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Abstract
Antipsychotics acting as antagonists at dopamine D2 receptors concentrated in the striatum are the cornerstone of effective treatment of psychosis. Substantial progress in treating persons with schizophrenia could be achieved by the identification of biomarkers which reliably determine the lowest efficacious dose of antipsychotics. Prolactin levels have been considered a promising treatment-response biomarker due to dopamine’s regulation of serum prolactin levels through D2 receptors in the hypothalamic-pituitary pathway. Prolactin secretion in response antipsychotic administration is associated with the antipsychotics affinity for D2 receptors. This review assesses the available literature on the use of serum prolactin levels as an antipsychotic-response biomarker. Articles were identified through PubMed as well as the reference lists of full text articles available online. Relevant publications were summarized briefly to define the limitations and utility of serum prolactin levels as a tool for improving antipsychotic dosing. Serum prolactin levels in combination with prolactin-inducing potencies for each antipsychotic may help identify the lowest effective dose of antipsychotic medications. , In addition to the fact that prolactin secretion is dependent on serum antipsychotic levels and not brain levels, recent findings show that prolactin release is independent of the β-arrestin-2 pathway and GSK3β regulation, one branch of the pathway that has been implicated in antipsychotic efficacy. Therefore, serum prolactin is an indirect biomarker for treatment response. Further investigations are warranted to characterize prolactin-antipsychotic dose-response curves and systematically test the utility of measuring prolactin levels in patients to identify a person’s lowest efficacious dose.
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Affiliation(s)
- Judith M Gault
- Departments of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, USA.,Departments of Neurosurgery, University of Colorado Denver, USA
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Veselinović T, Vernaleken I, Cumming P, Henning U, Winkler L, Kaleta P, Paulzen M, Luckhaus C, Gründer G. Antidopaminergic medication in healthy subjects provokes subjective and objective mental impairments tightly correlated with perturbation of biogenic monoamine metabolism and prolactin secretion. Neuropsychiatr Dis Treat 2018; 14:1125-1138. [PMID: 29731635 PMCID: PMC5927059 DOI: 10.2147/ndt.s148557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Off-label prescription of antipsychotics to patients without psychotic symptoms has become a routine matter for many psychiatrists and also some general practitioners. Nonetheless, little is known about the possibly detrimental effects of antidopaminergic medications on general psychopathology, subjective mental state, or a possible association with physiological parameters in nonpsychotic individuals. METHODS In this randomized, single-blinded study, groups of healthy volunteers (n=18) received low doses of reserpine, aripiprazole, haloperidol, or placebo on 7 successive days. Relevant physiological parameters (plasma prolactin, concentrations of catecholamine metabolites in plasma, and 24-hour urine) and each subject's mental state (Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression, visual analogue scale, Beck Depression Inventory II) were assessed at the start and end of the trial. RESULTS Of the three active treatments, only reserpine caused a significant increase in some plasma- and urine-catecholamine metabolites, but all three medications evoked objective and subjective changes in general psychopathology scores, which correlated with individual increases in plasma homovanillic acid concentrations. Both objective and subjective impairments were significantly more pronounced in the subgroup with greatest increase of plasma prolactin. Subjects experiencing the most pronounced side effects under haloperidol, which compelled them to drop out, showed significantly higher prolactin concentration increases than those who tolerated haloperidol well. CONCLUSION We found consistent associations between altered markers of dopamine transmission and several objective and subjective mental impairments in healthy volunteers after 1 week's treatment with antidopaminergic medications. These findings should draw attention to a more intensive risk-benefit evaluation in cases of off-label prescription of antipsychotic medications.
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Affiliation(s)
- Tanja Veselinović
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Ingo Vernaleken
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Paul Cumming
- IHBI, School of Psychology and Counselling, Queensland University of Technology.,QIMR Berghofer Institute, Brisbane, Australia
| | - Uwe Henning
- Neurobiochemical Research Unit, Department of Psychiatry, Heinrich Heine University, Düsseldorf
| | - Lina Winkler
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Peter Kaleta
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Michael Paulzen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany
| | - Christian Luckhaus
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr University Bochum, Bochum
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen.,Translational Brain Medicine, Jülich Aachen Research Alliance (JARA), Jülich, Germany.,Department of Molecular Neuroimaging, Central Institute of Mental Health, Mannheim, Germany
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van de Kerkhof NWA, Fekkes D, van der Heijden FMMA, Egger JIM, Verhoeven WMA. Relationship between plasma homovanillic acid and outcome in patients with psychosis spectrum disorders. Neuropsychobiology 2016; 71:212-7. [PMID: 26279280 DOI: 10.1159/000431095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 05/04/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychosis spectrum disorders, especially schizophrenia, have been linked to disturbed dopaminergic activity in the brain. Plasma homovanillic acid (pHVA) levels partly represent dopaminergic metabolism in the central nervous system. In the present study associations between (changes in) pHVA levels, symptom severity and symptomatic improvement in patients with psychoses were investigated. METHODS From a total of 80 patients, 58 fulfilled all inclusion criteria and their symptom profile and severity were assessed by means of the Comprehensive Assessment of Symptoms and History (CASH), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale for Severity and Improvement (CGI-S/CGI-I) at baseline and after 6 weeks of antipsychotic treatment. After inclusion, all patients were prescribed first- or second-generation antipsychotics by their treating psychiatrist. A total of 12 patients had first-episode psychosis (FEP). At both time points, pHVA levels were measured. Subsequently, pHVA levels were compared with an age-matched control sample and changes in pHVA levels (ΔpHVA) after treatment were associated with clinical parameters. RESULTS Before analyses, data were scrutinized for possible confounders, particularly gender, smoking, medication status (including antipsychotic class), and recent drug use. The pHVA levels in patients were not different from those in controls. Treatment resulted in a significant decrease of all parameters. Symptomatic improvement as well as ΔpHVA was most pronounced in FEP patients. CONCLUSION These findings show that patients with FEP have a more favourable outcome than non-FEP patients and that greater ΔpHVA also suggests that FEP patients still have the capacity to adjust dopaminergic neurotransmission.
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Affiliation(s)
- Nora W A van de Kerkhof
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
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Arteagoitia I, Zumarraga M, Dávila R, Barbier L, Santamaría G, Santamaria J. Plasma variations in stress markers: clinical trial of two anesthetics used in regional block in the extraction of impacted inferior third molars. Med Oral Patol Oral Cir Bucal 2014; 19:e274-9. [PMID: 24316704 PMCID: PMC4048117 DOI: 10.4317/medoral.19362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/03/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Was to evaluate the effect of different regional anesthetics (articaine with epinephrine versus prilocaine with felypressin) on stress in the extraction of impacted lower third molars in healthy subjects. STUDY DESIGN [corrected] A prospective single-blind, split-mouth cross-over randomized study was designed, with a control group. The experimental group consisted of 24 otherwise healthy male volunteers, with two impacted lower third molars which were surgically extracted after inferior alveolar nerve block (regional anesthesia), with a fortnight's interval: the right using 4% articaine with 1:100.000 epinephrine, and the left 3% prilocaine with 1:1.850.000 felypressin. Patients were randomized for the first surgical procedure. To analyze the variation in four stress markers, homovanillic acid, 3-methoxy-4-hydroxyphenylglycol, prolactin and cortisol, 10-mL blood samples were obtained at t = 0, 5, 60, and 120 minutes. The control group consisted of 12 healthy volunteers, who did not undergo either extractions or anesthetic procedures but from whom blood samples were collected and analyzed in the same way. RESULTS Plasma cortisol increased in the experimental group (multiple range test, P<0.05), the levels being significantly higher in the group receiving 3% prilocaine with 1:1.850,000 felypressin (signed rank test, p<0.0007). There was a significant reduction in homovanillic acid over time in both groups (multiple range test, P<0.05). No significant differences were observed in homovanillic acid, 3-methoxy-4-hydroxyphenylglycol or prolactin concentrations between the experimental and control groups. CONCLUSIONS The effect of regional anesthesia on stress is lower when 4% articaine with 1:100,000 epinephrine is used in this surgical procedure.
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Affiliation(s)
- Iciar Arteagoitia
- Hospital Universitario Cruces, Gurutzetako Unibertsitate Ospitalea, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain,
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Dávila R, Zumárraga M, Basterreche N, Arrúe A, Anguiano JB. Plasma homovanillic acid levels in schizophrenic patients: correlation with negative symptoms. Psychiatry Res 2007; 151:163-8. [PMID: 17434602 DOI: 10.1016/j.psychres.2005.07.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2003] [Revised: 04/13/2005] [Accepted: 07/20/2005] [Indexed: 11/29/2022]
Abstract
The relation between changes in the levels of plasma homovanillic acid (pHVA) and clinical evolution during neuroleptic treatment of schizophrenic patients has not been satisfactorily characterized, as a number of conflicting findings have been reported. Significant correlations have generally been found using the assessment of positive symptoms as an index of clinical outcome. Nevertheless, attempts to correlate pHVA concentrations with negative symptoms have yielded contradictory results. With a view to evaluating if different responses in negative symptoms are associated with distinct pHVA profiles, we examined the levels of pHVA in 46 neuroleptic-free schizophrenic patients and in these patients after neuroleptic treatment. Negative and positive symptoms were also addressed before and after treatment. Our results reveal that at least two classes of negative symptoms exist; the clinical evolution of the first class of negative symptoms parallels that of positive symptoms, and clinical improvement correlates with reduced dopaminergic activity. In contrast, in the second class, reduced dopaminergic activity is associated with a further deterioration of negative symptoms. These findings corroborate the heterogeneity of negative symptoms and may contribute to a better definition of endophenotypes in the schizophrenic syndrome.
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Affiliation(s)
- Ricardo Dávila
- Departamento de Investigación Neuroquímica, Hospital Psiquiátrico de Zamudio, Servicio Vasco de Salud (Osakidetza), Arteaga Auzoa N degrees 45, E-48170 Zamudio, Vizcaya, Spain.
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Dávila R, Zumárraga M, Basterreche N, Arrúe A, Zamalloa MI, Anguiano JB. Influence of the catechol-O-methyltransferase Val108/158Met polymorphism on the plasma concentration of catecholamine metabolites and on clinical features in type I bipolar disorder--a preliminary report. J Affect Disord 2006; 92:277-81. [PMID: 16542735 DOI: 10.1016/j.jad.2006.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 02/06/2006] [Accepted: 02/06/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND The activity of catechol-O-methyltransferase (COMT) may be related to psychosis susceptibility. The Val108/158Met polymorphism of the COMT gene influences its enzymatic activity and may result in altered concentrations of monoamine metabolites and different clinical responses of patients to pharmacological treatments. METHODS We examined in a sample of 42 bipolar patients if the Val108/158Met polymorphism influences: (a) the presence of psychosis in type I bipolar patients; (b) the blood plasma concentration of homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG), which are metabolites of dopamine and noradrenaline respectively and (c) the severity of the clinical characteristics of these patients and their response to pharmacological treatment. RESULTS No significant associations were found between the studied COMT genotypes and the studied parameters. However, a non-significant aggregation of bipolar patients presenting with psychosis was found in the homozygous Val-Val group. Clinical improvement was found to significantly correlate with the levels of plasma MHPG prior to treatment. Moreover, a significant difference was found between the standard deviations of the concentrations of HVA in the three genotypes, but not in their mean values. Significant associations were not detected between COMT polymorphisms and the initial severity of the disorder, or the clinical response to pharmacological treatment. LIMITATIONS The size of the studied sample is somewhat small and comparisons have been made with a previously studied control group. CONCLUSIONS The Val108/158Met polymorphism does not appear to be a crucial determinant in type I bipolar disorder.
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Affiliation(s)
- Ricardo Dávila
- Departamento de Investigación Neuroquímica, Hospital Psiquiátrico de Zamudio, Servicio Vasco de Salud (Osakidetza), Vizcaya, Spain.
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Oades RD, Klimke A, Henning U, Rao ML. Relations of clinical features, subgroups and medication to serum monoamines in schizophrenia. Hum Psychopharmacol 2002; 17:15-27. [PMID: 12404703 DOI: 10.1002/hup.368] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Plasma and serum indices of monoaminergic activity reflect partly the illness of schizophrenia (e.g. HVA/deficit syndrome) and sometimes the symptoms (e.g. HVA/anhedonia). But, such studies have rarely taken both metabolites and parent amines or inter-amine activity ratios into account. We hypothesized that comparing the major symptom dimensions to measures of transmitter activity (with and without control for antipsychotic drug treatment) would show differential patterns of activity useful for the design of pharmacological treatments. METHODS Dopamine (DA), noradrenaline (NA), serotonin (5-HT), their three major metabolites and prolactin were measured in the serum of 108 patients with schizophrenia and 63 matched controls: DA D2-receptor blocking-activity was estimated from a regression of butyrophenone displacement in striatum in vitro on to PET reports of drug-binding in vivo. Symptoms were factored into four dimensions (disorganized/thought disorder, nonparanoid/negative, ideas-of-reference and paranoid/positive symptoms). RESULTS (1). Patients' DA activity did not differ from controls: but their 5-HT and NA turnovers increased/decreased, respectively, and the DA/5HT-metabolite ratio was lower. Increased DA-D2-receptor occupancy was predicted by decreased DA-metabolism and its ratio to 5-HT-metabolism. (2). Patients had higher levels of NA, DA-metabolites and DA-/5-HT-metabolite ratios on atypical vs typical drugs. (3). Increased D2-occupancy was associated with lower DA metabolism in paranoid patients but was unrelated to relative increases of DA/5-HT- and NA-metabolism in nonparanoid patients. (4). Low DA-/5-HT-metabolite ratios, high prolactin and low DA-metabolism characterized thought-disordered patients. (5). High DA-/5-HT-metabolite ratios paralleled many ideas-of-reference. The metabolites were sensitive, respectively, to control for D2-occupancy and prolactin. CONCLUSIONS The role of DA in paranoid, and 5-HT in thought-disordered and ideas-of-reference dimensions point both to the mechanisms underlying the features typical of these subgroups and the type of medication appropriate.
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Affiliation(s)
- Robert D Oades
- University of Essen Clinic for Child and Adolescent Psychiatry and Psychotherapy, Essen, Germany.
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Chou JC, Douyon R, Czobor P, Volavka J, Cooper TB. Change in plasma prolactin and clinical response to haloperidol in schizophrenia and schizoaffective disorder. Psychiatry Res 1998; 81:51-5. [PMID: 9829650 DOI: 10.1016/s0165-1781(98)00085-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There has been a long-standing interest in plasma prolactin as a potential in vivo indicator of blockade of tuberoinfundibular D2 dopamine receptors. Potential relationships between prolactin response and neuroleptic treatment have been obscured by the use of high doses which have caused prolactin to plateau. With lower doses of neuroleptic now commonly in use, prolactin may be more valuable as a correlate of clinical response. In this study, 23 acutely exacerbated schizophrenic and schizoaffective patients were washed out for at least 6 days and were then treated with haloperidol to achieve fixed low to moderate plasma levels under double-blind conditions. Clinical response, plasma prolactin, and haloperidol plasma levels were measured weekly for 3 weeks. Clinical symptoms at endpoint were related to both prolactin change and final prolactin level during haloperidol treatment. Specifically, fewer symptoms at endpoint were associated with a greater increase in prolactin over time and a higher prolactin level at endpoint. Thus, prolactin increase caused by low to moderate doses of haloperidol may be a correlate of endpoint symptomatology. As lower doses of typical neuroleptics are now in use, prolactin response as a predictor of clinical response may have more clinical utility. Further study of prolactin and clinical response to typical neuroleptics should focus on low neuroleptic doses.
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Affiliation(s)
- J C Chou
- Nathan Kline Institute, Orangeburg, NY 10962, USA.
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Abstract
The study of psychoneuroendocrinology of schizophrenia has yielded an extensive but inconclusive body of data. Investigations to date have been limited by several factors, including the confounding effects of neuroleptic drugs, methodological limitations, and lack of appreciation for the heterogeneity of the illness. Previously, the focus of research has been on the measurement of anterior pituitary hormones, guided by the assumptions that these hormones are regulated by the central nervous system (CNS) to a significant degree and that the unique anatomic relationship of the pituitary gland to the hypothalamus and the CNS is potentially relevant. Patients with schizophrenia do appear to have distinct endocrinologic profiles. However, although the hormonal differences between patients with schizophrenia and the general population appear to be subtle in magnitude. Nonetheless, investigation, and the exploration of the possible effect of gonadal and posterior pituitary hormones merits particular attention.
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Affiliation(s)
- C E Marx
- Department of Psychiatry, University of North Carolina, Chapel Hill, USA
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