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BARCELONA – More than a third of treatment-naive patients with newly diagnosed schizophrenia had hyperprolactinemia, in an analysis of data from 73 such patients enrolled in a multicenter, international study.
"Hyperprolactinemia can be found independent of antipsychotic treatment in drug-naive, first-episode schizophrenia patients," Dr. Anita Riecher-Rössler said at the annual congress of the European College of Neuropsychopharmacology The frequent occurrence of hyperprolactinemia in these patients has clinical implications, she added.
First, physicians should measure prolactin levels in newly diagnosed schizophrenia patients to both check for hyperprolactinemia and to establish the patient’s baseline level before starting antipsychotic treatment. Patients should also get assessed for signs and symptoms of hyperprolactinemia, such as menstrual irregularities, loss of libido, and infertility, Dr. Riecher-Rössler said. Patients found to have hyperprolactinemia should undergo a thorough work-up to see if it has a somatic cause that requires treatment. Physicians should also avoid prescribing antipsychotic drugs that can raise prolactin levels to patients who already have an elevated level of the hormone. First-generation antipsychotic drugs, as well as certain second-generation agents such as amisulpride and risperidone are known inducers of hyperprolactinemia (Pharmacotherapy 2009;29:64-73).
"In patients with hyperprolactinemia, consider using a prolactin-sparing antipsychotic, or treat women with estradiol to normalize their prolactin level," said Dr. Riecher-Rössler, a professor of psychiatry and head of the Center for Gender Research and Early Detection at the University of Basel, Switzerland. Hyperprolactinemia poses a threat to young women of triggering early menopause with the resulting complications of loss of fertility and early-onset osteoporosis, she noted. But it also poses a threat to men, causing suppression of the testes and reduced sexuality. "Hyperprolactinemia is a reason to avoid using antipsychotic drugs that can cause it, especially in young women because of the risk of causing early menopause," she said, although drug-induced hyperprolactinemia is less of a threat in patients who start treatment with normal prolactin levels.
The finding also raises the possibility that hyperprolactinemia might play a role in causing schizophrenia, or that emerging schizophrenia or other stresses on the patient cause elevated prolactin levels,
If the patient has no other apparent cause of hyperprolactinemia "the idea is that it is stress induced, and stress is part of an emerging psychosis," she said in an interview. "If you treat the psychosis, you may also lower the prolactin."
Because elevated prolactin levels trigger release of prolactin-inhibiting factor, which is dopamine, another possibility is that high dopamine levels triggered by hyperprolactinemia might affect the brain and play a role in the pathogenesis of schizophrenia. These hypotheses need further study, Dr. Riecher-Rössler said.
The data she and her associates used came from the European First Episode of Schizophrenia Trial (EUFEST), which enrolled 498 patients with newly diagnosed schizophrenia at 50 centers in Europe and Israel (Lancet 2008;371:1085-97). From this group, 249 patients had reliable records on their medical treatment before entering the study and had blood samples available that had been drawn prior to the start of their treatment. The researchers identified 73 of these patients who had been completely free of any antipsychotic or other drug treatment that could have possibly caused elevated prolactin levels prior to their initial blood draw.
Analysis of the blood specimens showed that 19 of the 51 men (37%) and 11 of the 22 women (50%) had hyperprolactinemia, defined as a blood prolactin level greater than 38 U/L in men and greater than 53 U/L in women. The overall prevalence in all 73 patients was 41%.
All antipsychotics have adverse effects, and the risk that some might trigger hyperprolactinemia has to be taken into account along with all the other possible adverse effects when choosing drugs to prescribe to patients, she said.
"Do you prescribe olanzapine or quetiapine, which cause weight gain, or do you use amisulpride or risperidone, which raise prolactin?" Dr. Riecher-Rössler asked. "Which side effect is the patient prepared to cope with? I try to avoid using amisulpride in women who are young and still want to become pregnant or in young men so I don’t suppress their sexuality."
She and her associates reported the results in an article published earlier this year (Psychol Med. 2013 [doi:10.1017/S0033291713000226]).
EUFEST received support from Astra Zeneca, Pfizer, and Sanofi. Dr. Riecher-Rössler said she had no disclosures.
On Twitter @mitchelzoler
BARCELONA – More than a third of treatment-naive patients with newly diagnosed schizophrenia had hyperprolactinemia, in an analysis of data from 73 such patients enrolled in a multicenter, international study.
"Hyperprolactinemia can be found independent of antipsychotic treatment in drug-naive, first-episode schizophrenia patients," Dr. Anita Riecher-Rössler said at the annual congress of the European College of Neuropsychopharmacology The frequent occurrence of hyperprolactinemia in these patients has clinical implications, she added.
First, physicians should measure prolactin levels in newly diagnosed schizophrenia patients to both check for hyperprolactinemia and to establish the patient’s baseline level before starting antipsychotic treatment. Patients should also get assessed for signs and symptoms of hyperprolactinemia, such as menstrual irregularities, loss of libido, and infertility, Dr. Riecher-Rössler said. Patients found to have hyperprolactinemia should undergo a thorough work-up to see if it has a somatic cause that requires treatment. Physicians should also avoid prescribing antipsychotic drugs that can raise prolactin levels to patients who already have an elevated level of the hormone. First-generation antipsychotic drugs, as well as certain second-generation agents such as amisulpride and risperidone are known inducers of hyperprolactinemia (Pharmacotherapy 2009;29:64-73).
"In patients with hyperprolactinemia, consider using a prolactin-sparing antipsychotic, or treat women with estradiol to normalize their prolactin level," said Dr. Riecher-Rössler, a professor of psychiatry and head of the Center for Gender Research and Early Detection at the University of Basel, Switzerland. Hyperprolactinemia poses a threat to young women of triggering early menopause with the resulting complications of loss of fertility and early-onset osteoporosis, she noted. But it also poses a threat to men, causing suppression of the testes and reduced sexuality. "Hyperprolactinemia is a reason to avoid using antipsychotic drugs that can cause it, especially in young women because of the risk of causing early menopause," she said, although drug-induced hyperprolactinemia is less of a threat in patients who start treatment with normal prolactin levels.
The finding also raises the possibility that hyperprolactinemia might play a role in causing schizophrenia, or that emerging schizophrenia or other stresses on the patient cause elevated prolactin levels,
If the patient has no other apparent cause of hyperprolactinemia "the idea is that it is stress induced, and stress is part of an emerging psychosis," she said in an interview. "If you treat the psychosis, you may also lower the prolactin."
Because elevated prolactin levels trigger release of prolactin-inhibiting factor, which is dopamine, another possibility is that high dopamine levels triggered by hyperprolactinemia might affect the brain and play a role in the pathogenesis of schizophrenia. These hypotheses need further study, Dr. Riecher-Rössler said.
The data she and her associates used came from the European First Episode of Schizophrenia Trial (EUFEST), which enrolled 498 patients with newly diagnosed schizophrenia at 50 centers in Europe and Israel (Lancet 2008;371:1085-97). From this group, 249 patients had reliable records on their medical treatment before entering the study and had blood samples available that had been drawn prior to the start of their treatment. The researchers identified 73 of these patients who had been completely free of any antipsychotic or other drug treatment that could have possibly caused elevated prolactin levels prior to their initial blood draw.
Analysis of the blood specimens showed that 19 of the 51 men (37%) and 11 of the 22 women (50%) had hyperprolactinemia, defined as a blood prolactin level greater than 38 U/L in men and greater than 53 U/L in women. The overall prevalence in all 73 patients was 41%.
All antipsychotics have adverse effects, and the risk that some might trigger hyperprolactinemia has to be taken into account along with all the other possible adverse effects when choosing drugs to prescribe to patients, she said.
"Do you prescribe olanzapine or quetiapine, which cause weight gain, or do you use amisulpride or risperidone, which raise prolactin?" Dr. Riecher-Rössler asked. "Which side effect is the patient prepared to cope with? I try to avoid using amisulpride in women who are young and still want to become pregnant or in young men so I don’t suppress their sexuality."
She and her associates reported the results in an article published earlier this year (Psychol Med. 2013 [doi:10.1017/S0033291713000226]).
EUFEST received support from Astra Zeneca, Pfizer, and Sanofi. Dr. Riecher-Rössler said she had no disclosures.
On Twitter @mitchelzoler
BARCELONA – More than a third of treatment-naive patients with newly diagnosed schizophrenia had hyperprolactinemia, in an analysis of data from 73 such patients enrolled in a multicenter, international study.
"Hyperprolactinemia can be found independent of antipsychotic treatment in drug-naive, first-episode schizophrenia patients," Dr. Anita Riecher-Rössler said at the annual congress of the European College of Neuropsychopharmacology The frequent occurrence of hyperprolactinemia in these patients has clinical implications, she added.
First, physicians should measure prolactin levels in newly diagnosed schizophrenia patients to both check for hyperprolactinemia and to establish the patient’s baseline level before starting antipsychotic treatment. Patients should also get assessed for signs and symptoms of hyperprolactinemia, such as menstrual irregularities, loss of libido, and infertility, Dr. Riecher-Rössler said. Patients found to have hyperprolactinemia should undergo a thorough work-up to see if it has a somatic cause that requires treatment. Physicians should also avoid prescribing antipsychotic drugs that can raise prolactin levels to patients who already have an elevated level of the hormone. First-generation antipsychotic drugs, as well as certain second-generation agents such as amisulpride and risperidone are known inducers of hyperprolactinemia (Pharmacotherapy 2009;29:64-73).
"In patients with hyperprolactinemia, consider using a prolactin-sparing antipsychotic, or treat women with estradiol to normalize their prolactin level," said Dr. Riecher-Rössler, a professor of psychiatry and head of the Center for Gender Research and Early Detection at the University of Basel, Switzerland. Hyperprolactinemia poses a threat to young women of triggering early menopause with the resulting complications of loss of fertility and early-onset osteoporosis, she noted. But it also poses a threat to men, causing suppression of the testes and reduced sexuality. "Hyperprolactinemia is a reason to avoid using antipsychotic drugs that can cause it, especially in young women because of the risk of causing early menopause," she said, although drug-induced hyperprolactinemia is less of a threat in patients who start treatment with normal prolactin levels.
The finding also raises the possibility that hyperprolactinemia might play a role in causing schizophrenia, or that emerging schizophrenia or other stresses on the patient cause elevated prolactin levels,
If the patient has no other apparent cause of hyperprolactinemia "the idea is that it is stress induced, and stress is part of an emerging psychosis," she said in an interview. "If you treat the psychosis, you may also lower the prolactin."
Because elevated prolactin levels trigger release of prolactin-inhibiting factor, which is dopamine, another possibility is that high dopamine levels triggered by hyperprolactinemia might affect the brain and play a role in the pathogenesis of schizophrenia. These hypotheses need further study, Dr. Riecher-Rössler said.
The data she and her associates used came from the European First Episode of Schizophrenia Trial (EUFEST), which enrolled 498 patients with newly diagnosed schizophrenia at 50 centers in Europe and Israel (Lancet 2008;371:1085-97). From this group, 249 patients had reliable records on their medical treatment before entering the study and had blood samples available that had been drawn prior to the start of their treatment. The researchers identified 73 of these patients who had been completely free of any antipsychotic or other drug treatment that could have possibly caused elevated prolactin levels prior to their initial blood draw.
Analysis of the blood specimens showed that 19 of the 51 men (37%) and 11 of the 22 women (50%) had hyperprolactinemia, defined as a blood prolactin level greater than 38 U/L in men and greater than 53 U/L in women. The overall prevalence in all 73 patients was 41%.
All antipsychotics have adverse effects, and the risk that some might trigger hyperprolactinemia has to be taken into account along with all the other possible adverse effects when choosing drugs to prescribe to patients, she said.
"Do you prescribe olanzapine or quetiapine, which cause weight gain, or do you use amisulpride or risperidone, which raise prolactin?" Dr. Riecher-Rössler asked. "Which side effect is the patient prepared to cope with? I try to avoid using amisulpride in women who are young and still want to become pregnant or in young men so I don’t suppress their sexuality."
She and her associates reported the results in an article published earlier this year (Psychol Med. 2013 [doi:10.1017/S0033291713000226]).
EUFEST received support from Astra Zeneca, Pfizer, and Sanofi. Dr. Riecher-Rössler said she had no disclosures.
On Twitter @mitchelzoler
AT THE ECNP CONGRESS
Major finding: Hyperprolactinemia occurred in 50% of women and 37% of men with treatment-naive, first-episode schizophrenia.
Data source: EUFEST, a multinational study of 498 first-episode schizophrenia patients.
Disclosures: EUFEST received support from AstraZeneca, Pfizer, and Sanofi. Dr. Riecher-Rössler said she had no disclosures.
