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García Cano AM, Rosillo M, Gómez Lozano A, Jiménez Mendiguchía L, Marchán Pinedo M, Rodríguez Torres A, Araujo-Castro M. Pharmacological hyperprolactinemia: a retrospective analysis of 501 hyperprolactinemia cases in primary care setting. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:3239-3246. [PMID: 37910184 DOI: 10.1007/s00210-023-02803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To describe a series of cases with pharmacological hyperprolactinemia in primary care setting and the prolactin levels, clinical implications of different causes of pharmacological hyperprolactinemia. METHODS A retrospective study of all patients with detected hyperprolactinemia in hormonal studies was performed between 2019 and 2020 in 20 Spanish primary care centers. Hyperprolactinemia is defined as a serum prolactin >19.4ng/ml in men and >26.5ng/ml in women. Four pharmacological causes of hyperprolactinemia were established: (i) oral contraceptives (OCPs) and other hormonal treatments; (ii) antipsychotics and antidepressants; (iii) other drugs (calcium antagonists, antiemetics, H2 antihistamines, opioids, and anabolic agents); and (iv) hyperprolactinemia due to several drugs. RESULTS From a sample of 501 patients with elevated serum prolactin, 39.4% (n=162) had pharmacological hyperprolactinemia. The most common cause of pharmacological hyperprolactinemia in women was OCPs (n=61) while in men antipsychotics/antidepressants (n=21). In the cases of hyperprolactinemia due to antipsychotics/antidepressants, the prolactin levels were significantly higher in patients taking classical antipsychotics than in those taking second-generation antipsychotics (80.0±43.17 vs. 50.7±28.66 ng/dL, P=0.035). The antidepressant/antipsychotic group showed hyperprolactinemia-related symptoms more frequently than the group of other treatments (58.9% vs. 32%, P=0.001). The concomitant use of several drugs caused hyperprolactinemia-related symptoms more frequently than one drug alone (73% vs. 44%, P=0.031). CONCLUSION In this series of cases, drugs represented the 39.4% of the causes of hyperprolactinemia. The most common drugs were OCPs in women and antipsychotics/antidepressants in men. Antidepressants/antipsychotics were drugs that caused the greatest elevation of the prolactin levels and showed hyperprolactinemia-related symptoms more frequently.
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Affiliation(s)
- Ana M García Cano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo, km 9.1, Madrid, Spain.
| | - Marta Rosillo
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo, km 9.1, Madrid, Spain
| | - Ana Gómez Lozano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo, km 9.1, Madrid, Spain
| | - Lucía Jiménez Mendiguchía
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo, km 9.1, Madrid, Spain
| | - Marta Marchán Pinedo
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo, km 9.1, Madrid, Spain
| | - Argeme Rodríguez Torres
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo, km 9.1, Madrid, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo, km 9.1, Madrid, Spain.
- Department of Health Science, Universidad Alcalá, Carretera Colmenar Viejo, km 9.1, Madrid, Spain.
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Carretera Colmenar Viejo, km 9.1, Madrid, Spain.
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Kong L, Wang H, Yan N, Xu C, Chen Y, Zeng Y, Guo X, Lu J, Hu S. Effect of antipsychotics and mood stabilisers on metabolism in bipolar disorder: a network meta-analysis of randomised-controlled trials. EClinicalMedicine 2024; 71:102581. [PMID: 38618207 PMCID: PMC11015341 DOI: 10.1016/j.eclinm.2024.102581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background Antipsychotics and mood stabilisers are gathering attention for the disturbance of metabolism. This network meta-analysis aims to evaluate and rank the metabolic effects of the commonly used antipsychotics and mood stabilisers in treating bipolar disorder (BD). Methods Registries including PubMed, Embase, Cochrane Library, Web of Science, Ovid, and Google Scholar were searched before February 15th, 2024, for randomised controlled trials (RCTs) applying antipsychotics or mood stabilisers for BD treatment. The observed outcomes were twelve metabolic indicators. The data were extracted by two reviewers independently, and confirmed by another four reviewers and a corresponding author. The above six reviewers all participated in data analyses. Data extraction was based on PRISMA guidelines, and quality assessment was conducted according to the Cochrane Handbook. Use a random effects model for data pooling. The PROSPERO registration number is CRD42023466669. Findings Together, 5421 records were identified, and 41 publications with 11,678 complete-trial participants were confirmed eligible. After eliminating possible sensitivity, risperidone ranked 1st in elevating fasting serum glucose (SUCRA = 90.7%) and serum insulin (SUCRA = 96.6%). Lurasidone was most likely to elevate HbA1c (SUCRA = 82.1%). Olanzapine ranked 1st in elevating serum TC (SUCRA = 93.3%), TG (SUCRA = 89.6%), and LDL (SUCRA = 94.7%). Lamotrigine ranked 1st in reducing HDL (SUCRA = 82.6%). Amisulpride ranked 1st in elevating body weight (SUCRA = 100.0%). For subgroup analyses, quetiapine is more likely to affect indicators of glucose metabolism among male adult patients with bipolar mania, while long-term lurasidone tended to affect glucose metabolism among female patients with bipolar depression. Among patients under 18, divalproex tended to affect glucose metabolism, with lithium affecting lipid metabolism. In addition, most observed antipsychotics performed higher response and remission rates than placebo, and displayed a similar dropout rate with placebo, while no between-group significance of rate was observed among mood stabilisers. Interpretation Our findings suggest that overall, antipsychotics are effective in treating BD, while they are also more likely to disturb metabolism than mood stabilisers. Attention should be paid to individual applicability in clinical practice. The results put forward evidence-based information and clinical inspiration for drug compatibility and further research of the BD mechanism. Funding The National Key Research and Development Program of China (2023YFC2506200), and the Research Project of Jinan Microecological Biomedicine Shandong Laboratory (No. JNL-2023001B).
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Affiliation(s)
- Lingzhuo Kong
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Huaizhi Wang
- School of Psychiatry, Wenzhou Medical University, Wenzhou, 325000, China
| | - Ning Yan
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Shanghai Jing ‘an District Mental Health Centre, Shanghai, 200040, China
| | - Chenyue Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yiqing Chen
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yuanyuan Zeng
- Hangzhou Medical College, School of Clinical Medicine, Hangzhou, 310003, China
| | - Xiaonan Guo
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jing Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Zhejiang Key Laboratory of Precision Psychiatry, Hangzhou, 310003, China
- Brain Research Institute of Zhejiang University, Hangzhou, 310003, China
- Zhejiang Engineering Centre for Mathematical Mental Health, Hangzhou, 310003, China
- MOE Frontier Science Centre for Brain Science & Brain-Machine Integration, Zhejiang University, Hangzhou, 310003, China
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- School of Psychiatry, Wenzhou Medical University, Wenzhou, 325000, China
- Zhejiang Key Laboratory of Precision Psychiatry, Hangzhou, 310003, China
- Brain Research Institute of Zhejiang University, Hangzhou, 310003, China
- Zhejiang Engineering Centre for Mathematical Mental Health, Hangzhou, 310003, China
- MOE Frontier Science Centre for Brain Science & Brain-Machine Integration, Zhejiang University, Hangzhou, 310003, China
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310003, China
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Li T, Hu K, Ye L, Ma J, Huang L, Guo C, Huang X, Jiang J, Xie X, Guo C, He Q. Association of Antipsychotic Drugs with Venous Thromboembolism: Data Mining of Food and Drug Administration Adverse Event Reporting System and Mendelian Randomization Analysis. J Atheroscler Thromb 2024; 31:396-418. [PMID: 38030236 PMCID: PMC10999720 DOI: 10.5551/jat.64461] [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: 07/04/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS Past observational studies have reported on the association between antipsychotic drugs and venous thromboembolism (VTE); however, the conclusions remain controversial, and its mechanisms are yet to be fully understood. Thus, in this study, we aim to determine the associations of antipsychotic drugs with VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), and their potential mechanisms. METHODS We first mined the adverse event signals of VTE, DVT, and PE caused by antipsychotic drugs in Food and Drug Administration Adverse Event Reporting System (FAERS). Next, we used two-sample Mendelian randomization (MR) method to investigate the association of antipsychotic drug target gene expression with VTE, DVT, and PE, using single-nucleotide polymorphisms as genetic instruments. We not only used the expression of all antipsychotic drug target genes as exposure to perform MR analyses but also analyzed the effect of single target gene expression on the outcomes. RESULTS In the FAERS, 1694 cases of VTE events were reported by 16 drugs. However, using the MR approach, no significant association was determined between the expression of all antipsychotic target genes and VTE, DVT, or PE, either in blood or brain tissue. Although the analysis of single gene expression data showed that the expression of nine genes was associated with VTE events, these targets lacked significant pharmacological action. CONCLUSIONS Adverse event mining results have supported the claim that antipsychotic drugs can increase the risk of VTE. However, we failed to find any genetic evidence for this causal association and potential mechanisms. Thus, vigilance is still needed for antipsychotic drug-related VTE despite the limited supporting evidence.
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Affiliation(s)
- Tong Li
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Kai Hu
- Department of Neurology, Xiangya Hospital, Central South University, Hunan, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, P.R. China
- Clinical Research Center for Epileptic disease of Hunan Province, Central South University, Hunan, P.R. China
| | - Ling Ye
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Junlong Ma
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Longjian Huang
- Youjiang Medical University for Nationalities, Guangxi, P.R. China
| | - Chengjun Guo
- School of Applied Mathematics, Guangdong University of Technology, Guangdong, P.R. China
| | - Xin Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Jie Jiang
- Department of Pediatrics, The Affiliated Changsha Central Hospital, University of South China Hengyang Medical School,University of South China, Hunan, P.R. China
| | - Xiaoxue Xie
- Department of Radiotherapy, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Hunan, P.R. China
| | - Chengxian Guo
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
| | - Qingnan He
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Hunan, P.R. China
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Shettima FB, Wakil MA, Sheikh TL, Abdulaziz M, Wakawa IA, Beida O. Antipsychotics-related hyperprolactinaemia among patients with schizophrenia in Maiduguri. S Afr J Psychiatr 2024; 30:2133. [PMID: 38444408 PMCID: PMC10912972 DOI: 10.4102/sajpsychiatry.v30i0.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/10/2023] [Indexed: 03/07/2024] Open
Abstract
Background Hyperprolactinaemia among patients on antipsychotic medications is generally overlooked due to lack of outwardly visible symptoms, patient resistance to reporting because the symptoms are perceived as shameful, or to clinician's insufficient knowledge. Aim The study aimed to evaluate the patterns and correlates of hyperprolactinemia among patients with schizophrenia on antipsychotic medications. Setting The study was conducted in a psychiatric facility in Maiduguri, Northeastern Nigeria. Methods A total of 209 patients with schizophrenia were evaluated through a cross-sectional design and assayed for serum prolactin with ELISA Kits. Frequencies and percentages were tabulated for categorical variables. Variables with significant associations with hyperprolactinaemia on chi-square (p < 0.05) were subjected to logistic regression analysis. Results The prevalence of hyperprolactinaemia was 45.9% in all patients on antipsychotic medication. The prevalence because of the use of typical and atypical antipsychotics was 51.5% and 25.0%, respectively. Hyperprolactinaemia was significantly associated with typical antipsychotics (β = 0314, p = 0.002), high overall drug dosage (β = 2.340, p = 0.003), high-dose typical antipsychotics (β = 3.228, p = 0.000), twice daily dosing frequency (β = 2.751, p = 0.001) and polypharmacy (β = 1.828, p = 0.0024). Conclusion The findings support that patients on typical, high-dose antipsychotic medications and polypharmacy have a high prevalence of hyperprolactinaemia. As hyperprolactinaemia is often undetectable, screening and patient psycho-education on the significance of the signs and symptoms of hyperprolactinaemia is required for necessary clinical intervention. Contribution The study provides evidence for the rational use of antipsychotic medications in sub-Saharan Africa.
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Affiliation(s)
- Falmata B Shettima
- Department of Mental Health, Faculty of Psychiatry, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Musa A Wakil
- Department of Mental Health, Faculty of Psychiatry, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Taiwo L Sheikh
- Department of Mental Health, Faculty of Psychiatry, Ahmadu Bello University Zaria, Kaduna, Nigeria
| | - Mohammed Abdulaziz
- Department of Mental Health, Faculty of Psychiatry, Federal Neuropsychiatric Hospital Kaduna, Kaduna, Nigeria
| | - Ibrahim A Wakawa
- Department of Mental Health, Faculty of Psychiatry, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Omeiza Beida
- Department of Mental Health, Faculty of Psychiatry, Federal Neuropsychiatric Hospital Kaduna, Kaduna, Nigeria
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Durrani US, Vasireddy S, Arshad MZ, Paracha A, Paracha MA, Waheed F, Abid A, Siddiqui Z, Thomure M. The Effect of Antipsychotics on Prolactinoma Growth: A Radiological and Serological Analysis. Cureus 2023; 15:e49342. [PMID: 38143631 PMCID: PMC10748855 DOI: 10.7759/cureus.49342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Many antipsychotic (AP) medications work by reducing dopamine levels. As hyperdopaminergia is known to cause psychosis, antipsychotics work to relieve these symptoms by antagonizing dopamine receptors and lowering dopamine levels. Dopamine is also a known negative modulator of the prolactin pathway, which allows for drug agents like dopamine agonists (DAs) to be incredibly effective in managing tumors that secrete excess prolactin (prolactinomas). While the effects of DAs on prolactinoma size and growth have been studied for decades, the effects of APs on prolactinoma size remain to be seen. We hope to investigate the effects of APs on prolactinomas by conducting a thorough PubMed search, including patients with diagnosed prolactinoma on concurrent AP therapy. Our search led to 27 studies with a total of 32 patients. We identified themes regarding seven antipsychotics: risperidone, haloperidol, amisulpride, thioridazine, aripiprazole, olanzapine, and clozapine. Risperidone, haloperidol, amisulpride, and thioridazine caused a significant increase in prolactin in most cases where they were used, and prolactin decreased after their discontinuation. For example, risperidone discontinuation resulted in a decrease in prolactin levels by an average of 66%, while haloperidol, amisulpride, and thioridazine discontinuation lowered prolactin by an average of 82%, 72%, and 89.7%, respectively. However, there were some exceptions in regard to risperidone, haloperidol, and thioridazine, where prolactin levels were not as severely affected. Aripiprazole, olanzapine, and clozapine all had significant reductions in prolactin levels when patients were switched from another antipsychotic, such as risperidone or haloperidol. The average percent decrease in prolactin when switched to aripiprazole was 67.65%, while it was 54.16% and 68% for olanzapine and clozapine, respectively. The effect of individual antipsychotics on prolactinoma size was difficult to ascertain, as imaging was not obtained (or indicated) after every antipsychotic switch, and many patients were taking dopamine agonists concurrently. Therefore, it would be difficult to ascertain which factor affected size more. Also, some patients received surgery or radiotherapy, which completely negated our ability to make any assertions about the effects of certain pharmacological agents. Although it is difficult to ascertain the role that antipsychotic medications play in the formation of prolactinoma, we have found that the cessation of certain antipsychotic medications may lead to a reduction in prolactin levels and possibly the presence of a measurable prolactinoma.
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Affiliation(s)
- Umar S Durrani
- Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Satvik Vasireddy
- Radiology, Touro University Nevada College of Osteopathic Medicine, Saint Louis, USA
| | - Maha Z Arshad
- School of Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Awais Paracha
- Oncology, Saint Louis University School of Medicine, St. Louis, USA
| | - Maria A Paracha
- College of Arts and Sciences, University of Virginia, Charlottesville, USA
| | - Fatima Waheed
- Oncology, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Ali Abid
- College of Arts and Sciences, Saint Louis University, St. Louis, USA
| | - Zohair Siddiqui
- Internal Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Michael Thomure
- Obstetrics, Gynecology, and Women's Health-Repo Endocrinology, Saint Louis University School of Medicine, Saint Louis, USA
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Odetayo AF, Olayaki LA. Omega 3 fatty acid improves sexual and erectile function in BPF-treated rats by upregulating NO/cGMP signaling and steroidogenic enzymes activities. Sci Rep 2023; 13:18060. [PMID: 37872365 PMCID: PMC10593954 DOI: 10.1038/s41598-023-45344-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
Bisphenol F (BPF) is an environmental pollutant that has been implicated in sexual dysfunction. Omega 3 fatty acid (O3FA), on the other hand, is an antioxidant with the ability to improve fertility indices. However, no study has explored the possible ameliorative effect of O3FA on BPF-induced sexual dysfunction. Thus, the effect of BPF and/or O3FA on male sexual performance was investigated. Male Wistar rats were randomized into 6 groups, corn oil-treated, O3FA low and high dose (100 and 300 mg/kg), BPF-treated, BPF + O3FA low and BPF + O3FA high dose. BPF significantly impaired male sexual competence, evidenced by a reduction in motivation to mate, prolonged mount, intromission and ejaculation latency, and post-ejaculatory index. Furthermore, a reduction in mount, intromission, and ejaculation frequency were observed. Also, BPF caused a decrease in gonadotropin releasing hormone, follicle stimulating hormone, luteinizing hormone, testosterone, nitric oxide (NO) cyclic guanosine monophosphate (cGMP), 3beta-hydroxysteroid dehydrogenase (3β-HSD), 17beta-hydroxysteroid dehydrogenase (17β-HSD), dopamine, and acetylcholine esterase. Furthermore, it was accompanied by a significant increase in prolactin and estrogen and poor pregnancy outcomes. These observed BPF-led alterations were abolished by O3FA administration. This study showed that O3FA ameliorates BPF-induced sexual dysfunction by upregulating NO/cGMP signaling and steroidogenic enzymes activities.
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Affiliation(s)
- Adeyemi Fatai Odetayo
- Physiology Department, University of Ilorin, Ilorin, Kwara State, Nigeria.
- Physiology Department, Federal University of Health Sciences, Ila Orangun, Osun State, Nigeria.
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Cai Q, Jin S, Zong H, Pei L, Cao K, Qu L, Li Z. A Quadruplex Ultrasensitive Immunoassay for Simultaneous Assessment of Human Reproductive Hormone Proteins in Multiple Biofluid Samples. Anal Chem 2023; 95:11641-11648. [PMID: 37489999 DOI: 10.1021/acs.analchem.3c01399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Reproductive hormones play vital roles in reproductive health and can be used to assess a woman's ovarian function and diagnose diseases associated with reproductive endocrine disorders. As these hormones are important biomarkers for reproductive health monitoring and diagnosis, a rapid, high-throughput, and low-invasive detection and simultaneous assessment of the levels of multiple reproductive hormones has important clinical applications. In this work, a quadruplex ultrasensitive immunoassay was developed for simultaneous assessment of 4 human reproductive hormone proteins (follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and anti-Müllerian hormone (AMH)) in a variety of human biofluid samples. This assay takes advantage of single-molecule imaging of microwell arrays and capture antibody beads as a reaction interface to construct multiplex bead array immunoassays. The analyte-bound beads can easily be parsed to individual wells and detected via fluorophores, emitting distinct wavelengths associated to the beads. As a result, this proposed quadruplex immunoassay exhibits four good 4-parameter logistic calibration curves ranging from 2.7 to 2000, 1.6 to 1200, 1.8 to 1300, and 0.3 to 220 pg/mL with limits of detection of 0.32, 0.28, 0.14, and 0.02 pg/mL for FSH, LH, PRL, and AMH, respectively. Furthermore, the developed quadruplex immunoassay was used to test clinical venous serum samples where it showed remarkable consistency with clinical test results in methodological comparison and the diagnosis of polycystic ovary syndrome. In addition, we successfully applied the ultrasensitive capability of this assay to the simultaneous testing and evaluation of four proteins in fingertip blood as well as urine samples, in which the urinary AMH level (1.42-156 pg/mL) was measured and assessed quantitatively for the first time.
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Affiliation(s)
- Qiyong Cai
- Institute of Chemical Biology and Clinical Application at the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450001, People's Republic of China
- College of Chemistry, Institute of Analytical Chemistry for Life Science, Henan Joint International Research Laboratory of Green Construction of Functional Molecules and Their Bioanalytical Applications, Zhengzhou Key Laboratory of Functional Nanomaterial and Medical Theranostic, Zhengzhou University, Zhengzhou 450001, People's Republic of China
| | - Shuiling Jin
- Institute of Chemical Biology and Clinical Application at the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450001, People's Republic of China
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Hong Zong
- Institute of Chemical Biology and Clinical Application at the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450001, People's Republic of China
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Lu Pei
- Department of Laboratory Medicine, Zhengzhou Hospital of Traditional Chinese Medicine, Zhengzhou 450006, People's Republic of China
| | - Ke Cao
- Department of Laboratory Medicine, Zhengzhou Hospital of Traditional Chinese Medicine, Zhengzhou 450006, People's Republic of China
| | - Lingbo Qu
- Institute of Chemical Biology and Clinical Application at the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450001, People's Republic of China
- College of Chemistry, Institute of Analytical Chemistry for Life Science, Henan Joint International Research Laboratory of Green Construction of Functional Molecules and Their Bioanalytical Applications, Zhengzhou Key Laboratory of Functional Nanomaterial and Medical Theranostic, Zhengzhou University, Zhengzhou 450001, People's Republic of China
| | - Zhaohui Li
- Institute of Chemical Biology and Clinical Application at the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450001, People's Republic of China
- College of Chemistry, Institute of Analytical Chemistry for Life Science, Henan Joint International Research Laboratory of Green Construction of Functional Molecules and Their Bioanalytical Applications, Zhengzhou Key Laboratory of Functional Nanomaterial and Medical Theranostic, Zhengzhou University, Zhengzhou 450001, People's Republic of China
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8
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Ren F, Shang Q, Zhao S, Yang C, Feng K, Liu J, Kang X, Zhang R, Wang X, Wang X. An exploration of the correlations between seven psychiatric disorders and the risks of breast cancer, breast benign tumors and breast inflammatory diseases: Mendelian randomization analyses. Front Psychiatry 2023; 14:1179562. [PMID: 37448488 PMCID: PMC10338175 DOI: 10.3389/fpsyt.2023.1179562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Background Previous observational studies have showed that certain psychiatric disorders may be linked to breast cancer risk, there is, however, little understanding of relationships between mental disorders and a variety of breast diseases. This study aims to investigate if mental disorders influence the risks of overall breast cancer, the two subtypes of breast cancer (ER+ and ER-), breast benign tumors and breast inflammatory diseases. Methods During our research, genome-wide association study (GWAS) data for seven psychiatric disorders (schizophrenia, major depressive disorder, bipolar disorder, post-traumatic stress disorder, panic disorder, obsessive-compulsive disorder and anorexia nervosa) from the Psychiatric Genomics Consortium (PGC) and the UK Biobank were selected, and single-nucleotide polymorphisms (SNPs) significantly linked to these mental disorders were identified as instrumental variables. GWAS data for breast diseases came from the Breast Cancer Association Consortium (BCAC) as well as the FinnGen consortium. We performed two-sample Mendelian randomization (MR) analyses and multivariable MR analyses to assess these SNPs' effects on various breast diseases. Both heterogeneity and pleiotropy were evaluated by sensitivity analyses. Results When the GWAS data of psychiatric disorders were derived from the PGC, our research found that schizophrenia significantly increased the risks of overall breast cancer (two-sample MR: OR 1.05, 95%CI [1.03-1.07], p = 3.84 × 10-6; multivariable MR: OR 1.06, 95%CI [1.04-1.09], p = 2.34 × 10-6), ER+ (OR 1.05, 95%CI [1.02-1.07], p = 5.94 × 10-5) and ER- (two-sample MR: OR 1.04, 95%CI [1.01-1.07], p = 0.006; multivariable MR: OR 1.06, 95%CI [1.02-1.10], p = 0.001) breast cancer. Nevertheless, major depressive disorder only showed significant positive association with overall breast cancer (OR 1.12, 95%CI [1.04-1.20], p = 0.003) according to the two-sample MR analysis, but not in the multivariable MR analysis. In regards to the remainder of the mental illnesses and breast diseases, there were no significant correlations. While as for the data from the UK Biobank, schizophrenia did not significantly increase the risk of breast cancer. Conclusions The correlation between schizophrenia and breast cancer found in this study may be false positive results caused by underlying horizontal pleiotropy, rather than a true cause-and-effect relationship. More prospective studies are still needed to be carried out to determine the definitive links between mental illnesses and breast diseases.
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Affiliation(s)
- Fei Ren
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingyao Shang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuangtao Zhao
- Department of Thoracic Surgery, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Chenxuan Yang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kexin Feng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxiang Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiyu Kang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Tarzian M, Soudan M, Alhajji M, Ndrio M, Fakoya AO. Lurasidone for Treating Schizophrenia and Bipolar Depression: A Review of Its Efficacy. Cureus 2023; 15:e38071. [PMID: 37228542 PMCID: PMC10208134 DOI: 10.7759/cureus.38071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Lurasidone is an antipsychotic medication that blocks dopamine D2 and serotonin 5-hydroxy-tryptamine (5-HT)2A receptors and affects other serotoninergic and noradrenergic receptors. It has rapid absorption and linear pharmacokinetics. The rates of metabolic syndrome for patients taking lurasidone are comparable to placebo groups. Lurasidone is a safe and effective treatment for patients with acute schizophrenia and bipolar depression. It has been found to improve the brief psychiatric rating scale and other secondary measures in schizophrenic patients and reduce depressive symptoms in bipolar I depression. The once-daily administration of lurasidone is generally well-tolerated and does not cause clinically significant differences in extrapyramidal symptoms, adverse effects, or weight gain compared to a placebo. However, lurasidone's effectiveness in combination with lithium or valproate has been mixed. Further research is needed to determine optimal dosing, treatment duration, and combination with other mood stabilizers. Long-term safety and effectiveness and its use in different subpopulations should also be evaluated.
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Affiliation(s)
- Martin Tarzian
- Psychiatry, University of Medicine and Health Sciences, Basseterre, KNA
| | - Majd Soudan
- Psychiatry, Nuvance Health Medical Practice - Primary Care Carmel, New York, USA
| | - Muhammed Alhajji
- Internal Medicine, Augusta University/University of Georgia Medical Partnership, Athens, USA
| | - Mariana Ndrio
- Psychiatry, University of Medicine and Health Sciences, Basseterre, KNA
| | - Adegbenro O Fakoya
- Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, USA
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10
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Abstract
Schizophrenia is a chronic, heterogeneous, severe psychiatric disorder characterized by a spectrum of symptomology and is associated with substantial morbidity and mortality. For the last 70 years, available treatments have shared blockade of dopamine D2 receptors as their primary mechanism of action (MOA), the efficacy of which has been limited by incomplete resolution of all symptoms as well as treatment non-response in a select subset of patients. In addition, antipsychotics are associated with class-related side effects attributed to this primary MOA, including extrapyramidal symptoms (EPS). The need for non-D2 treatment options for patients which offer a novel risk/benefit profile is therefore apparent. There has been substantial investment in the research and development of non-D2 drug candidates. However, none of these programs have received successful regulatory approval by the FDA (as of Oct 2022). In this article, the scale of industry-sponsored clinical trials for D2-based investigational pharmacological treatments in schizophrenia was quantified and compared with investigational compounds with non-D2 MOAs. In a dataset of 545 clinical trials identified in ClinicalTrials.gov from January 2002 to July 2022, total enrollments in trials of non-D2-based compounds for the treatment of schizophrenia summed to approximately 34,000 patients, compared with 27,144 patients for D2-based compounds. These data indicate that there remains substantial and ongoing investment in the development of novel non-D2 options for schizophrenia, with a success rate measured by regulatory approval that is well-below recent benchmarks for the broader category of CNS drugs. Improved trial design, conduct, endpoints, and analyses/methods may influence signal detection and reliability to support development and registration of non-D2 compounds.
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Affiliation(s)
| | - Robert Lew
- Sunovion Pharmaceuticals Inc, Marlborough, MA, USA
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11
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Liu X, Sun X, Li L, Zeng K, Li Y, Gao Y, Ma J. Co-prescription of aripiprazole on prolactin levels in long-term hospitalized chronic schizophrenic patients with co-morbid type 2 diabetes: A retrospective clinical study. Front Psychiatry 2023; 14:1124691. [PMID: 36816406 PMCID: PMC9933920 DOI: 10.3389/fpsyt.2023.1124691] [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: 12/15/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND One of the most frequent side effects of atypical antipsychotics is hyperprolactinemia (HPRL), and metformin or aripiprazole co-prescription is regarded as an effective therapy option for reducing prolactin (PRL) levels. However, whether either of the two drugs can reduce PRL levels in patients with long-term hospitalized chronic schizophrenia with co-morbid type 2 diabetes (T2DM) has not been adequately reported. METHODS In our study, long-term hospitalized chronic schizophrenia patients with co-T2DM who were prescribed olanzapine or risperidone as the primary antipsychotic medication were enrolled. A total of 197 of these cases with co-prescribed aripiprazole were set up as the study group (co-Ari group), and the other 204 cases without co-prescribed aripiprazole were set up as the control group (non-Ari group). The two groups' variations in each target parameter were compared, and the variables affecting PRL levels were examined. RESULTS Compared to the non-Ari group, fasting blood glucose (FBG), blood uric acid (UA), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher in the co-Ari group, but there was no difference in PRL levels. Co-prescribing aripiprazole had no impact on PRL levels in all patients with co-T2DM, and aripiprazole dose had no impact on PRL levels in the clinical subgroup of the co-Ari group. CONCLUSION Aripiprazole not only worsened the severity of index disturbances associated to metabolism in long-term hospitalized chronic schizophrenia patients with co-T2DM on metformin-based hypoglycemic medications but also failed to lower PRL levels.
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Affiliation(s)
- Xuebing Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Xianzhi Sun
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lu Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Kuan Zeng
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yi Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yujun Gao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Ma
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China.,Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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12
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Ilzarbe L, Ilzarbe D, Gutiérrez-Arango F, Baeza I. Sex Differences in Serum Prolactin Levels in Children and Adolescents on Antipsychotics: A Systematic Review and Meta-Analysis. Curr Neuropharmacol 2023; 21:1319-1328. [PMID: 36305138 PMCID: PMC10324329 DOI: 10.2174/1570159x21666221027143920] [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: 12/31/2021] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Serum prolactin levels are influenced by sex, physical development and medications among other factors. Antipsychotics usually increase serum prolactin levels in both adults and younger patients, but no study has reviewed the potential association between sex and vulnerability for developing hyperprolactinemia among children and adolescents. OBJECTIVE Systematic review and meta-analysis of serum prolactin levels in children and adolescents on antipsychotic treatment for any psychiatric diagnosis to determine the effect of sex. METHODS A systematic search was performed in MEDLINE/PubMed/Web of Science and Cochrane databases for randomized controlled trials of antipsychotics in children and adolescents reporting serum prolactin levels by sex. RESULTS Of 1278 identified records, seven studies were included, comparing different single antipsychotics to placebo (risperidone N=4; lurasidone N=1; olanzapine N=1; queriapine N=1). Both male and female children and adolescents on antipsychotics presented a significant increase in prolactin levels relative to subjects receiving a placebo. (Male: 16.53 with 95% CI: 6.15-26.92; Female: 26.97 with 95% CI: 9.18-44.75). The four studies using risperidone had similar findings (Male: 26.49 with 95% CI: 17.55-35.43; Female: 37.72 with 95% CI: 9.41-66.03). In the direct comparison between sexes, females showed greater increases in prolactin, but the differences were not statistically significant. CONCLUSION Serum prolactin levels are increased in children and adolescents of both sexes on antipsychotics, with females showing a slightly greater increase than males. Further research is needed to clarify the influence of sex and pubertal status on prolactin levels in children and adolescents taking antipsychotics.
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Affiliation(s)
- Lidia Ilzarbe
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Daniel Ilzarbe
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic of Neurosciences, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Felipe Gutiérrez-Arango
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic of Neurosciences, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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13
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Cozzi R, Auriemma RS, De Menis E, Esposito F, Ferrante E, Iatì G, Mazzatenta D, Poggi M, Rudà R, Tortora F, Cruciani F, Mitrova Z, Saulle R, Vecchi S, Basile M, Cappabianca P, Paoletta A, Papini E, Persichetti A, Samperi I, Scoppola A, Bozzao A, Caputo M, Doglietto F, Ferraù F, Lania AG, Laureti S, Lello S, Locatelli D, Maffei P, Minniti G, Peri A, Ruini C, Settanni F, Silvani A, Veronese N, Grimaldi F, Attanasio R. Italian Guidelines for the Management of Prolactinomas. Endocr Metab Immune Disord Drug Targets 2023; 23:1459-1479. [PMID: 37171003 PMCID: PMC10556400 DOI: 10.2174/1871530323666230511104045] [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: 02/27/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered. METHODS This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinologi (AME) has identified potentially relevant outcomes, which have then been rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" have been considered in the systematic review of evidence and only those classified as "critical" have been considered in the formulation of recommendations. RESULTS The present GL provides recommendations regarding the role of pharmacological and neurosurgical treatment in the management of prolactinomas. We recommend cabergoline (Cab) vs. bromocriptine (Br) as the firstchoice pharmacological treatment to be employed at the minimal effective dose capable of achieving the regression of the clinical picture. We suggest that medication and surgery are offered as suitable alternative first-line treatments to patients with non-invasive PRL-secreting adenoma, regardless of size. We suggest Br as an alternative drug in patients who are intolerant to Cab and are not candidates for surgery. We recommend pituitary tumor resection in patients 1) without any significant neuro-ophthalmologic improvement within two weeks from the start of Cab, 2) who are resistant or do not tolerate Cab or other dopamine-agonist drugs (DA), 3) who escape from previous efficacy of DA, and 4) who are unwilling to undergo a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed by a multidisciplinary team with specific expertise in pituitary diseases using a multimodal approach that includes repeated surgery, radiotherapy, DA, and possibly, the use of temozolomide. CONCLUSION The present GL is directed to endocrinologists, neurosurgeons, and gynecologists working in hospitals, in territorial services or private practice, and to general practitioners and patients.
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Affiliation(s)
- Renato Cozzi
- Department of Endocrinology ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Renata Simona Auriemma
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Italy
| | - Ernesto De Menis
- Internal Medicine 2, Treviso Hospital, Treviso; Functional Department of Endocrinology and Metabolism, AULSS 2 Veneto, Italy
| | - Felice Esposito
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Italy
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Maurizio Poggi
- Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - Roberta Rudà
- Division of Neurology, Castelfranco Veneto and Treviso Hospital, Treviso; Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Italy
| | - Fabio Tortora
- Radiology Unit, Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Fabio Cruciani
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Michele Basile
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Paolo Cappabianca
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Italy
| | | | - Enrico Papini
- Endocrinology, Ospedale Regina Apostolorum, Albano Laziale
| | - Agnese Persichetti
- Ministry of Interior - Department of Firefighters, Public Rescue and Civil Defense, Rome, Italy
| | | | | | - Alessandro Bozzao
- Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Italy
| | - Marco Caputo
- Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano (FI), Italy
| | - Francesco Doglietto
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Francesco Ferraù
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Andrea Gerardo Lania
- Department of Biomedical Sciences, Endocrinology Unit, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano (MI), Italy
| | | | - Stefano Lello
- Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Pietro Maffei
- Department of Medicine (DIMED), 3 Medical Clinic, Padua University, Italy
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Alessandro Peri
- Pituitary Diseases and Sodium Alterations Unit, Endocrinology, AOU Careggi, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Italy
| | - Chiara Ruini
- Department of Psychology, University of Bologna, Italy
| | - Fabio Settanni
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Antonio Silvani
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Nadia Veronese
- Department of Endocrinology ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Gao Z, Xi Y, Shi H, Ni J, Xu W, Zhang K. Antipsychotic exposure is an independent risk factor for breast cancer: A systematic review of epidemiological evidence. Front Oncol 2022; 12:993367. [PMID: 36591471 PMCID: PMC9798228 DOI: 10.3389/fonc.2022.993367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background The effect of antipsychotics on breast cancer remains controversial. Materials and methods Embase, Scopus, PubMed, Web of Science, Cochrane Library, and Hebei Medical University Library were used for the literature search. Observational studies with original data for the effects of antipsychotics on breast cancer were used. Studies of bed quality, those with inadequate sample size, incomplete follow-up works, or studies that did not meet the criteria were excluded. Meta-analysis was performed using R version 4.1.2. The odds ratio (OR) and its 95% confidence interval (CI) were used to evaluate the proportion of breast cancer in different groups. To detect possible sources of heterogeneity, subgroup and meta-regression analyses were employed. Results Pooled data from 11 relevant studies with 1,499,001 participants suggested that individuals exposed to antipsychotics were more likely to suffer from breast cancer than those who were not exposed (OR, 1.23; 95% CI, 1.04-1.47). No significant difference in breast cancer prevalence between the atypical and typical antipsychotic groups was found (OR, 1.23; 95% CI, 0.93-1.63). Prolactin (PRL)-increasing and PRL-sparing antipsychotics posed a similar risk of breast cancer (OR, 1.13; 95% CI, approximately 0.97-1.31). Furthermore, the use of antipsychotics is attributed to increased mortality in patients with breast cancer (OR, 1.54; 95% CI, 1.29-1.82). Those exposed to antipsychotics at the maximum dose were more likely to suffer from breast cancer than those exposed to the minimum dose. Conclusions Antipsychotic exposure is an independent risk factor for breast cancer. No significant difference in the risk of breast cancer between typical and atypical antipsychotics was noted. Those exposed to antipsychotics at higher doses are more likely to suffer from breast cancer. Moreover, the use of antipsychotics is attributed to increased mortality in patients with breast cancer. PRL-increasing and PRL-sparing antipsychotics pose a similar risk of breast cancer. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022307624.
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Affiliation(s)
- Zheng Gao
- Department of Cardiology, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yin Xi
- Department of Internal Medicine, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hekai Shi
- Department of Internal Medicine, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiyuan Ni
- Department of Orthopedics, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wei Xu
- Department of Internal Medicine, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kaili Zhang
- Department Of Adenosurgery, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China,*Correspondence: Kaili Zhang,
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15
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Joo SW, Lee BC, Lee J, Seo GH. Risk of Breast Cancer in Association with the Use of Second-generation Antipsychotics. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:675-684. [PMID: 36263642 PMCID: PMC9606429 DOI: 10.9758/cpn.2022.20.4.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Previous studies regarding the relationship between the risk of breast cancer (BC) and antipsychotics use have reported inconsistent findings. Insufficient sample size and/or observation period may have hindered revealing the risk of BC associated with antipsychotics use. We aimed to investigate whether the use of second-generation antipsychotics (SGA) is associated with increased risk of BC. METHODS We used the Health Insurance Review Agency database in South Korea between 2008 and 2018. The index date was determined as the date of the first antipsychotic prescription. We selected women prescribed SGAs for more than 30 days within a year from the index date and age-matched controls, yielding 498,970 cases and 997,940 controls. The Cox proportional hazards regression model was used for estimating the risk. RESULTS The incidence rates of BC were 109.74 and 101.51 per 100,000 person-years in the case and control groups, respectively. There was an increased risk of BC in the case group (hazard ratio [HR] = 1.08, 95% confidence interval [CI] 1.04-1.13). There was a higher risk of BC in subjects prescribed with ≥ 10,000 mg of olanzapine equivalent dose (HR = 1.29, 95% CI 1.14-1.46) than those with < 10,000 mg (HR = 1.05, 95% CI 1.00-1.11). The increased risk of BC in the case group became significant after six years of the observation period (≥ 6 years: HR = 1.24, 95% CI 1.14-1.35, 3 to < 6 years: HR = 1.06, 95% CI 0.97-1.15, < 3 years: HR = 1.02, 95% CI 0.95-1.09). CONCLUSION This study indicated that the use of SGAs is associated with increased risk of BC in a long-term relationship with a dose-response pattern.
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Affiliation(s)
- Sung Woo Joo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boung Chul Lee
- Department of Psychiatry, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Jungsun Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Address for correspondence: Jungsun Lee Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea, E-mail: , ORCID: https://orcid.org/0000-0003-2171-2720, Gi Hyeon Seo, Health Insurance Review and Assessment Service, 60 Hyeoksin-ro, Wonju 26465, Korea, E-mail: , ORCID: https://orcid.org/0000-0001-7414-0258
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Wonju, Korea,Address for correspondence: Jungsun Lee Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea, E-mail: , ORCID: https://orcid.org/0000-0003-2171-2720, Gi Hyeon Seo, Health Insurance Review and Assessment Service, 60 Hyeoksin-ro, Wonju 26465, Korea, E-mail: , ORCID: https://orcid.org/0000-0001-7414-0258
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16
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Coronel DA, De la Peña FR, Palacios-Cruz L, Cuevas D, Duran S. Sociodemographic and clinical characteristics related with hyperprolactinaemia in psychiatric clinical population. Int J Psychiatry Clin Pract 2022; 26:387-394. [PMID: 35471923 DOI: 10.1080/13651501.2022.2050259] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hyperprolactinaemia (HyperPRL) induced by psychotropic drugs is a high-prevalence consequence which has repercussions in psychical and mental health in the psychiatric population, so this research had the objective to expand which sociodemographic and clinical features are associated with prolactin (PRL) elevation in patients treated with antidepressant and/or antipsychotic drugs. METHODS An observational, cross-sectional, comparative and retrolective study was conducted on 300 patients who received clinical attention in a third level of psychiatric care unit in Mexico during 2017. These patients have been reported to show PRL levels greater than 25 ng/mL among women and greater than 20 ng/mL among men. In the same way, sociodemographic and clinical variables were collected, as well as psychiatric diagnosis and type of psychopharmacological treatment used by the patients. RESULTS HyperPRL was more frequent in women (80.7%) than men (19.3%). The mean levels of PRL were 68.94 ± 62.28 ng/mL with higher levels in women (71.9 ± 67.3, p=.02). Regarding the treatment, 78.3%, 71.3% and 49.7% consumed antipsychotics, antidepressants, and both drugs, respectively. The relationship between hyperPRL (>100 n/mL) and typical antipsychotics was dose-dependent (33.23 ± 13.24 mg, p=.01). In the multivariate regression models according to the type of treatment, as well as the demographic and clinical features, hyperPRL was associated independently with the use of antipsychotic treatment, pituitary adenoma and hypertension (R2=0.05). CONCLUSIONS HyperPRL is a complex clinical syndrome frequent in the psychiatric population with detrimental long-term consequences, as well as its relationship with the use of psychotropic drugs as in the case of antipsychotics. Effective actions should be implemented in the prevention, approach and treatment of this condition paying special attention to the accompanying medical comorbidities.
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Affiliation(s)
- D A Coronel
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, Mexico
| | - F R De la Peña
- Unit of Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, Mexico
| | - L Palacios-Cruz
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, Mexico
| | - D Cuevas
- Department of Neuroendocrinology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, México City, Mexico
| | - S Duran
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, Mexico
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17
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Indrakusuma AABP, Sadeva IGKA, Kusuma IGNAW, Lesmana CBJ, Wihandani DM. The Risk of Antipsychotic Drugs on Breast Cancer: A Systematic Review and Meta-analysis. Oman Med J 2022; 37:e453. [PMID: 36475277 PMCID: PMC9682323 DOI: 10.5001/omj.2022.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/04/2022] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES To investigate the association between the consumption of antipsychotic drugs and breast cancer. METHODS In this systematic review and meta-analysis study, relevant studies were extracted from different databases including PubMed, ScienceDirect, Cochrane, Medline, and additional sources. The selected studies were statistically analyzed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Of a total of 11 studies selected, five were case-control type and six were cohort type. The overall study quality was 6.7. Meta-analysis of the five case-control studies (which together had 81 766 breast cancer patients and 1 150 316 control participants) showed no significant association between the overall use of antipsychotic drugs and the incidence of breast cancer (odds ratio = 1.06; 95% CI: 0.94-1.19; p =0.36). Q-test results showed evidence of heterogeneity (p < 0.10) in the overall analysis. The I2 statistical assessment also show evidence of heterogeneity (I2> 75%). CONCLUSIONS The use of antipsychotic drugs does not significantly increase the risk of breast cancer.
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Atkinson S, Bachinsky M, Raiter Y, Abreu P, Ianos C, Chappell P, Findling RL. 26-Week Open-Label Extension Study Evaluating the Safety and Tolerability of Flexible Doses of Oral Ziprasidone in Children and Adolescents with Bipolar I Disorder (Most Recent Episode Manic). J Child Adolesc Psychopharmacol 2022; 32:453-458. [PMID: 36282771 DOI: 10.1089/cap.2022.0030] [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] [Indexed: 02/28/2023]
Abstract
Objective: To describe the longer-term effectiveness, safety, and tolerability of open-label ziprasidone in children and adolescents with bipolar I disorder (BD-I). Methods: A subset of 23 participants aged 10-17 years, who were previously treated in a multi-site, 4-week randomized controlled trial received open-label ziprasidone (20-80 mg twice a day) for up to 26 weeks. Results: The most common adverse events (AEs) were fatigue (30%), somnolence (17%), and nausea (13%). Effects on weight, body mass index, and metabolic parameters (glucose, cholesterol, and triglycerides) were minimal. No participant had a Fridericia-corrected QT interval ≥ 460 msec or a change from baseline of ≥60 msec, and there were no cardiac-related AEs. Both the participants who continued ziprasidone and those who initiated ziprasidone in the open-label extension showed improvements in their symptoms of mania. Conclusions: The overall findings of the study are consistent with the accumulating knowledge on the safety profile of ziprasidone in the acute and long-term treatment of children and adolescents with BD-I, in the midst of a manic episode. ClinicalTrial.gov ID: NCT03768726.
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Affiliation(s)
- Sarah Atkinson
- Psychiatry, Child and Adolescent Psychiatry, Finger Lakes Clinical Research, Rochester, New York, USA
| | - Mary Bachinsky
- Clinical Development and Operations, Pfizer, Inc., Groton, Connecticut, USA
| | - Yaron Raiter
- Clinical Development, GE Healthcare, Eindhoven, The Netherlands
| | - Paula Abreu
- Global Biometrics and Data Management, Pfizer, Inc., New York, New York, USA
| | - Claudia Ianos
- Worldwide Medical and Safety, Pfizer AG, Zurich, Switzerland
| | - Phillip Chappell
- Clinical Development and Operations, Pfizer, Inc., Groton, Connecticut, USA
| | - Robert L Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
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19
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Proton pump inhibitors therapy and risk of hyperprolactinemia with associated sexual disorders. Endocr Regul 2022; 56:134-147. [PMID: 35489049 DOI: 10.2478/enr-2022-0015] [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] [Indexed: 11/20/2022] Open
Abstract
Proton pump inhibitors (PPIs) are the most widely prescribed medications in the world. According to numerous studies, PPIs have been linked to hyperprolactinemia, which can lead to a variety of sexual and reproductive issues. This review summarizes the effects of numerous PPIs on the blood prolactin levels and associated sexual dysfunctions, which have an effect on the patient's life quality and fertility. The study is taken into account all the available resources till January 31, 2021. Out of total 364, only 27 relevant resources were involved in this review. In certain studies, short-term PPIs use has been shown to have little or no effect on the blood prolactin and other reproductive hormones levels. PPIs have been linked to the development of hyperprolactinemia in several case studies with varying degrees of the blood prolactin levels increase seen in individuals taking PPI alone or in combination with medications, like prokinetics. The relative risk of the sexual consequences development, such as gynecomastia, has been documented using lansoprazole and omeprazole in various cohort studies. On the other hand, other bits of data are insufficient to establish a definite relationship that can turn a possibility into certainty. The majority of the literature data is comprising of double-blind, randomized, crossover studies, case reports, and adverse drug reaction incidents reported to various pharmacovigilance centers. To investigate this link, high-quality studies in patients taking PPIs for a longer time period are needed. We conclude this article with a comprehensive discussion of the hyperprolactinemia clinical implications and the PPIs' function.
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Nakamura M, Nagamine T. Impact of Lurasidone on Metabolic Parameters and Prolactin Levels Based on Differences of Psychiatric Diagnosis, Dosage, and Introducing Methods: An Observational Study. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:70-77. [PMID: 35958975 PMCID: PMC9341320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Lurasidone is a second-generation antipsychotic (SGA) that contributes an antipsychotic and antidepressant effect, with low incidences of metabolic-related diseases and hyperprolactinemia for the treatment of psychological disorders. However, evidence on lurasidone is limited in psychiatric clinical settings. This study aimed to investigate the effect of short-term lurasidone treatment on metabolic effects and prolactin (PRL) levels, in relation to the differences of psychiatric disorders, lurasidone dosages, and introducing methods, in 35 female and 12 male Japanese inpatients with psychiatric disorders. METHODS Subjects were placed into six subgroups divided by three categories (schizophrenia/schizoaffective disorder or bipolar disorder, 20mg/day or 40mg/day, adding or switching). Sequential changes in 10 items of metabolic parameters, including estimated insulin resistance and PRL levels at one month, were evaluated. The variations of metabolic parameters that were significantly changed from baseline were analyzed against sample characteristics and other metabolic parameter variations. RESULTS In the 40mg/day and switching introduction method groups, lurasidone significantly reduced body weight, body mass index (BMI), levels of alanine amiotransaminase, and levels of fasting blood glucose. PRL levels seemed to increase when lurasidone was added and decrease when lurasidone was switched to from other antipsychotics. Switching introduction method and higher dosage correlated with weight loss and lowering fasting blood glucose levels, respectively. CONCLUSION Lurasidone administration offered the potential for weight loss, lowered serum blood glucose levels, and converging serum PRL concentrations. Moreover, switching introduction method with higher dosages might alleviate basal metabolism and glucose homeostasis. Further prospective studies combining measurements of serum insulin and psychometric evaluation will help to confirm our conclusions.
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Affiliation(s)
- Masaru Nakamura
- Dr. Nakamura is with the Department of Psychiatric Internal Medicine, Kosekai-Kusatsu Hospital in Hiroshima, Japan
- Dr. Nagamine is with the Department of Psychiatric Internal Medicine, Sunlight Brain Research Center in Yamaguchi, Japan
| | - Takahiko Nagamine
- Dr. Nakamura is with the Department of Psychiatric Internal Medicine, Kosekai-Kusatsu Hospital in Hiroshima, Japan
- Dr. Nagamine is with the Department of Psychiatric Internal Medicine, Sunlight Brain Research Center in Yamaguchi, Japan
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21
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Cozzi R, Ambrosio MR, Attanasio R, Battista C, Bozzao A, Caputo M, Ciccarelli E, De Marinis L, De Menis E, Faustini Fustini M, Grimaldi F, Lania A, Lasio G, Logoluso F, Losa M, Maffei P, Milani D, Poggi M, Zini M, Katznelson L, Luger A, Poiana C. Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors. Eur J Endocrinol 2022; 186:P1-P33. [PMID: 35000899 PMCID: PMC8859924 DOI: 10.1530/eje-21-0977] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022]
Abstract
Prolactinomas are the most frequent pituitary adenomas. Prolactinoma may occur in different clinical settings and always require an individually tailored approach. This is the reason why a panel of Italian neuroendocrine experts was charged with the task to provide indications for the diagnostic and therapeutic approaches that can be easily applied in different contexts. The document provides 15 recommendations for diagnosis and 54 recommendations for treatment, issued according to the GRADE system. The level of agreement among panel members was formally evaluated by RAND-UCLA methodology. In the last century, prolactinomas represented the paradigm of pituitary tumors for which the development of highly effective drugs obtained the best results, allowing to avoid neurosurgery in most cases. The impressive improvement of neurosurgical endoscopic techniques allows a far better definition of the tumoral tissue during surgery and the remission of endocrine symptoms in many patients with pituitary tumors. Consequently, this refinement of neurosurgery is changing the therapeutic strategy in prolactinomas, allowing the definitive cure of some patients with permanent discontinuation of medical therapy.
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Affiliation(s)
- Renato Cozzi
- Division of Endocrinology, Niguarda Hospital, Milan, Italy
- Correspondence should be addressed to R Cozzi;
| | - Maria Rosaria Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Claudia Battista
- Endocrinology Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
| | - Alessandro Bozzao
- Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Rome, Italy
| | - Marco Caputo
- Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano, Florence, Italy
| | | | - Laura De Marinis
- Pituitary Unit, Department of Endocrinology, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy
| | | | | | - Franco Grimaldi
- AME President, Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Andrea Lania
- Department of Biomedical Sciences, Endocrinology Unit, Rozzano, Italy
| | - Giovanni Lasio
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | | | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Padua University Hospital, Padua, Italy
| | - Davide Milani
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Maurizio Poggi
- Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Zini
- Endocrinology Unit, Azienda Ospedaliera S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | | | - Anton Luger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Catalina Poiana
- ‘Carol Davila’ University of Medicine and Pharmacy – Endocrinology, “C.I. Parhon” National Institute of Endocrinology – Pituitary and Neuroendocrine Disorders, Bucharest, Romania
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Effectiveness and Adverse Effects of Risperidone in Children with Autism Spectrum Disorder in a Naturalistic Clinical Setting at a University Hospital in Oman. AUTISM RESEARCH AND TREATMENT 2022; 2022:2313851. [PMID: 35127178 PMCID: PMC8814715 DOI: 10.1155/2022/2313851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/17/2022] [Indexed: 11/17/2022]
Abstract
Objective This study aimed at examining the effectiveness of treating children with autism spectrum disorder (ASD) who present with irritability, aggression, and disruptive behavior at the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, with risperidone, and to note any sex-based differences among this cohort. Method This was a retrospective study conducted at the Department of Behavioral Medicine at SQUH over two years from January 2017 to December 2018. This study included all children aged 3 to 18 years attending the Child and Adolescent Mental Health Service (CAMHS) outpatient clinic with a diagnosis of ASD, based on the DSM-5 criteria, and comorbid disruptive behavior, who had been prescribed risperidone. Result This study identified 95 ASD patients (72 males). Male patients' BMI score after 12 months of risperidone treatment showed an increase by 0.62 (1.57 SD; P=0.001); however, there was no significant change among female patients. Somnolence was noted in 69.6% of female patients as compared to 34.7% of males (P=0.003). Among those with a family history of ASD, 5 out of 17 patients had treatment success (29.4%), whereas 70 out of 78 patients (90.0%) who did not have a similar history had successful treatment. Conclusion In conclusion, low-dose risperidone monotherapy is effective and well tolerated among some children with ASD who present with disruptive behavior in a naturalistic clinical setting. However, we found that some of the side effects, such as weight gain and somnolence, were concerning.
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Macotela Y, Ruiz-Herrera X, Vázquez-Carrillo DI, Ramírez-Hernandez G, Martínez de la Escalera G, Clapp C. The beneficial metabolic actions of prolactin. Front Endocrinol (Lausanne) 2022; 13:1001703. [PMID: 36213259 PMCID: PMC9539817 DOI: 10.3389/fendo.2022.1001703] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
The role of prolactin (PRL) favoring metabolic homeostasis is supported by multiple preclinical and clinical studies. PRL levels are key to explaining the direction of its actions. In contrast with the negative outcomes associated with very high (>100 μg/L) and very low (<7 μg/L) PRL levels, moderately high PRL levels, both within but also above the classically considered physiological range are beneficial for metabolism and have been defined as HomeoFIT-PRL. In animal models, HomeoFIT-PRL levels counteract insulin resistance, glucose intolerance, adipose tissue hypertrophy and fatty liver; and in humans associate with reduced prevalence of insulin resistance, fatty liver, glucose intolerance, metabolic syndrome, reduced adipocyte hypertrophy, and protection from type 2 diabetes development. The beneficial actions of PRL can be explained by its positive effects on main metabolic organs including the pancreas, liver, adipose tissue, and hypothalamus. Here, we briefly review work supporting PRL as a promoter of metabolic homeostasis in rodents and humans, the PRL levels associated with metabolic protection, and the proposed mechanisms involved. Finally, we discuss the possibility of using drugs elevating PRL for the treatment of metabolic diseases.
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24
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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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Culpepper L, Vieta E, Kelly DL, Patel MD, Szatmári B, Hankinson A, Earley WR. Minimal Effects of Cariprazine on Prolactin Levels in Bipolar Disorder and Schizophrenia. Neuropsychiatr Dis Treat 2022; 18:995-1011. [PMID: 35591886 PMCID: PMC9112044 DOI: 10.2147/ndt.s348143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many medications used to treat schizophrenia and bipolar I disorder are linked to hyperprolactinemia. The effects of cariprazine, a dopamine D3/D2 receptor partial agonist, on prolactin levels in patients with schizophrenia or bipolar I disorder were evaluated. METHODS Effects on prolactin were evaluated using pooled data from randomized, double-blind, placebo-controlled studies in patients with schizophrenia (4 studies; 6-week duration; cariprazine 1.5-3 mg/d, 4.5-6 mg/d, and 9-12 mg/d), bipolar mania (3 studies; 3-week duration; cariprazine 3-6 and 9-12 mg/d), and bipolar depression (3 studies; 6- to 8-week duration; cariprazine 1.5 and 3 mg/d). Long-term effects were analyzed using open-label studies in patients with schizophrenia (2 studies; 48-week duration) and patients with bipolar mania (1 study; 16-week duration). Change in prolactin levels (ng/mL) from baseline to study endpoint was evaluated in subsets of sex and prior medication use. RESULTS In patients with schizophrenia (male, n = 1377; female, n = 558), median prolactin changes were -1.2 for males and -7.4 for females on placebo, and ranged from -4.2 to -3.6 for males and -12.4 to +0.2 for females in the cariprazine-treatment groups. In patients with bipolar mania (male, n = 570; female, n = 395), median prolactin changes were -0.2 for males and -1.1 for females on placebo and ranged from -2.1 to -3.0 for males and 0 to +1.8 for females in the cariprazine-treatment groups. Median decreases were also seen in the long-term studies of schizophrenia (range, -14.6 to -2.0) and bipolar mania (range, -0.8 to +1.9). In patients with bipolar depression (male, n = 485; female, n = 780), median prolactin changes were +0.3 for males and +0.7 for females on placebo and ranged from +0.4 to +0.5 for males and +3.0 to +3.1 for females in the cariprazine-treatment groups. CONCLUSION Treatment with cariprazine for schizophrenia or bipolar I disorder was associated with minimal effects on prolactin levels.
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Affiliation(s)
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Abstract
Prolactin coordinates with the ovarian steroids to orchestrate mammary development and lactation, culminating in nourishment and an increasingly appreciated array of other benefits for neonates. Its central activities in mammary epithelial growth and differentiation suggest that it plays a role(s) in breast cancer, but it has been challenging to identify its contributions, essential for incorporation into prevention and treatment approaches. Large prospective epidemiologic studies have linked higher prolactin exposure to increased risk, particularly for ER+ breast cancer in postmenopausal women. However, it has been more difficult to determine its actions and clinical consequences in established tumors. Here we review experimental data implicating multiple mechanisms by which prolactin may increase the risk of breast cancer. We then consider the evidence for role(s) of prolactin and its downstream signaling cascades in disease progression and treatment responses, and discuss how new approaches are beginning to illuminate the biology behind the seemingly conflicting epidemiologic and experimental studies of prolactin actions across diverse breast cancers.
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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: 6] [Impact Index Per Article: 3.0] [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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Kirsch P, Kunadia J, Shah S, Agrawal N. Metabolic effects of prolactin and the role of dopamine agonists: A review. Front Endocrinol (Lausanne) 2022; 13:1002320. [PMID: 36246929 PMCID: PMC9562454 DOI: 10.3389/fendo.2022.1002320] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Prolactin is a polypeptide hormone that is well known for its role in reproductive physiology. Recent studies highlight its role in neurohormonal appetite regulation and metabolism. Elevated prolactin levels are widely associated with worsening metabolic disease, but it appears that low prolactin levels could also be metabolically unfavorable. This review discusses the pathophysiology of prolactin related metabolic changes, and the less commonly recognized effects of prolactin on adipose tissue, pancreas, liver, and small bowel. Furthermore, the effect of dopamine agonists on the metabolic profiles of patients with hyperprolactinemia are discussed as well.
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Affiliation(s)
- Polly Kirsch
- New York University (NYU) Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Jessica Kunadia
- Department of Medicine, NYU Langone Health, New York, NY, United States
| | - Shruti Shah
- New York University (NYU) Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Nidhi Agrawal
- Department of Medicine, NYU Langone Health, New York, NY, United States
- *Correspondence: Nidhi Agrawal,
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Bellman V, Russell N, Depala K, Dellenbaugh A, Desai S, Vadukapuram R, Patel S, Srinivas S. Challenges in Treating Cancer Patients With Unstable Psychiatric Disorder. World J Oncol 2021; 12:137-148. [PMID: 34804276 PMCID: PMC8577605 DOI: 10.14740/wjon1402] [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: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022] Open
Abstract
In this review, we first present a case of chronic myeloid leukemia with acute psychosis, and then we will discuss the incidence of cancer in patients with psychotic disorders, the manifestations of new-onset psychosis, and the prevalence of preexisting psychosis in cancer patients, coupled with their impact on the treatment, diagnosis, and prognosis of cancer. This was a case that presented with acute psychosis and was found to have an elevated white blood cell count upon admission to an inpatient psychiatric unit. He was diagnosed with chronic myeloid leukemia and successfully managed with imatinib/dasatinib therapy. Psychiatrically, he was stabilized on two long-acting injectable medications to help maintain adherence. We were able to eliminate his active psychotic symptoms and return him to normal functioning in affect and thinking, achieving sustained compliance with treatment. We identified multiple inconsistencies in screening for cancer of all types in these patients, masking of signs and symptoms that would typically clue physicians to the presence of cancers, underreporting of symptoms, and disparate access to healthcare resources in patients with mental disorders when compared to the general population. Treatment of cancer in these patients as compared to the general population has also been shown to be incongruent, which will be elaborated upon. Psychiatric interventions, as well as supportive measures, for treating patients who are facing challenges during active cancer treatment will be discussed.
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Affiliation(s)
- Val Bellman
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, 1000 E. 24th Street, Kansas City, MO 64108, USA
| | - Nina Russell
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Kartik Depala
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Saral Desai
- Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Ramu Vadukapuram
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sushma Srinivas
- A.J. Institute of Medical Sciences and Research Centre, NH66, Kuntikan, Mangalore, Karnataka, India
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Hongkaew Y, Gaedigk A, Wilffert B, Gaedigk R, Kittitharaphan W, Ngamsamut N, Limsila P, Puangpetch A, Sukprasong R, Sukasem C. Pharmacogenomics Factors Influencing the Effect of Risperidone on Prolactin Levels in Thai Pediatric Patients With Autism Spectrum Disorder. Front Pharmacol 2021; 12:743494. [PMID: 34690776 PMCID: PMC8527557 DOI: 10.3389/fphar.2021.743494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/14/2021] [Indexed: 01/15/2023] Open
Abstract
We investigated the association between genetic variations in pharmacodynamic genes and risperidone-induced increased prolactin levels in children and adolescents with autism spectrum disorder (ASD). In a retrospective study, variants of pharmacodynamic genes were analyzed in 124 ASD patients treated with a risperidone regimen for at least 3 months. To simplify genotype interpretation, we created an algorithm to calculate the dopamine D2 receptor (DRD2) gene genetic risk score. There was no relationship between prolactin levels and single SNPs. However, the H1/H3 diplotype (A2/A2-Cin/Cin-A/G) of DRD2/ankyrin repeat and kinase domain containing 1 (ANKK1) Taq1A, DRD2 -141C indel, and DRD2 -141A>G, which had a genetic risk score of 5.5, was associated with the highest median prolactin levels (23 ng/ml). As the dose-corrected plasma levels of risperidone, 9-OH-risperidone, and the active moiety increased, prolactin levels in patients carrying the H1/H3 diplotype were significantly higher than those of the other diplotypes. DRD2 diplotypes showed significantly high prolactin levels as plasma risperidone levels increased. Lower levels of prolactin were detected in patients who responded to risperidone. This is the first system for describing DRD2 haplotypes using genetic risk scores based on their protein expression. Clinicians should consider using pharmacogenetic-based decision-making in clinical practice to prevent prolactin increase.
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Affiliation(s)
- Yaowaluck Hongkaew
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand.,Research and Development Laboratory, Bumrungrad International Hospital, Bangkok, Thailand
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, Kanas City, MO, United States.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Bob Wilffert
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Roger Gaedigk
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, Kanas City, MO, United States.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Wiranpat Kittitharaphan
- Department of Mental Health Services, Yuwaprasart Waithayopathum Child and Adolescent Psychiatric Hospital, Ministry of Public Health, Samut Prakan, Thailand
| | - Nattawat Ngamsamut
- Department of Mental Health Services, Yuwaprasart Waithayopathum Child and Adolescent Psychiatric Hospital, Ministry of Public Health, Samut Prakan, Thailand
| | - Penkhae Limsila
- Department of Mental Health Services, Yuwaprasart Waithayopathum Child and Adolescent Psychiatric Hospital, Ministry of Public Health, Samut Prakan, Thailand
| | - Apichaya Puangpetch
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Rattanaporn Sukprasong
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand.,Pharmacogenomics and Precision Medicine, Preventive Genomics and Family Check-up Services Center, Bumrungrad International Hospital, Bangkok, Thailand
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Wu TH, Lin CH, Goh KK, Chen CYA, Chen CH, Lane HY, Lu ML. The Relationships Between Hyperprolactinemia, Metabolic Disturbance, and Sexual Dysfunction in Patients With Schizophrenia Under Olanzapine Treatment. Front Pharmacol 2021; 12:718800. [PMID: 34421613 PMCID: PMC8374865 DOI: 10.3389/fphar.2021.718800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to assess the relationship between prolactin levels and sexual dysfunction in patients with schizophrenia who use olanzapine medication. The potential risk factors of hyperprolactinemia and sexual dysfunction were also investigated. Patients with schizophrenia undergoing olanzapine monotherapy were invited to participate in this cross-sectional study. The Arizona Sexual Experiences Scale (ASEX) and the Positive and Negative Syndrome Scale were used to evaluate subjective sexual dysfunction and psychopathology, respectively. Levels of prolactin and metabolic parameters were also measured. In total, 279 participants with schizophrenia were recruited. The overall incidences of hyperprolactinemia, sexual dysfunction, and metabolic syndrome were 51.6, 53.8, and 43.7%, respectively. Higher ASEX scores, higher insulin levels, female sex, and younger age were associated with hyperprolactinemia. Prolactin level was significantly correlated with ASEX score. Elevated prolactin levels, concomitant antidepressant, increased insulin resistance, longer illness duration, and female sex were associated with sexual dysfunction. Female participants recorded higher levels of sexual dysfunction than their male counterparts did, whereas male participants had comparatively lower prolactin levels and lower rates of spousal partnership. Hyperprolactinemia, metabolic syndrome, and sexual dysfunction are prevalent in patients with schizophrenia treated with olanzapine. Clinicians should maintain awareness of these problems and monitor them regularly with their patients.
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Affiliation(s)
- Tzu-Hua Wu
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Hsin Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kah Kheng Goh
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cynthia Yi-An Chen
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hsin Chen
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Mong-Liang Lu
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study. NPJ SCHIZOPHRENIA 2021; 7:39. [PMID: 34408155 PMCID: PMC8373883 DOI: 10.1038/s41537-021-00170-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 07/20/2021] [Indexed: 12/04/2022]
Abstract
Current guidelines for patients with schizophrenia spectrum disease do not take sex differences into account, which may result in inappropriate sex-specific treatment. In the BeSt InTro study, a total of 144 patients (93 men and 51 women) with a schizophrenia spectrum diagnosis and ongoing psychosis were included and randomized to amisulpride, aripiprazole, or olanzapine in flexible dose. This trial is registered with ClinicalTrials.gov (NCT01446328). Primary outcomes were sex differences in dose, dose-corrected serum levels, efficacy, and tolerability. Dosing was higher for men than for women in the aripiprazole group (p = 0.025) and, at trend level, in the olanzapine group (p = 0.056). Dose-corrected serum levels were 71.9% higher in women than in men for amisulpride (p = 0.019) and 55.8% higher in women than in men for aripiprazole (p = 0.049). In the amisulpride group, men had a faster decrease in psychotic symptoms than women (p = 0.003). Moreover, amisulpride was more effective than the other medications in men but not in women. Prolactin levels were higher in women than in men, especially for amisulpride (p < 0.001). Also, women had higher BMI increase on amisulpride compared to the two other antipsychotics (p < 0.001). We conclude that clinicians should be aware of the risks of overdosing in women, especially for amisulpride and aripiprazole. Amisulpride is highly effective in men, but in women, amisulpride showed more severe side effects and may thus not be the drug of first choice. Our study shows that sex differences should be taken into account in future studies on antipsychotics. Future research is warranted to evaluate these preliminary results.
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Hyperprolactinemia in Adults with Prader-Willi Syndrome. J Clin Med 2021; 10:jcm10163613. [PMID: 34441908 PMCID: PMC8396901 DOI: 10.3390/jcm10163613] [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: 07/10/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/25/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare neurodevelopmental genetic disorder typically characterized by body composition abnormalities, hyperphagia, behavioural challenges, cognitive dysfunction, and hypogonadism. Psychotic illness is common, particularly in patients with maternal uniparental disomy (mUPD), and antipsychotic medications can result in hyperprolactinemia. Information about hyperprolactinemia and its potential clinical consequences in PWS is sparse. Here, we present data from an international, observational study of 45 adults with PWS and hyperprolactinemia. Estimated prevalence of hyperprolactinemia in a subset of centres with available data was 22%, with 66% of those related to medication and 55% due to antipsychotics. Thirty-three patients were men, 12 women. Median age was 29 years, median BMI 29.8 kg/m2, 13 had mUPD. Median prolactin was 680 mIU/L (range 329–5702). Prolactin levels were higher in women and patients with mUPD, with only 3 patients having severe hyperprolactinemia. Thyroid function tests were normal, 24 were treated with growth hormone, 29 with sex steroids, and 20 with antipsychotic medications. One patient had kidney insufficiency, and one a microprolactinoma. In conclusion, severe hyperprolactinemia was rare, and the most common aetiology of hyperprolactinemia was treatment with antipsychotic medications. Although significant clinical consequences could not be determined, potential negative long-term effects of moderate or severe hyperprolactinemia cannot be excluded. Our results suggest including measurements of prolactin in the follow-up of adults with PWS, especially in those on treatment with antipsychotics.
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Amerio A, Giacomini C, Fusar-Poli L, Aguglia A, Costanza A, Serafini G, Aguglia E, Amore M. Efficacy and safety of lurasidone in children and adolescents: Recommendations for clinical management and future research. Curr Pharm Des 2021; 27:4062-4069. [PMID: 34348620 DOI: 10.2174/1381612827666210804110853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
Lurasidone is a novel azapirone derivative, and atypical antipsychotic agent with a high binding affinity for dopaminergic (D2), serotoninergic (5-HT2A), and 5-HT7 receptors (antagonist), a moderate affinity for 5-HT1A receptors (partial agonist), and no appreciable affinity for histaminergic (H1) and muscarinic (M1) receptors. It was recently included by the European Medication Agency among the in-label pharmacological treatments for children and adolescents affected by early onset schizophrenia. As a dopamine and serotonin antagonist, lurasidone acts on a variety of receptors and showed its efficacy both as an antipsychotic and an activating compound. Administered with food or within 30 minutes from a meal, it presents sufficient bioavailability and does not interact ith most of the other drugs during metabolism. With little effects on hormones and weight gain, potential procognitive profile due to its 5-HT7 antagonism, and reduced extrapyramidal side effects, lurasidone could be a good choice in terms of both effectiveness and tolerability, particularly for patients headed towards a long-term treatment. This article aims to summarize the available scientific evidence from the literature on the use of lurasidone in children and adolescents and to provide recommendations for clinical management and future research.
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Costanza Giacomini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania. Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva. Switzerland
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania. Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
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Tang CH, Lai YC, Chen YC, Chang SM, Chen YH, Liao JY, Wang YC, Ho CH, Chen PJ. Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158118. [PMID: 34360410 PMCID: PMC8345939 DOI: 10.3390/ijerph18158118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
Background: People with dementia are a high-risk group for hip fractures. Although the increased risk of hip fractures associated with antipsychotic drugs (APD) is found in older populations, little is known about the risk for people with dementia living in Asia. We aimed to investigate the association between hip fractures and the characteristics of APD use in patients with dementia. Methods: A nested case-control analysis was conducted on a nationwide cohort in Taiwan. People with diagnoses of dementia during 2003–2012 were identified. Conditional logistic regression analysis was performed, and adjusted odds ratios (aORs) were calculated with a 95% confidence interval (CI) to estimate the risk of hip fractures. Results: APD use was associated with an increased risk of hip fractures in patients with dementia; current use or combined use of first and second generations of APDs had even higher risks. Regarding the duration of APD use, a U-shape curve of hip fracture risk was noted, and the risk peaked during 0–15 days and >215 days of exposure (aOR = 1.46, 95% CI 1.37–1.57; aOR = 1.47, 95% CI 1.37–1.58; respectively). Considering the doses of APDs, the hip fracture risk was significantly increased with all four levels of the cumulative doses and average daily doses and peaked in the group with the highest average daily dose. Conclusions: The findings suggest that caution must be taken when initiating APD use in patients with dementia, even in a small dose, and mixed types of APD prescriptions should be administered with care. Furthermore, frequent evaluation of the possibility of tapering or withdrawal of the medication is necessary, as the risk does not attenuate after long-term use.
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Affiliation(s)
- Chia-Hung Tang
- Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan 700, Taiwan;
| | - Yi-Chen Lai
- Department of Emergency Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan;
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan;
| | - Shun-Min Chang
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan;
| | - Yu-Han Chen
- Department of Family Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan;
| | - Jung-Yu Liao
- Department of Public Health, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Yi-Chi Wang
- Department of Family Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan;
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan;
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan 710, Taiwan
- Correspondence: (C.-H.H.); or (P.-J.C.); Tel.: +44-207-679-9713 (P.-J.C.)
| | - Ping-Jen Chen
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (C.-H.H.); or (P.-J.C.); Tel.: +44-207-679-9713 (P.-J.C.)
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Tasaki M, Yasui-Furukori N, Yokoyama S, Shinozaki M, Sugawara N, Shimoda K. Hypoprolactinemia and hyperprolactinemia in male schizophrenia patients treated with aripiprazole and risperidone and their relationships with testosterone levels. Neuropsychopharmacol Rep 2021; 41:379-384. [PMID: 34189861 PMCID: PMC8411320 DOI: 10.1002/npr2.12190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/29/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
Aim Several reports have shown that risperidone increases prolactin concentrations, while aripiprazole decreases prolactin concentrations. The frequency of abnormal prolactin concentrations in patients with schizophrenia receiving these drugs is still unknown. Furthermore, although hyperprolactinemia leads to sexual dysfunction, the relationship between hyperprolactinemia and testosterone, which may be directly related to male sexual function, is not well understood. Methods The subjects were 94 male schizophrenia outpatients receiving risperidone or paliperidone (risperidone group) and 83 male schizophrenia outpatients receiving aripiprazole. We measured the serum prolactin and total and free testosterone concentrations. We compared the prolactin and testosterone levels in patients receiving risperidone or paliperidone and patients receiving aripiprazole. Results The average serum prolactin concentration was 27.5 ± 13.1 ng/mL for the risperidone group and 3.9 ± 3.5 ng/mL for the aripiprazole group, and the concentrations were significantly different (P < .001). Hypoprolactinemia was observed in 75% of the aripiprazole group and hyperprolactinemia in 65% of the risperidone group. A positive correlation between prolactin levels and the risperidone daily dose was found, whereas a negative correlation between prolactin levels and the aripiprazole daily dose was observed. In the risperidone group, total testosterone concentrations were correlated with age, while free testosterone concentrations were inversely correlated with age and prolactin levels. Conclusion We found very common hyperprolactinemia and hypoprolactinemia in the risperidone or paliperidone group and aripiprazole group, respectively. Testosterone concentrations were associated with elevated prolactin levels in patients receiving risperidone or paliperidone. Further studies are needed to determine the clinical relevance of abnormal prolactin concentrations in male and female patients with schizophrenia. There were very common hyperprolactinemia and hypoprolactinemia in the risperidone group and aripiprazole group, respectively. Free testosterone concentrations were associated with elevated prolactin levels in patients receiving risperidone or paliperidone.![]()
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Affiliation(s)
- Minami Tasaki
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Shimotuga, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Shimotuga, Japan.,Department of Neuropsychiatry, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan
| | - Saaya Yokoyama
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Shimotuga, Japan
| | - Masataka Shinozaki
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Shimotuga, Japan
| | - Norio Sugawara
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Shimotuga, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Shimotuga, Japan
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Chen Y, Zhang Y, Fan K, Xu W, Teng C, Wang S, Tang W, Zhu X. Association between gonadal hormones and osteoporosis in schizophrenia patients undergoing risperidone monotherapy: a cross-sectional study. PeerJ 2021; 9:e11332. [PMID: 33987015 PMCID: PMC8086585 DOI: 10.7717/peerj.11332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/01/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Patients with schizophrenia are at increased risk of osteoporosis. This study first determined the osteoporosis rate in patients with schizophrenia and then then explored the association between serum gonadal hormone levels and osteoporosis among these patients. Methods A total of 250 patients with schizophrenia and 288 healthy controls were recruited. Osteoporosis was defined by decreased bone mineral density (BMD) of the calcaneus. Serum fasting levels of gonadal hormones (prolactin, estradiol, testosterone, progesterone, follicle-stimulating hormone, luteinizing hormone) were determined. The relationship between osteoporosis and hormone levels was statistically analyzed by binary logistic regression analysis. Results Our results showed that patients with schizophrenia had a markedly higher rate of osteoporosis (24.4% vs. 10.1%) than healthy controls (P < 0.001). Patients with osteoporosis were older, had a longer disease course, and had a lower body mass index (BMI) than patients without osteoporosis (all P < 0.05). Regarding gonadal hormones, we found significantly higher prolactin, but lower estradiol, levels in patients with osteoporosis than in those without osteoporosis (both P < 0.05). The regression analysis revealed that PRL (OR = 1.1, 95% CI [1.08–1.15], P < 0.001) and E2 level (OR = 0.9, 95%CI [0.96–0.99], P = 0.011) were significantly associated with osteoporosis in patients with schizophrenia. Conclusion Our results indicate that patients with schizophrenia who are being treated with risperidone have a high rate of osteoporosis. Increased prolactin and reduced estradiol levels are significantly associated with osteoporosis.
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Affiliation(s)
- Yi Chen
- Department of Psychiatry, The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yaoyao Zhang
- Department of Psychiatry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kaili Fan
- Department of Psychiatry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weiqian Xu
- Department of Psychiatry, The Second People's Hospital of TaiZhou, Taizhou, Zhejiang, China
| | - Chao Teng
- Department of Psychiatry, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shuangshuang Wang
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wei Tang
- Department of Psychiatry, The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Psychiatry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
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Besag FMC, Vasey MJ, Salim I. Is Adjunct Aripiprazole Effective in Treating Hyperprolactinemia Induced by Psychotropic Medication? A Narrative Review. CNS Drugs 2021; 35:507-526. [PMID: 33880739 DOI: 10.1007/s40263-021-00812-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/10/2023]
Abstract
Psychotropic medication treatment can cause elevated serum prolactin levels and hyperprolactinaemia (HPRL). Reports have suggested that aripiprazole may decrease elevated prolactin. The aim of this review was to assess evidence for the efficacy of adjunct aripiprazole in the treatment of psychotropic-induced HPRL. PubMed and Google Scholar were searched to identify randomised placebo-controlled trials (RCTs) of adjunct aripiprazole in patients with HPRL attributed to primary psychotropic medications. Data for individual patients from case studies, chart reviews and open-label studies were also identified and assessed. Six RCTs, with a total of 609 patients, met inclusion criteria. Primary psychotropics included risperidone, haloperidol, paliperidone, fluphenazine and loxapine. Reductions in prolactin from baseline, before the introduction of aripiprazole, were significantly greater for adjunct aripiprazole than for adjunct placebo in all the studies (p = 0.04 to p < 0.0001). Normalisation of serum prolactin levels was significantly more likely with adjunct aripiprazole than adjunct placebo (p = 0.028 to p < 0.001, data from three studies). Improvement or resolution of HPRL-related symptoms (galactorrhoea, oligomenorrhoea, amenorrhoea and sexual dysfunction) were reported in three studies. Prolactin levels decreased in all case reports and in both of two open-label studies; they normalised in 30/41 patients (73.2%) in case studies and 12/29 (41.4%) in the open-label studies. Adjunct aripiprazole was statistically significantly effective in treating elevated serum prolactin levels in six RCTs. Evidence from case reports and open-label studies suggests a degree of effectiveness in most patients.
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Affiliation(s)
- Frank M C Besag
- East London Foundation NHS Trust, 9 Rush Court, Bedford, MK40 3JT, UK. .,University College London, London, UK. .,King's College London, London, UK.
| | | | - Iffah Salim
- East London Foundation NHS Trust, Glen Road, Cherry Tree Way, Newham, London, E13 8SP, UK
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Genome-wide association study of antipsychotic-induced sinus bradycardia in Chinese schizophrenia patients. PLoS One 2021; 16:e0249997. [PMID: 33914752 PMCID: PMC8084176 DOI: 10.1371/journal.pone.0249997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/29/2021] [Indexed: 01/10/2023] Open
Abstract
Second-generation antipsychotics (SGAs) play a critical role in current treatment of schizophrenia (SCZ). It has been observed that sinus bradycardia, rare but in certain situations life threatening adverse drug reaction, can be induced by SGAs across different schizophrenia populations. However, the roles of genetic factors in this phenomenon have not been studied yet. In the present study, a genome-wide association study of single nucleotide polymorphisms (SNPs) was performed on Chinese Han SCZ patients to identify susceptibility loci that were associated with sinus bradycardia induced by SGAs. This study applied microarray to obtain genotype profiles of 88 Han Chinese SCZ patients. Our results found that there were no SNPs had genome-wide significant association with sinus bradycardia induced by SGAs. The top GWAS hit located in gene KIAA0247, which mainly regulated by the tumor suppressor P53 and thus plays a role in carcinogenesis based on resent research and it should not be a susceptibility locus to sinus bradycardia induced by SGAs. Using gene-set functional analysis, we tested that if top 500 SNPs mapped genes were relevant to sinus bradycardia. The result of gene prioritization analysis showed CTNNA3 was strongly correlated with sinus bradycardia, hinting it was a susceptibility gene of this ADR. Our study provides a preliminary study of genetic variants associated with sinus bradycardia induced by SGAs in Han Chinese SCZ patients. The discovery of a possible susceptibility gene shed light on further study of this adverse drug reaction in Han Chinese SCZ patients.
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Rice TR, Walther A. Male-Specific Metabolic Considerations Concerning the Prescription of Second-Generation Antipsychotics to Adolescents. J Child Adolesc Psychopharmacol 2021; 31:53-55. [PMID: 32614249 DOI: 10.1089/cap.2020.0052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: Although males and females gain comparable weight when prescribed second-generation antipsychotics (SGAs), males may be uniquely vulnerable to an array of endocrinological, inflammatory, and psychosocial adverse drug effects. Methods: This opinion piece reviews work in each of these three areas for consideration. Results: Androgens may decrease both through hypothalamic-pituitary-gonadal axis dysregulation and as a consequence of increased adiposity. Testosterone has anti-inflammatory properties, and declining levels as well as many other factors may influence overall immunological functioning. Psychosocial stressors are gender specific in obesity, and SGA-induced obesity may affect males in unique and severe ways. Conclusion: This opinion piece supports the framework of the World Federation of Societies of Biological Psychiatry's Task Force on Men's Mental Health to advocate for further studies concerning the adverse drug effects of SGAs as unique manifested in male children, adolescents, and young men.
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Affiliation(s)
- Timothy R Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andreas Walther
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
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Menard ML, Ilies D, Abadie P, Jean-Baptiste T, Choquette R, Huet AS, Ben Amor L. Monitoring of metabolic adverse events of second-generation antipsychotics in a naive paediatric population followed in mental health outpatient and inpatient clinical settings: MEMAS prospective study protocol. BMJ Open 2021; 11:e040764. [PMID: 33455928 PMCID: PMC7813300 DOI: 10.1136/bmjopen-2020-040764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Second-generation antipsychotics (SGAs) are widely used in the paediatric population. It is currently established that SGAs may induce metabolic adverse events (AEs) such as weight gain, perturbation of blood lipids or glucose with risk of potential cardiovascular morbidity and mortality. The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in children (CAMESA) has published recommendations for monitoring the metabolic AEs of SGAs. Factors that may be associated with the onset of SGA's metabolic AEs and long-term consequences are less studied in the literature. The objectives of our research are to evaluate some factors that can influence the development of the SGA's metabolic AEs and to study clinical adherence to CAMESA guidelines. METHODS AND ANALYSIS The Monitoring des Effets Métaboliques des Antipsychotiques de Seconde Génération study is a multicenter, prospective, longitudinal observational study with repeated measures of metabolic monitoring over 24 months. Two recruiting centres have been selected for patients under 18 years of age, previously naive of antipsychotics, starting an SGA or who have started an SGA for less than 4 weeks regardless of the diagnosis that motivated the prescription. Assessments are performed for anthropometric measures, blood pressure, blood tests at baseline and 1, 2, 3, 6, 9, 12 and 24 months of follow-up. ETHICS AND DISSEMINATION The study protocol was approved by the CHU Sainte-Justine's Research Ethics Board (MP-21-2016-1201) in 2016 and obtained institutional suitability for the 'Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal' Research Center in May 2018. For all participants, written consent will be obtained from parents/caregivers as well as the participant's assent in order to enable their participation in this research project. The results of this research will be published. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (number NCT04395326).
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Affiliation(s)
- Marie-Line Menard
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
| | - Drigissa Ilies
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada
- Child and Adolescents Psychiatry Division, Department of Psychiatry, Rivière-des-Prairies Mental Health Hospital, CIUSSS-NIM, Montréal, Québec, Canada
| | - Pascale Abadie
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada
- Child and Adolescents Psychiatry Division, Department of Psychiatry, Rivière-des-Prairies Mental Health Hospital, CIUSSS-NIM, Montréal, Québec, Canada
| | | | - Rachel Choquette
- Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
| | - Anne-Sophie Huet
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada
| | - Leila Ben Amor
- University Department of Child and Adolescent Psychiatry, CHU Sainte-Justine, Montreal, Québec, Canada
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Zhang L, Qi H, Xie YY, Zheng W, Liu XH, Cai DB, Ng CH, Ungvari GS, Xiang YT. Efficacy and Safety of Adjunctive Aripiprazole, Metformin, and Paeoniae-Glycyrrhiza Decoction for Antipsychotic-Induced Hyperprolactinemia: A Network Meta-Analysis of Randomized Controlled Trials. Front Psychiatry 2021; 12:728204. [PMID: 34658963 PMCID: PMC8511431 DOI: 10.3389/fpsyt.2021.728204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022] Open
Abstract
Aripiprazole, metformin, and paeoniae-glycyrrhiza decoction (PGD) have been widely used as adjunctive treatments to reduce antipsychotic (AP)-induced hyperprolactinemia in patients with schizophrenia. However, the comparative efficacy and safety of these medications have not been previously studied. A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety between aripiprazole, metformin, and PGD as adjunctive medications in reducing AP-induced hyperprolactinemia in schizophrenia. Both international (PubMed, PsycINFO, EMBASE, and Cochrane Library databases) and Chinese (WanFang, Chinese Biomedical, and Chinese National Knowledge infrastructure) databases were searched from their inception until January 3, 2019. Data were analyzed using the Bayesian Markov Chain Monte Carlo simulations with the WinBUGS software. A total of 62 RCTs with 5,550 participants were included in the meta-analysis. Of the nine groups of treatments included, adjunctive aripiprazole (<5 mg/day) was associated with the most significant reduction in prolactin levels compared to placebo (posterior MD = -65.52, 95% CI = -104.91, -24.08) and the other eight treatment groups. Moreover, adjunctive PGD (>1:1) was associated with the lowest rate of all-cause discontinuation compared to placebo (posterior odds ratio = 0.45, 95% CI = 0.10, 3.13) and adjunctive aripiprazole (>10 mg/day) was associated with fewer total adverse drug events than placebo (posterior OR = 0.93, 95% CI = 0.65, 1.77) and other eight treatment groups. In addition, when risperidone, amisulpride, and olanzapine were the primary AP medications, adjunctive paeoniae/glycyrrhiza = 1:1, aripiprazole <5 mg/day, and aripiprazole >10 mg/day were the most effective treatments in reducing the prolactin levels, respectively. Adjunctive aripiprazole, metformin, and PGD showed beneficial effects in reducing AP-induced hyperprolactinemia in schizophrenia, with aripiprazole (<5 mg/day) being the most effective one.
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Affiliation(s)
- Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Han Qi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yun-Yi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiao-Hui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia.,Section of Psychiatry, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR China
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Abstract
Physicians who treat patients with schizophrenia frequently encounter complex clinical situations not fully addressed by published treatment guidelines. Some of these situations lead to antipsychotic polypharmacy, often prescribed when clinical and social obstacles prevent access to clozapine and patients have had suboptimal responses to nonclozapine monotherapy. We offer our perspective on the place of antipsychotic polypharmacy in the current treatment guidelines for patients with schizophrenia. We summarize data on the prevalence of antipsychotic polypharmacy and describe common clinical situations in which this practice is encountered, along with the pharmacological underpinnings of this practice. We briefly review evidence on common risks of antipsychotic polypharmacy and describe the limited evidence for the possible benefits of such practice. Moreover, we take a look at alternative antipsychotic augmentation strategies that address all domains of psychosis.
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Affiliation(s)
- Adriana Foster
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami (Foster, King); Citrus Health Network Inc., Hialeah, Florida (Foster, King)
| | - Jordanne King
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami (Foster, King); Citrus Health Network Inc., Hialeah, Florida (Foster, King)
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Hicks BM, Busby J, Mills K, O'Neil FA, McIntosh SA, Zhang SD, Liberante FG, Cardwell CR. Post-diagnostic antipsychotic use and cancer mortality: a population based cohort study. BMC Cancer 2020; 20:804. [PMID: 32831062 PMCID: PMC7446212 DOI: 10.1186/s12885-020-07320-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Many antipsychotics elevate prolactin, a hormone implicated in breast cancer aetiology however no studies have investigated antipsychotic use in patients with breast cancer. This study investigated if antipsychotic use is associated with an increased risk of cancer-specific mortality among breast cancer patients. METHODS A cohort of 23,695 women newly diagnosed with a primary breast cancer between 1st January 1998 and 31st December 2012 was identified from the UK Clinical Practice Research Datalink linked to English cancer-registries and followed for until 30th September 2015. Time-dependent Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of breast cancer-specific mortality comparing use of antipsychotics with non-use, overall, and by prolactin elevating activitiy. Analyses were repeated restricting to patients with a history of severe mental illness to control for potential confounding by indication. RESULTS In total 848 patients were prescribed an antipsychotic and of which 162 died due to their breast cancer. Compared with non-use, antipsychotic use was associated with an increased risk of breast-cancer specific mortality (HR 2.25, 95%CI 1.90-2.67), but this did not follow a dose response relation. Restricting the cohort to patients with severe mental illness attenuated the association between antipsychotic use and breast cancer-specific mortality (HR 1.11, 95%CI 0.58-2.14). CONCLUSIONS In this population-based cohort of breast cancer patients, while the use of antipsychotics was associated with increased breast cancer-specific mortality, there was a lack of a dose response, and importantly null associations were observed in patients with severe mental illness, suggesting the observed association is likely a result of confounding by indication. This study provides an exemplar of confounding by indication, highlighting the importance of consideration of this important bias in studies of drug effects in cancer patients.
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Affiliation(s)
- Blánaid M Hicks
- Centre for Public Health, ICSB, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland.
| | - John Busby
- Centre for Public Health, ICSB, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland
| | - Ken Mills
- Centre for Cancer Research and Cell Biology (CCRCB), Queen's University Belfast, Belfast, Northern Ireland
| | - Francis A O'Neil
- Centre for Public Health, ICSB, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland
| | - Stuart A McIntosh
- Centre for Cancer Research and Cell Biology (CCRCB), Queen's University Belfast, Belfast, Northern Ireland
- Breast Surgery Department, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Shu-Dong Zhang
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, University of Ulster, C-TRIC Building, Altnagelvin Area Hospital, Londonderry, UK
| | - Fabio Giuseppe Liberante
- Centre for Cancer Research and Cell Biology (CCRCB), Queen's University Belfast, Belfast, Northern Ireland
- Ludwig Boltzmann Institute of Cancer Research, Vienna, Austria
| | - Chris R Cardwell
- Centre for Public Health, ICSB, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland
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Chiang TI, Lane HY, Lin CH. D2 dopamine receptor gene (DRD2) Taq1A (rs1800497) affects bone density. Sci Rep 2020; 10:13236. [PMID: 32764574 PMCID: PMC7414035 DOI: 10.1038/s41598-020-70262-0] [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] [Received: 09/04/2019] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia patients are susceptible to lower bone mineral density (BMD). However, studies exploring the genetic effects are lacking. Genes that affect the activity of antipsychotics may be associated with BMD, particularly in patients receiving long-term antipsychotic treatment. We aimed to explore the relationship between the dopamine receptor D2 (DRD2) gene Taq1A (rs1800497) polymorphism and BMD in chronic schizophrenia patients. We recruited schizophrenia patients (n = 47) and healthy controls (n = 39) from a medical center in Taiwan and collected data that may affect BMD. Patients’ BMD was measured by dual-energy X-ray absorptiometer (DEXA). DRD2 rs1800497 was genotyped through polymerase chain reaction–Restriction Fragment Length Polymorphism (PCR–RFLP). Among all participants, subjects with DRD2 rs1800497(T;T) allele had lower DEXA T score and DEXA Z score compared to those with rs1800497(C;T) and rs1800497(C;C) alleles (p = 0.008, 0.003, respectively). In schizophrenia patients, subjects with rs1800497(T;T) allele also had lower DEXA Z score compared to the other two alleles (p = 0.045). Our findings suggest that individuals with the DRD2 rs1800497(T;T) had lower BMD than those with the rs1800497(C;T) and rs1800497(C;C) genotypes. Therefore, genes should be considered as one of the risk factors of lower BMD.
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Affiliation(s)
- Ting-I Chiang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong District, Kaohsiung City, 833, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Hsueh-Shih Rd., North Dist., Taichung City, 404, Taiwan. .,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan. .,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
| | - Chieh-Hsin Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong District, Kaohsiung City, 833, Taiwan. .,Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Hsueh-Shih Rd., North Dist., Taichung City, 404, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Fedorenko OY, Paderina DZ, Loonen AJM, Pozhidaev IV, Boiko AS, Kornetova EG, Bokhan NA, Wilffert B, Ivanova SA. Association of ANKK1 polymorphism with antipsychotic-induced hyperprolactinemia. Hum Psychopharmacol 2020; 35:e2737. [PMID: 32383805 PMCID: PMC7507142 DOI: 10.1002/hup.2737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Schizophrenia is a severe highly heritable mental disorder. Genetic polymorphisms of dopaminergic pathways are related to pathogenesis of drug response. Hyperprolactinemia (HPRL), a common adverse effect of antipsychotics, is attributed to blockade of dopamine D2 receptors. Ankyrin Repeat and Kinase Domain containing 1 (ANKK1) gene is closely related to Dopamine Receptor D2 type (DRD2) gene functioning. We examined whether the functional polymorphism rs2734849 in the ANKK1 gene is associated with antipsychotic-induced HPRL. METHODS We recruited 446 patients with schizophrenia from among the Russian population of the Siberian region. The polymorphism rs2734849 in the ANKK1 gene was genotyped with The MassARRAY® Analyzer 4 by Agena Bioscience™, using the kit SEQUENOM Consumables iPLEXGold 384. Genotype and allele frequencies were compared between groups of schizophrenia patients with and without HPRL using the χ2 test. RESULTS A comparison between schizophrenia patients with and without HPRL revealed significantly higher frequency of the C allele of the polymorphic variant rs2734849 in the ANKK1 gene in patients with HPRL as compared to the patients without it (χ2 = 3.70; p = .05; odds ratio [OR] = 1.30 [0.99-1.69]). CONCLUSION The functional polymorphism rs2734849 in the ANKK1 gene was associated with HPRL in patients with schizophrenia.
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Affiliation(s)
- Olga Yu. Fedorenko
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Division for Control and Diagnostics, School of Non‐Destructive Testing and SecurityNational Research Tomsk Polytechnic UniversityTomskRussia
| | - Diana Z. Paderina
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Department of Cytology and Genetics, National Research Tomsk State UniversityTomskRussia
| | - Anton J. M. Loonen
- PharmacoTherapy, ‐Epidemiology and ‐Economics, Groningen Research Institute of PharmacyUniversity of GroningenGroningenThe Netherlands,Policy Office for Quality and Innovation of Care (BZI), GGZ Westelijk Noord‐BrabantHalsterenThe Netherlands
| | - Ivan V. Pozhidaev
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Department of Cytology and Genetics, National Research Tomsk State UniversityTomskRussia
| | - Anastasiia S. Boiko
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia
| | - Elena G. Kornetova
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Hospital, Siberian State Medical UniversityTomskRussia
| | - Nikolay A. Bokhan
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Department of Psychotherapy and Psychological Counseling, National Research Tomsk State UniversityTomskRussia,Department of Psychiatry, Addictology and Psychotherapy, Siberian State Medical UniversityTomskRussia
| | - Bob Wilffert
- PharmacoTherapy, ‐Epidemiology and ‐Economics, Groningen Research Institute of PharmacyUniversity of GroningenGroningenThe Netherlands,Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Svetlana A. Ivanova
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Division for Control and Diagnostics, School of Non‐Destructive Testing and SecurityNational Research Tomsk Polytechnic UniversityTomskRussia,Department of Psychiatry, Addictology and Psychotherapy, Siberian State Medical UniversityTomskRussia
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Atkin-Smith GK, Duan M, Zanker DJ, Loh L, Nguyen THO, Koutsakos M, Nguyen T, Jiang X, Carrera J, Phan TK, Liu C, Paone S, Oveissi S, Hodge AL, Baxter AA, Kedzierska K, Mackenzie JM, Hulett MD, Bilsel P, Chen W, Poon IKH. Monocyte apoptotic bodies are vehicles for influenza A virus propagation. Commun Biol 2020; 3:223. [PMID: 32385344 PMCID: PMC7210108 DOI: 10.1038/s42003-020-0955-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/20/2020] [Indexed: 02/03/2023] Open
Abstract
The disassembly of apoptotic cells into small membrane-bound vesicles termed apoptotic bodies (ApoBDs) is a hallmark of apoptosis; however, the functional significance of this process is not well defined. We recently discovered a new membrane protrusion (termed beaded apoptopodia) generated by apoptotic monocytes which fragments to release an abundance of ApoBDs. To investigate the function of apoptotic monocyte disassembly, we used influenza A virus (IAV) infection as a proof-of-concept model, as IAV commonly infects monocytes in physiological settings. We show that ApoBDs generated from IAV-infected monocytes contained IAV mRNA, protein and virions and consequently, could facilitate viral propagation in vitro and in vivo, and induce a robust antiviral immune response. We also identified an antipsychotic, Haloperidol, as an unexpected inhibitor of monocyte cell disassembly which could impair ApoBD-mediated viral propagation under in vitro conditions. Together, this study reveals a previously unrecognised function of apoptotic monocyte disassembly in the pathogenesis of IAV infections.
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Affiliation(s)
- Georgia K Atkin-Smith
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Mubing Duan
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Damien J Zanker
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Liyen Loh
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, 3010, Australia
| | - Thi H O Nguyen
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, 3010, Australia
| | - Marios Koutsakos
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, 3010, Australia
| | - Tien Nguyen
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Xiangrui Jiang
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Julio Carrera
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, 3010, Australia
| | - Thanh Kha Phan
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Chuanxin Liu
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Stephanie Paone
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sara Oveissi
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Amy L Hodge
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Amy A Baxter
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, 3010, Australia
| | - Jason M Mackenzie
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, 3010, Australia
| | - Mark D Hulett
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Pamuk Bilsel
- FluGen, 597 Science Drive, Madison, WI, 53711, USA
| | - Weisan Chen
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Ivan K H Poon
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia.
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Mattingly GW, Haddad PM, Tocco M, Xu J, Phillips D, Pikalov A, Loebel A. Switching to Lurasidone following 12 months of treatment with Risperidone: results of a 6-month, open-label study. BMC Psychiatry 2020; 20:199. [PMID: 32370778 PMCID: PMC7201608 DOI: 10.1186/s12888-020-02523-1] [Citation(s) in RCA: 9] [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: 09/05/2019] [Accepted: 02/28/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Patients with a diagnosis of schizophrenia are at an increased risk for developing metabolic syndrome, which is associated with greater cardiovascular morbidity and mortality. Treatment with some commonly used antipsychotic medications may increase the risk of developing metabolic syndrome. The aim of the study was to evaluate the safety of lurasidone in patients who continued lurasidone or switched from risperidone to lurasidone. A secondary aim was assessment of the effect of long-term lurasidone on the Positive and Negative Syndrome Scale (PANSS). METHODS The treatment sample in the current study consisted of clinically stable patients with schizophrenia (N = 223) who had completed a 12-month, double-blind study of lurasidone vs. risperidone. In the current extension study, all patients received 6 months of open-label treatment with lurasidone, either continuing lurasidone assigned during the preceding double-blind trial, or switching from double-blind risperidone to lurasidone. Safety and tolerability parameters included body weight, prolactin, and metabolic laboratory tests. RESULTS Six months of OL treatment with lurasidone was generally well-tolerated, with a low incidence of parkinsonism (4.5%) and akathisia (3.1%). Overall, few adverse events were rated as severe (4.9%), and discontinuation due to an adverse event was low in the lurasidone continuation vs. risperidone switch groups (3.7% vs. 6.9%). In the lurasidone continuation versus risperidone switch groups, change from OL baseline to 6-month endpoint (observed case) was observed in mean body weight (- 0.6 vs. -2.6 kg), median total cholesterol (- 4.0 vs. + 4.5 mg/dL), triglycerides (- 4.5 vs. -5.5 mg/dL), glucose (0.0 vs. -3.0 mg/dL) and prolactin (males, + 0.15 vs. -11.2 ng/mL; females, + 1.3 vs. -30.8 ng/mL). Improvement in PANSS total score was maintained, from OL baseline to endpoint in the continuation vs. switch groups (+ 1.0 vs. -1.0; OC). CONCLUSIONS In this 6-month extension study, lurasidone treatment was generally well-tolerated and associated with minimal effects on weight, metabolic parameters, and prolactin levels. Patients who switched from risperidone to lurasidone experienced reductions in weight, metabolic parameters and prolactin levels commensurate with increases in these safety parameters experienced during the previous 12 months of treatment with risperidone. TRIAL REGISTRATION ClinicalTrials.gov NCT00641745 (Date of Registration: March 24, 2008).
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Affiliation(s)
- Greg W. Mattingly
- grid.4367.60000 0001 2355 7002Washington University School of Medicine, St. Louis, MO USA
| | - Peter M. Haddad
- grid.413548.f0000 0004 0571 546XHamad Medical Corporation, Doha, Qatar ,grid.412603.20000 0004 0634 1084Clinical Professor of Psychiatry, Qatar University, Doha, Qatar ,grid.5379.80000000121662407Honorary Professor of Psychiatry, University of Manchester, Manchester, UK ,grid.451052.70000 0004 0581 2008Honorary Consultant Psychiatrist, GMMH NHS Foundation Trust, Manchester, UK
| | - Michael Tocco
- Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA, 01752, USA.
| | - Jane Xu
- grid.419756.8Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA 01752 USA
| | - Debra Phillips
- grid.419756.8Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA 01752 USA
| | - Andrei Pikalov
- grid.419756.8Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA 01752 USA
| | - Antony Loebel
- grid.419756.8Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA 01752 USA
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Arakawa K, Maehara S. Combination of the phosphodiesterase 10A inhibitor, MR1916 with risperidone shows additive antipsychotic-like effects without affecting cognitive enhancement and cataleptic effects in rats. Neuropsychopharmacol Rep 2020; 40:190-195. [PMID: 32351052 PMCID: PMC7722671 DOI: 10.1002/npr2.12108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 11/07/2022] Open
Abstract
AIM Phosphodiesterase 10A (PDE10A) inhibitors not only have antipsychotic-like effects but also cause cognitive enhancement without affecting extrapyramidal side effects in rodents, suggesting that PDE10A may be a novel approach for the treatment of schizophrenia. However, how a combination of PDE10A inhibitor with a currently available antipsychotic drug, risperidone contributes to the effect of each compound in rats remains unclear. The purpose of the present study was to examine the combination effects of MR1916 with a currently available antipsychotic drug, risperidone, in rats. METHODS We examined the combination effects of the PDE10A inhibitor, MR1916 with risperidone on conditioned avoidance response (CAR) to assess antipsychotic-like effects in rats. We also examined them on catalepsy as extrapyramidal side effects and novel object recognition test in cognitive functions in rats. RESULTS MR1916 (0.025-0.2 mg/kg, p.o.) and risperidone (0.75-6 mg/kg, p.o.) alone attenuated the CAR in a dose-dependent manner. The combination of MR1916 (0.025 mg/kg, p.o.) with risperidone (0.75 mg/kg, p.o.) significantly enhanced the attenuation of CAR without increasing the escape failure response. At the same dosage, the cataleptic effects were not enhanced by combined treatment of MR1916 with risperidone. Furthermore, the enhancement of object recognition memory induced by MR1916 (0.3 mg/kg, p.o.) was not affected by the combination with risperidone (0.75 mg/kg, p.o.). CONCLUSION The combination of MR1916 with risperidone may have additive antipsychotic-like effects without affecting extrapyramidal side effects, and the cognitive-enhancing effect of MR1916 may not be interfered with the addition of risperidone.
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Affiliation(s)
- Keita Arakawa
- Biology Laboratory, Discovery Research, Mochida Pharmaceutical Co., Ltd., Gotemba, Japan
| | - Shunsuke Maehara
- Biology Laboratory, Discovery Research, Mochida Pharmaceutical Co., Ltd., Gotemba, Japan
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Cytochrome P450 (CYP450) Interactions Involving Atypical Antipsychotics are Common in Community-Dwelling Older Adults Treated for Behavioral and Psychological Symptoms of Dementia. PHARMACY 2020; 8:pharmacy8020063. [PMID: 32276526 PMCID: PMC7355621 DOI: 10.3390/pharmacy8020063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
Treatment of behavioral and psychological symptoms of dementia (BPSD) and comorbidities often necessitates the concomitant use of antipsychotics and non-antipsychotic drugs, thereby potentiating the risk for drug–drug interactions (DDIs). The primary objective of our study was to identify potentially clinically relevant cytochrome P450 (CYP)-mediated DDIs involving antipsychotics among participants enrolled in the Program of All-Inclusive Care for the Elderly (PACE) with BPSD. Additionally, we wanted to determine the prevalence of antipsychotic use in this population. The study included 10,001 PACE participants. The practice setting used a proprietary clinical decision support system (CDSS) to analyze simultaneous multidrug interactions. A retrospective analysis of pharmacy claims data was conducted to identify DDIs involving antipsychotics prescribed for BPSD, using snapshots of medication profiles paired with the CDSS. Of the participants who met inclusion criteria, 1190 (11.9%) were prescribed an antipsychotic; of those, 1071 (90.0%) were prescribed an atypical antipsychotic. Aripiprazole commonly caused (being a perpetrator drug 94.6% of the time) potential DDIs with antidepressants (e.g., duloxetine, venlafaxine, mirtazapine), opioids (e.g., hydrocodone, oxycodone, tramadol) and metoprolol via the CYP2D6 isoform. Risperidone commonly caused (85.7%) potential DDIs with donepezil, lamotrigine and trazodone via the CYP3A4 isoform. Quetiapine exclusively suffered (100%) from potential DDIs with amlodipine, buspirone, omeprazole or topiramate via the CYP3A4 isoform. Antipsychotics are commonly prescribed to PACE participants for BPSD treatment and they may interact with other drugs used to treat comorbidities. A thorough review of concomitant medications will help mitigate the likelihood of potentially dangerous CYP-mediated DDIs involving antipsychotics.
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