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Aymerich C, Pedruzo B, Pacho M, Laborda M, Herrero J, Pillinger T, McCutcheon RA, Alonso-Alconada D, Bordenave M, Martínez-Querol M, Arnaiz A, Labad J, Fusar-Poli P, González-Torres MÁ, Catalan A. Prolactin and morning cortisol concentrations in antipsychotic naïve first episode psychosis: A systematic review and meta-analysis. Psychoneuroendocrinology 2023; 150:106049. [PMID: 36758330 DOI: 10.1016/j.psyneuen.2023.106049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/02/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Alterations in prolactin and cortisol levels have been reported in antipsychotic naïve patients with first episode psychosis (FEP). However, it has been studied in very small samples, and inter-group variability has never been studied before. OBJECTIVE To provide estimates of standardized mean differences (SMD) and inter-group variability for prolactin, cortisol awakening response (CAR) and morning cortisol concentrations in antipsychotic naïve FEP (AN-FEP) patients and healthy controls (HC). DATA SOURCES BIOSIS, KCI, MEDLINE, Russian Science Citation Index, SciELO, Cochrane, PsycINFO, Web of Science were searched from inception to February 28, 2022. STUDY SELECTION Peer-reviewed cohort studies that reported on prolactin or cortisol blood concentrations in AN- FEP patients and HC were included. DATA EXTRACTION AND SYNTHESIS Study characteristics, means and standard deviations (SD) were extracted from each article. Inter group differences in magnitude of effect were estimated using Hedges g. Inter-group variability was estimated with the coefficient of variation ratio (CVR). In both cases estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. PRISMA guideline was followed (No. CRD42022303555). MAIN OUTCOMES AND MEASURES Prolactin, CAR and morning cortisol blood concentrations in AN-FEP group in relation to HC group. RESULTS Fourteen studies for prolactin (N = 761 for AN-FEP group, N = 687 for HC group) and twelve studies for morning cortisol (N = 434 for AN-FEP group, N = 528 for HC group) were included. No studies were found in CAR in AN-FEP patients. Mean SMD for prolactin blood concentration was 0.88 (95% CI 0.57, 1.20) for male and 0.56 (95% CI 0.26, 0.87) for female. As a group, AN-FEP presented greater inter-group variability for prolactin levels than HC (CVR=1.28, 95% CI 1.02, 1.62). SMD for morning cortisol concentrations was non-significant: 0.34 (95% CI -0.01, 0.69) and no inter-group variability significant differences were detected: CVR= 1.05 (95% CI 0.91, 1.20). Meta-regression analyses for age and quality were non-significant. Funnel plots did not suggest a publication bias. CONCLUSIONS AND RELEVANCE Increased prolactin levels were found in AN-FEP patients. A greater inter-group variability in the AN-FEP group suggests the existence of patient subgroups with different prolactin levels. No significant abnormalities were found in morning cortisol levels. Further research is needed to clarify whether prolactin concentrations could be used as an illness biomarker.
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Affiliation(s)
- Claudia Aymerich
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain. Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Borja Pedruzo
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Malein Pacho
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | - María Laborda
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Jon Herrero
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; MRC London Institute of Medical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Robert A McCutcheon
- Department of Psychiatry, University of Oxford, UK. Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatric Imaging Group, Medical Research Council, London Institute of Medical Sciences, Hammersmith Hospital, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Alonso-Alconada
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Marta Bordenave
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | | | - Ainara Arnaiz
- Erandio Mental Health Center, Basque Health Service (Osakidetza), Erandio, Spain. Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Javier Labad
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Spain. Salut Mental Taulí, Parc Taulí University Hospital, I3PT, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Miguel Ángel González-Torres
- Psychiatry Department. Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto. School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain; Centro de Investigación en Red de Salud Mental. (CIBERSAM), Instituto de Salud Carlos III, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Ana Catalan
- Psychiatry Department. Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto. School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain; Centro de Investigación en Red de Salud Mental. (CIBERSAM), Instituto de Salud Carlos III, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
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Ciocca G, Jannini TB, Ribolsi M, Rossi R, Niolu C, Siracusano A, Jannini EA, Di Lorenzo G. Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature. Front Psychiatry 2021; 12:750033. [PMID: 34777053 PMCID: PMC8579023 DOI: 10.3389/fpsyt.2021.750033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.
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Affiliation(s)
- Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Tommaso B Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michele Ribolsi
- Unit of Neurology, Neurobiology, Neurophysiology and Psychiatry, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS - Fondazione Santa Lucia, Rome, Italy
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