction of yoga practice in the 1st year of medical school could ameliorate the negative stressors to which undergraduate medical students are exposed. Although there are some studies in the U.S. and internationally that support the use of Yoga in UGME, they do not provide sufficient data to make a compelling case for widespread implementation of yoga programs in undergraduate curricula. We, therefore, wish to advocate for conducting a trial of the integration of yoga in the undergraduate medical curriculum to combine yoga's ancient health wisdom into the context of modern scientific medicine. Large, prospective, multicenter, and multi-method pilot projects are needed to identify how a program of yoga practice and theory could counter the UGME environment that ultimately produces depression, anxiety, and non-effective coping strategies among medical students. A curriculum for yoga for undergraduate medical students deserves serious consideration and a prominent place among efforts to improve UGME.