Hyperprolactinemia - side effect or part of the illness

Area of Science:

• Neuroscience
• Psychiatry
• Endocrinology

Background:

• Hyperprolactinemia is a known side effect of antipsychotic medications in patients with psychotic disorders.
• However, elevated prolactin levels have been observed in patients experiencing their first psychotic episode even before antipsychotic therapy initiation.
• This suggests that the disease itself, rather than the treatment, may influence prolactin levels.

Purpose of the Study:

• To investigate the association between prolactin levels and psychotic disorders.
• To determine if elevated prolactin is linked to the disease process or antipsychotic therapy.
• To explore the relationship between prolactin levels and the severity of psychotic symptoms.

Main Methods:

• The study included 54 female patients diagnosed with psychotic disorders (ICD-10, F20-F29).
• Patients were assessed for first psychotic episode (18 patients) or relapse (36 patients).
• Methods included the Positive and Negative Syndrome Scale (PANSS) and prolactin concentration measurement using an Immunoanalyzer ACCESS 2 (CLIA method).

Main Results:

• 75.5% of patients exhibited prolactin levels above reference values.
• Elevated prolactin was observed in 77.8% of first-episode patients and 74.2% of relapsed patients.
• Higher prolactin levels significantly correlated with increased symptom severity, particularly delusions (P1), apathy (N4), preoccupation (G15), and active avoidance (G16) on the PANSS.

Conclusions:

• Elevated prolactin levels in patients with psychotic disorders are present irrespective of antipsychotic therapy, questioning the therapy's role in etiology.
• A significant association exists between hyperprolactinemia and the severity of the clinical presentation.
• These findings challenge the notion of a protective role for prolactin in psychotic disorders and suggest disease-related mechanisms.