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Brand BA, de Boer JN, Willemse EJM, Weickert CS, Sommer IE, Weickert TW. Antipsychotic-induced prolactin elevation in premenopausal women with schizophrenia: associations with estrogen, disease severity and cognition. Arch Womens Ment Health 2024:10.1007/s00737-024-01491-9. [PMID: 38995314 DOI: 10.1007/s00737-024-01491-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Antipsychotic-induced prolactin elevation may impede protective effects of estrogens in women with schizophrenia-spectrum disorders (SSD). Our study sought to confirm whether the use of prolactin-raising antipsychotics is associated with lower estrogen levels, and to investigate how estrogen and prolactin levels relate to symptom severity and cognition in premenopausal women with SSD. METHODS This cross-sectional study included 79 premenopausal women, divided in three groups of women with SSD treated with prolactin-sparing antipsychotics (n = 21) or prolactin-raising antipsychotics (n = 27), and age-matched women without SSD (n = 31). Circulating 17β-estradiol was compared among groups. In patients, we assessed the relationship between prolactin and 17β-estradiol, and the relationships of these hormones to symptom severity and cognition, using correlation analyses and backward regression models. RESULTS In women receiving prolactin-raising antipsychotics, 17β-estradiol levels were lower as compared to both other groups (H(2) = 8.34; p = 0.015), and prolactin was inversely correlated with 17β-estradiol (r=-0.42, p = 0.030). In the prolactin-raising group, 17β-estradiol correlated positively with verbal fluency (r = 0.52, p = 0.009), and 17β-estradiol and prolactin together explained 29% of the variation in processing speed (β17β-estradiol = 0.24, βprolactin = -0.45, F(2,25) = 5.98, p = 0.008). In the prolactin-sparing group, 17β-estradiol correlated negatively with depression/anxiety (r = -0.57, p = 0.014), and together with prolactin explained 26% of the variation in total symptoms (β17β-estradiol = -0.41, βprolactin = 0.32, F(2,18) = 4.44, p = 0.027). CONCLUSIONS In women with SSD, antipsychotic-induced prolactin elevation was related to lower estrogen levels. Further, estrogens negatively correlated with symptom severity and positively with cognition, whereas prolactin levels correlated negatively with cognition. Our findings stress the clinical importance of maintaining healthy levels of prolactin and estrogens in women with SSD.
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Affiliation(s)
- Bodyl A Brand
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands.
- Department of Biomedical Sciences and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
| | - Janna N de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands
- Department of Biomedical Sciences and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Center for Young Children, Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
| | - Elske J M Willemse
- Department of Biomedical Sciences and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Cynthia S Weickert
- Neuroscience Research Australia, Sydney, NSW, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Iris E Sommer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands
- Department of Biomedical Sciences and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Thomas W Weickert
- Neuroscience Research Australia, Sydney, NSW, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Strube W, Wagner E, Luykx JJ, Hasan A. A review on side effect management of second-generation antipsychotics to treat schizophrenia: a drug safety perspective. Expert Opin Drug Saf 2024; 23:715-729. [PMID: 38676922 DOI: 10.1080/14740338.2024.2348561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/24/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Effective side effects management present a challenge in antipsychotic treatment with second-generation antipsychotics (SGAs). In recent years, most of the commonly used SGAs, except for clozapine, have been shown to differ only slightly in their effectiveness, but considerably regarding perceived side effects, safety profiles, and compatibility to preexisting medical conditions. AREAS COVERED The current state of available evidence on side-effect management in SGA treatment of patients with schizophrenia spectrum disorders (SSD) is reviewed. In addition, current guideline recommendations are summarized, highlighting evidence gaps. EXPERT OPINION SGA safety and side effects needs to be considered in treatment planning. Shared decision-making assistants (SDMA) can support patients, practitioners and relatives to orient their decisions toward avoiding side effects relevant to patients' adherence. Alongside general measures like psychosocial and psychotherapeutic care, switching to better tolerated SGAs can be considered a relatively safe strategy. By contrast, novel meta-analytical evidence emphasizes that dose reduction of SGAs can statistically increase the risk of relapse and other unfavorable outcomes. Further, depending on the type and severity of SGA-related side effects, specific treatments can be used to alleviate induced side effects (e.g. add-on metformin to reduce weight-gain). Finally, discontinuation should be reserved for acute emergencies.
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Affiliation(s)
- Wolfgang Strube
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Augsburg, Augsburg, Germany
| | - Elias Wagner
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Augsburg, Augsburg, Germany
- Evidence-based psychiatry and psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Jurjen J Luykx
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Outpatient second opinion clinic, GGNet Mental Health, Warnsveld, The Netherlands
| | - Alkomiet Hasan
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Augsburg, Augsburg, Germany
- DZPG (German Center for Mental Health), partner site München/Augsburg, Augsburg, Germany
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Mu E, Gurvich C, Kulkarni J. Estrogen and psychosis - a review and future directions. Arch Womens Ment Health 2024:10.1007/s00737-023-01409-x. [PMID: 38221595 DOI: 10.1007/s00737-023-01409-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/02/2023] [Indexed: 01/16/2024]
Abstract
The link between sex hormones and schizophrenia has been suspected for over a century; however, scientific evidence supporting the pharmacotherapeutic effects of exogenous estrogen has only started to emerge during the past three decades. Accumulating evidence from epidemiological and basic research suggests that estrogen has a protective effect in women vulnerable to schizophrenia. Such evidence has led multiple researchers to investigate the role of estrogen in schizophrenia and its use in treatment. This narrative review provides an overview of the effects of estrogen as well as summarizes the recent work regarding estrogen as a treatment for schizophrenia, particularly the use of new-generation selective estrogen receptor modulators.
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Affiliation(s)
- Eveline Mu
- HER Centre Australia, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Caroline Gurvich
- HER Centre Australia, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jayashri Kulkarni
- HER Centre Australia, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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UÇAR Z, YILDIRIM B, TATLI SZ, ÖZEL KIZIL ET. Comparison of psychotropic drug preferences and side effects in old and young patients with schizophrenia and schizoaffective disorder. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1139145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The current study investigates the preferred psychotropic drug treatments and their tolerability in elderly patients (EP) with a diagnosis of schizophrenia or schizoaffective disorder compared to younger patients (YP).
Materials and Methods: The study included 154 EP and 195 YP with schizophrenia/schizoaffective disorder admitted to the outpatient unit at a university hospital in the last decade. The medical records of the patients were reviewed. The types and doses of antipsychotic drugs used by each patient, use of other psychotropic drugs, ongoing complaints, drug-related side effects and compliance with treatment were also examined.
Results: Second generation antipsychotic use was higher in YP (88% in YP, 80% in EP). Antipsychotic equivalent doses were found 266.63 mg in EP, 522.21 mg in YP, that also higher in the YP group. The use of clozapine (7% in EP, 37% in YP) and mood stabilizers (4.5% in EP, 18% in YP) were higher in YP. There was a higher rate of dose reduction of antipsychotic drugs in EP (21.5% in YP, 52% in EP). When the groups were compared in terms of the reasons of antipsychotic dose reduction, it was more frequent in EP due to side effects (21.4% in YP, 40% in EP), while the dose reduction due to remission was more common in YP (78.6% in YP, 60% in EP) .
Conclusion: Lower doses of antipsychotics in EP suggests milder symptoms or lower tolerability. The higher clozapine and mood stabilizer use in YP can be explained by avoiding side effects like extrapyramidal, cardiovascular and metabolic side effects that are more frequent in EP.
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Affiliation(s)
- Zehra UÇAR
- Ankara University School of Medicine, Department of Psychiatry
| | - Betül YILDIRIM
- Ankara University School of Medicine, Department of Psychiatry
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Stojkovic M, Radmanovic B, Jovanovic M, Janjic V, Muric N, Ristic DI. Risperidone Induced Hyperprolactinemia: From Basic to Clinical Studies. Front Psychiatry 2022; 13:874705. [PMID: 35599770 PMCID: PMC9121093 DOI: 10.3389/fpsyt.2022.874705] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/28/2022] [Indexed: 12/25/2022] Open
Abstract
Risperidone is one of the most commonly used antipsychotics (AP), due to its safety and efficacy in reducing psychotic symptoms. Despite the favorable side effect profile, the therapy is accompanied by side effects due to the non-selectivity of this medicine. This review will briefly highlight the most important basic and clinical findings in this area, consider the clinical effects of AP-induced hyperprolactinemia (HPL), and suggest different approaches to the treatment.The route of application of this drug primarily affects the daily variation and the total concentration of drug levels in the blood, which consequently affects the appearance of side effects, either worsening or even reducing them. Our attention has been drawn to HPL, a frequent but neglected adverse effect observed in cases treated with Risperidone and its secondary manifestations. An increase in prolactin levels above the reference values result in impairment of other somatic functions (lactation, irregular menses, fertility) as well as a significant reduction in quality of life. It has been frequently shown that the side effects of the Risperidone are the most common cause of non-compliance with therapy, resulting in worsening of psychiatric symptoms and hospitalization. However, the mechanism of Risperidone-induced HPL is complicated and still far from fully understood. Most of the preclinical and clinical studies described in this study show that hyperprolactinemia is one of the most common if not the leading side effect of Risperidone therefore to improve the quality of life of these patients, clinicians must recognize and treat HPL associated with the use of these drugs.
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Affiliation(s)
- Milena Stojkovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Psychiatric Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Branimir Radmanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Psychiatric Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Mirjana Jovanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Psychiatric Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Vladimir Janjic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Psychiatric Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Nemanja Muric
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Psychiatric Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Dragana Ignjatovic Ristic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Psychiatric Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia
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Brand BA, Haveman YRA, de Beer F, de Boer JN, Dazzan P, Sommer IEC. Antipsychotic medication for women with schizophrenia spectrum disorders. Psychol Med 2022; 52:649-663. [PMID: 34763737 PMCID: PMC8961338 DOI: 10.1017/s0033291721004591] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.
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Affiliation(s)
- Bodyl A. Brand
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yudith R. A. Haveman
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Franciska de Beer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janna N. de Boer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Iris E. C. Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Al Harthi MS, Al Ghafri TS, Al Wasify L, Al Akhzami S, AlHarthi A, Al Harthi S, Al Sibani N. Hyperprolactinemia in Adults Treated With Anti-psychotic Drugs Attending Tertiary Hospitals in Oman: An Observational Study. Cureus 2022; 14:e21532. [PMID: 35223307 PMCID: PMC8863899 DOI: 10.7759/cureus.21532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction: Hyperprolactinemia is a common side effect associated with the use of anti-psychotic medications. This study aimed at exploring the rate of hyperprolactinemia induced by anti-psychotic drugs in adult patients admitted to Sultan Qaboos University Hospital (SQUH) and Al Masarra hospital (AMH). Additionally, factors associated with higher prolactin levels in anti-psychotic patients were explored. Methods: Bespoke XL sheets on age, gender, region (place of stay), BMI, diagnosis, type of drugs, dose, symptoms, and prolactin levels were recorded from the existing health information system. All adult patients who were on anti-psychotic medication between January 2016 and June 2019 were included. Patients diagnosed with pre-existing endocrine conditions, pregnant females, and those with high prolactin levels at baseline were excluded. Results: A total of 1103 cases were included in this study of which 34.1% were from the SQUH vs 65.9% from AMH. The mean (SD) age of the study population was 35.6 (12.1), 56.7% were females and 58.7% cases were from Muscat. The common diagnoses were schizophrenia (59.3%) and bipolar affective disorder (14.7%). High prolactin levels existed in 68.3% of the cases from which 59.6% were treated with atypical anti-psychotic drugs. The proportion of cases with high prolactin levels in AMH was significantly different (higher) compared to cases in SQUH (76.9% vs 51.6%, P<0.001). The most common symptoms were painful breasts (55.2%), galactorrhoea (10.5%), amenorrhea (14.3%) and irregular periods (20.0%). Type of drugs used [haloperidol (typical) vs risperidone (atypical) anti-psychotics (P<0.001)], older vs younger age (P=0.03), and presence vs absence of symptoms (P<0.001) were predictors for the high prolactin levels. Conclusion: Similar to evidence from the west, results from this study showed a high rate of hyperprolactinemia in adults treated with anti-psychotics. More work is required to standardize anti-psychotic management and monitoring guidelines for psychotic patients across all psychiatric hospitals in Oman.
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Zhu X, Hu J, Xiao T, Huang S, Shang D, Wen Y. Integrating machine learning with electronic health record data to facilitate detection of prolactin level and pharmacovigilance signals in olanzapine-treated patients. Front Endocrinol (Lausanne) 2022; 13:1011492. [PMID: 36313772 PMCID: PMC9606398 DOI: 10.3389/fendo.2022.1011492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND AIM Available evidence suggests elevated serum prolactin (PRL) levels in olanzapine (OLZ)-treated patients with schizophrenia. However, machine learning (ML)-based comprehensive evaluations of the influence of pathophysiological and pharmacological factors on PRL levels in OLZ-treated patients are rare. We aimed to forecast the PRL level in OLZ-treated patients and mine pharmacovigilance information on PRL-related adverse events by integrating ML and electronic health record (EHR) data. METHODS Data were extracted from an EHR system to construct an ML dataset in 672×384 matrix format after preprocessing, which was subsequently randomly divided into a derivation cohort for model development and a validation cohort for model validation (8:2). The eXtreme gradient boosting (XGBoost) algorithm was used to build the ML models, the importance of the features and predictive behaviors of which were illustrated by SHapley Additive exPlanations (SHAP)-based analyses. The sequential forward feature selection approach was used to generate the optimal feature subset. The co-administered drugs that might have influenced PRL levels during OLZ treatment as identified by SHAP analyses were then compared with evidence from disproportionality analyses by using OpenVigil FDA. RESULTS The 15 features that made the greatest contributions, as ranked by the mean (|SHAP value|), were identified as the optimal feature subset. The features were gender_male, co-administration of risperidone, age, co-administration of aripiprazole, concentration of aripiprazole, concentration of OLZ, progesterone, co-administration of sulpiride, creatine kinase, serum sodium, serum phosphorus, testosterone, platelet distribution width, α-L-fucosidase, and lipoprotein (a). The XGBoost model after feature selection delivered good performance on the validation cohort with a mean absolute error of 0.046, mean squared error of 0.0036, root-mean-squared error of 0.060, and mean relative error of 11%. Risperidone and aripiprazole exhibited the strongest associations with hyperprolactinemia and decreased blood PRL according to the disproportionality analyses, and both were identified as co-administered drugs that influenced PRL levels during OLZ treatment by SHAP analyses. CONCLUSIONS Multiple pathophysiological and pharmacological confounders influence PRL levels associated with effective treatment and PRL-related side-effects in OLZ-treated patients. Our study highlights the feasibility of integration of ML and EHR data to facilitate the detection of PRL levels and pharmacovigilance signals in OLZ-treated patients.
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Affiliation(s)
- Xiuqing Zhu
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Jinqing Hu
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Tao Xiao
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shanqing Huang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Dewei Shang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- *Correspondence: Dewei Shang, ; Yuguan Wen,
| | - Yuguan Wen
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- *Correspondence: Dewei Shang, ; Yuguan Wen,
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Zhao W, Zhao YL, Liu M, Liu L, Wang Y. Possible repair mechanisms of renin-angiotensin system inhibitors, matrix metalloproteinase-9 inhibitors and protein hormones on methamphetamine-induced neurotoxicity. Mol Biol Rep 2021; 48:7509-7516. [PMID: 34623593 DOI: 10.1007/s11033-021-06741-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/08/2021] [Indexed: 12/31/2022]
Abstract
Methamphetamine is a highly addictive central stimulant with extensive and strong neurotoxicity. The neurotoxicity of methamphetamine is closely related to the imbalance of dopamine levels and the destruction of the blood-brain barrier. An increase in dopamine may induce adverse effects such as behavioral sensitization and excessive locomotion. Damage to the blood-brain barrier can cause toxic or harmful substances to leak to the central nervous system, leading to neurotoxicity. The renin-angiotensin system is essential for the regulation of dopamine levels in the brain. Matrix metalloproteinase-9 causes reward effects and behavioral sensitization by inducing dopamine release. Prolactin has been shown to be involved in the regulation of tight junction proteins and the integrity of the blood-brain barrier. At present, the treatment of methamphetamine detoxification is still based on psychotherapy, and there is no specific medicine. With the rapid increase in global seizures of methamphetamine, the treatment of its toxicity has attracted more and more attention. This review intends to summarize the therapeutic mechanisms of renin-angiotensin inhibitors, matrix metalloproteinase-9 inhibitors and protein hormones (prolactin) on methamphetamine neurotoxicity. The repair effects of these three on methamphetamine may be related to the maintenance of brain dopamine balance and the integrity of the blood-brain barrier. This review is expected to provide the new therapeutic strategy of methamphetamine toxicity.
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Affiliation(s)
- Wei Zhao
- Department of Drug Control, Criminal Investigation Police University of China, Shenyang, 110854, Liaoning, People's Republic of China.,Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Yuan-Ling Zhao
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Ming Liu
- Department of Drug Control, Criminal Investigation Police University of China, Shenyang, 110854, Liaoning, People's Republic of China
| | - Lian Liu
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Yun Wang
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China.
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Seeman MV, González-Rodríguez A. Stratification by Sex and Hormone Level When Contrasting Men and Women in Schizophrenia Trials Will Improve Personalized Treatment. J Pers Med 2021; 11:929. [PMID: 34575706 PMCID: PMC8471344 DOI: 10.3390/jpm11090929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sex and gender differences have been reported in the prevalence, expression, treatment response, and outcome of schizophrenia, but most reports are based on relatively small samples that have not been stratified for the impact of sex hormone levels. This literature review aims to show how women's hormone levels can impact the results of male/female comparisons. METHODS This is a narrative review of data from publications of the last decade. RESULTS Epidemiologic evidence, reports of the impact of hormones on cognition, results of sexually dimorphic responses to treatment, and male/female trajectories of illness over time all suggest that female hormone fluctuations exert major effects on male/female differences in schizophrenia. CONCLUSIONS Information on hormonal status in women participants is rarely available in clinical studies in schizophrenia, which makes male/female comparisons largely uninterpretable. These are the current challenges. Opportunities for individualized treatment are growing, however, and will undoubtedly result in improved outcomes for both women and men in the future.
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Affiliation(s)
- Mary V. Seeman
- Department of Psychiatry, University of Toronto, #605 260 Heath St. W., Toronto, ON M5P 3L6, Canada
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, University of Barcelona, 08221 Terrassa, Barcelona, Spain;
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Abstract
PURPOSE OF REVIEW Schizophrenia is a heterogeneous psychiatric disorder with a different, but not necessarily milder clinical presentation in women as compared to men. These sex differences have largely been attributed to the protective role of estrogens. This article reviews the current state of estrogen research in schizophrenia. RECENT FINDINGS Estrogens regulate important pathophysiological pathways in schizophrenia, including dopamine activity, mitochondrial function, and the stress system. Estrogen deficiency is common in both sexes and is associated with increases in psychotic symptoms. Hyperprolactinemia causes secondary estrogen deficiency and can be a reaction to stress, or secondary to prolactin-raising antipsychotics. Therefore, prolactin-sparing antipsychotics should be preferred especially in premenopausal women, who are more prone to hyperprolactinemia. Premenopausal women furthermore require lower doses of antipsychotics than men, since estrogens raise the availability and efficacy of antipsychotics. SUMMARY The past years have established the importance of estrogens in the pathophysiology of schizophrenia and have shown its relevance to clinical practice through its influence on antipsychotic drug efficacy. Future research should focus on the neurobiological and clinical effect of contraceptives in premenopausal women with schizophrenia. Furthermore, the potential of estrogen-like augmentation with raloxifene and phytoestrogens in schizophrenia should be established in the coming years.
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Affiliation(s)
- Bodyl A. Brand
- University of Groningen, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen
| | - Janna N. de Boer
- University of Groningen, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands
| | - Iris E.C. Sommer
- University of Groningen, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen
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12
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Zhuo C, Xu Y, Wang H, Fang T, Chen J, Zhou C, Li Q, Liu J, Xu S, Yao C, Yang W, Yang A, Li B, Chen Y, Tian H, Lin C. Safety and Efficacy of High-Dose Vitamin B6 as an Adjunctive Treatment for Antipsychotic-Induced Hyperprolactinemia in Male Patients With Treatment-Resistant Schizophrenia. Front Psychiatry 2021; 12:681418. [PMID: 34512411 PMCID: PMC8426548 DOI: 10.3389/fpsyt.2021.681418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
This study aimed to investigate the safety and efficacy of high-dose vitamin B6 (vB6) as an adjunct treatment for antipsychotic-induced hyperprolactinemia (AIHP) in male patients with treatment-resistant schizophrenia (TRS). In this randomized double-blinded controlled study, patients were randomized (1:1) into a control group given aripiprazole (ARI; 10 mg/day; n = 100) or an intervention group given vB6 (300 mg/12 h for 16 weeks; n = 100). Prolactin levels, psychotic symptoms [Positive and Negative Syndrome Scale (PANSS)], cognitive function [MATRICS Consensus Cognitive Battery (MCCB)], liver function, kidney function, growth hormone level, micronutrient levels, blood lipids, and adverse secondary effects (ASEs)[Treatment Emergent Symptom Scale (TESS) and Barnes-Akathisia scale] were monitored. After a 16-week treatment period, the vB6 group showed a 68.1% reduction in serum prolactin levels (from 95.52 ± 6.30 μg/L to 30.43 ± 18.65 μg/L) while the ARI group showed only a 37.4% reduction (from 89.07 ± 3.59 μg/L to 55.78 ± 7.39 μg/L). During weeks 1-4, both treatments reduced prolactin similarly. Subsequently, the ARI effect plateaued, while the vB6 effect remained robust. The vB6 group showed better alleviation of psychotic symptoms and cognitive impairment. No serious ASEs were observed; ASEs were more frequent in the ARI group. AIHP reduction efficacy of vB6 was associated with baseline prolactin and triglyceride levels, total vB6 dosage, and education level. In conclusion, compared with the ARI group, TRS patients given vB6 showed better attenuation of AIHP, lower ASE scores, and greater improvements in clinical symptoms and cognitive impairments. These results support further consideration of vB6 as a putative treatment for AIHP. Trial Registration: ChiCTR1800014755.
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Affiliation(s)
- Chuanjun Zhuo
- Key Laboratory of Multiple Organ Damages of Major Psychoses (MODMP_Lab), Tianjin Fourth Center Hospital, The Fourth Central Hospital Affiliated With Nankai University, The Fourth Central Hospital Affiliated to Tianjin Medical University, Tianjin, China.,Key Laboratory of Real Time Brain Circuit Tracing in Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital, The Fourth Central Hospital Affiliated With Nankai University, The Fourth Central Hospital Affiliated to Tianjin Medical University, Tianjin, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,Mental Disorder Therapy Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Tao Fang
- Key Laboratory of Multiple Organ Damages of Major Psychoses (MODMP_Lab), Tianjin Fourth Center Hospital, The Fourth Central Hospital Affiliated With Nankai University, The Fourth Central Hospital Affiliated to Tianjin Medical University, Tianjin, China.,Key Laboratory of Real Time Brain Circuit Tracing in Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital, The Fourth Central Hospital Affiliated With Nankai University, The Fourth Central Hospital Affiliated to Tianjin Medical University, Tianjin, China
| | - Jiayue Chen
- Key Laboratory of Real Time Brain Circuit Tracing in Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital, The Fourth Central Hospital Affiliated With Nankai University, The Fourth Central Hospital Affiliated to Tianjin Medical University, Tianjin, China.,Laboratory of Neuro-Imaging and Comorbidity (PNGC_Lab), Tianjin Anding Hospital Affiliated to Nankai University, Tianjin Medical University, Tianjin, China
| | - Chunhua Zhou
- Department of Pharmacology, The First Hospital Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Qianchen Li
- Department of Pharmacology, The First Hospital Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Jie Liu
- Laboratory of Neuro-Imaging and Comorbidity (PNGC_Lab), Tianjin Anding Hospital Affiliated to Nankai University, Tianjin Medical University, Tianjin, China
| | - Shuli Xu
- Laboratory of Neuro-Imaging and Comorbidity (PNGC_Lab), Tianjin Anding Hospital Affiliated to Nankai University, Tianjin Medical University, Tianjin, China
| | - Cong Yao
- Laboratory of Neuro-Imaging and Comorbidity (PNGC_Lab), Tianjin Anding Hospital Affiliated to Nankai University, Tianjin Medical University, Tianjin, China
| | - Weiliang Yang
- Laboratory of Neuro-Imaging and Comorbidity (PNGC_Lab), Tianjin Anding Hospital Affiliated to Nankai University, Tianjin Medical University, Tianjin, China
| | - Anqu Yang
- Department of Treatment Resistant Schizophrenia, Tianjin Kangtai Hospital, Tianjin, China
| | - Bo Li
- Department of Treatment Resistant Schizophrenia, Tianjin Kangtai Hospital, Tianjin, China
| | - Yuhui Chen
- Department of Treatment Resistant Schizophrenia, Tianjin Kangtai Hospital, Tianjin, China
| | - Hongjun Tian
- Key Laboratory of Multiple Organ Damages of Major Psychoses (MODMP_Lab), Tianjin Fourth Center Hospital, The Fourth Central Hospital Affiliated With Nankai University, The Fourth Central Hospital Affiliated to Tianjin Medical University, Tianjin, China.,Key Laboratory of Real Time Brain Circuit Tracing in Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital, The Fourth Central Hospital Affiliated With Nankai University, The Fourth Central Hospital Affiliated to Tianjin Medical University, Tianjin, China
| | - Chongguang Lin
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
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13
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Aripiprazole for the treatment of delusional disorders: A systematic review. Gen Hosp Psychiatry 2020; 66:34-43. [PMID: 32650190 DOI: 10.1016/j.genhosppsych.2020.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Delusional disorder is an uncommon psychotic disorder. The first-line treatments for this chronic and resistant condition are antipsychotic medications, usually associated with several side effects that can exacerbate poor adherence. Conversely, aripiprazole is a well-tolerated antipsychotic drug that is effective in the treatment of other psychotic disorders. Here, we aimed to systematically review and summarize the currently available literature to evaluate the effectiveness and tolerability of aripiprazole in delusional disorders. METHODS A comprehensive literature search from inception until February 2020 was performed in PubMed, Cochrane Database of Systematic Reviews, and Scopus databases using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS We identified 21 single cases of delusional disorders, mostly somatic type, treated with aripiprazole. All studies reported patient clinical improvements after the beginning of the treatment with aripiprazole. The average dose of aripiprazole was 11.1 mg/day, and the average time to achieve a clinical response was 5.7 weeks. Few adverse effects were reported, including asthenia, extrapyramidal symptoms, hyperprolactinemia, and insomnia. CONCLUSIONS Our findings suggest that aripiprazole may be an effective treatment for delusional disorders with good tolerability. Further studies comparing aripiprazole with other antipsychotics in the treatment of delusional disorders are needed.
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Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155594. [PMID: 32756418 PMCID: PMC7432627 DOI: 10.3390/ijerph17155594] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life—paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods—while constituting vulnerable time periods for the mother—require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.
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