Melkersson Kristina
Sollentuna Psychiatric Polyclinic and the Department of Molecular Medicine, Karolinska Institute, Stockholm, Sweden.
J Clin Psychiatry. 2005 Jun;66(6):761-7. doi: 10.4088/jcp.v66n0614.
The aim of this cross-sectional study was to investigate the degree and frequency of prolactin (PRL) elevation and related symptoms in patients treated with 3 different atypical antipsychotics: clozapine, olanzapine, and risperidone.
Twenty-eight patients receiving clozapine, 29 patients receiving olanzapine, and 18 patients receiving risperidone (all meeting DSM-IV criteria for schizophrenia, schizophreni-form disorder, or schizoaffective disorder) were studied. The median daily dose was 400 mg of clozapine, 10 mg of olanzapine, and 3 mg of risperidone. Fasting morning blood samples were analyzed for PRL, and the occurrence of hyper-prolactinemic symptoms in the patients was evaluated.
Elevated PRL levels were found in 16 (89%) of the patients receiving risperidone and in 7 (24%) of the patients receiving olanzapine, but in none of the patients receiving clozapine. In addition, there was a significant difference in median PRL level among the treatment groups (p < .0001), in that the PRL level was higher both in the patients treated with risperidone and in the patients treated with olanzapine, compared to those treated with clozapine. Moreover, hyperpro-lactinemic symptoms-menstrual disturbances, galactorrhea, impotence, oligospermia, and decreased libido-were reported in 8 (44%) of the risperidone-treated patients and in 1 (3%) of the olanzapine-treated patients, but in none of the clozapine-treated patients.
Treatment with risperidone was frequently associated with hyperprolactinemia and related symptoms, whereas the occurrence of PRL elevation and related symptoms was modest in patients receiving olanzapine and nonexistent in those receiving clozapine. Thus, atypical anti-psychotics in therapeutic doses differ with regard to effect on PRL secretion.
本横断面研究旨在调查使用三种不同非典型抗精神病药物（氯氮平、奥氮平和利培酮）治疗的患者中催乳素（PRL）升高的程度和频率以及相关症状。
对28例接受氯氮平治疗的患者、29例接受奥氮平治疗的患者和18例接受利培酮治疗的患者（均符合精神分裂症、分裂样障碍或分裂情感性障碍的DSM-IV标准）进行研究。氯氮平的日均剂量中位数为400毫克，奥氮平为10毫克，利培酮为3毫克。分析空腹晨尿样本中的PRL，并评估患者中高催乳素血症症状的发生情况。
接受利培酮治疗的患者中有16例（89%）PRL水平升高，接受奥氮平治疗的患者中有7例（24%）PRL水平升高，但接受氯氮平治疗的患者中无一例PRL水平升高。此外，各治疗组之间的PRL中位数水平存在显著差异（p <.0001），即与接受氯氮平治疗的患者相比，接受利培酮治疗的患者和接受奥氮平治疗的患者的PRL水平均更高。此外，接受利培酮治疗的患者中有8例（44%）报告有高催乳素血症症状——月经紊乱、溢乳、阳痿、少精子症和性欲减退，接受奥氮平治疗的患者中有1例（3%）报告有此类症状，但接受氯氮平治疗的患者中无一例报告有此类症状。
利培酮治疗常与高催乳素血症及相关症状相关，而接受奥氮平治疗的患者中PRL升高及相关症状的发生率适中，接受氯氮平治疗的患者中则不存在此类情况。因此，治疗剂量的非典型抗精神病药物对PRL分泌的影响有所不同。
