Adjunctive treatment with a dopamine partial agonist, aripiprazole, for anti psychotic-induced hyperprolactinemia: A placebo-controlled trial
Adjunctive treatment with a dopamine partial agonist, aripiprazole, for anti psychotic-induced hyperprolactinemia: A placebo-controlled trial
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DOI：
10.1176/appi.ajp.2007.06071075
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发表时间：
2007-09-01
影响因子：
17.7
通讯作者：
Conley, Robert R.
中科院分区：
文献类型：
--
作者：
Shim, Joo-Cheol;Shin, Jae-Goo K.;Conley, Robert R.
目的：抗精神病药物常发生高催乳素血症及相关副作用。观察阿立哌唑辅助治疗对氟哌啶醇所致精神分裂症患者高催乳素血症的影响及对精神病理的影响。氟哌啶醇剂量固定，阿立哌唑前4周15 mg/d，后4周30 mg/d。测定血清催乳素、氟哌啶醇和阿立哌唑水平。用简明精神病评定量表(BPRS)、阴性症状评定量表、临床总体印象症状量表、Simpson-Angus评定量表、Barnes静坐不能评定量表在治疗后1、2、4、6、8周评定患者的症状和不良反应。结果：阿立哌唑治疗后患者的催乳素水平随时间延长显著降低，存在明显的时间效应和时间交互作用。在阿立哌唑组，88.5%的患者在8周时催乳素水平恢复正常，而接受安慰剂治疗的患者中这一比例为3.6%。在随机分配给阿立哌唑的11名月经紊乱的女性患者中，有7名患者在研究期间恢复了月经，而接受安慰剂治疗的患者没有一人恢复月经。氟哌啶醇血药浓度无明显变化。在BPRS、阴性症状评定量表和Simpson-Angus评定量表评分上没有显著的时间效应和时间交互作用。结论：阿立哌唑辅助治疗可以逆转女性患者的高催乳素血症，导致女性患者恢复月经，而对精神病理和锥体外系症状没有显著影响。阿立哌唑对多巴胺D-2受体的亲和力高于氟哌啶醇，这可能是观察到的原因。
Objective: Hyperprolactinemia and associated side effects often occur with antipsychotics. The authors investigated the effect of adjunctive treatment with aripiprazole on hyperprolactinemia and psychopathology in patients with schizophrenia maintained with haloperidol.Method: Fifty-six patients with hyperprolactinemia taking haloperidol were enrolled. Haloperidol dose was fixed; aripiprazole was dosed at 15 mg/day for the first 4 weeks, then 30 mg/day for the following 4 weeks. Serum prolactin, haloperidol, and aripiprazole levels were measured. Symptoms and side effects were assessed with the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms, Clinical Global Impression symptom scale, Simpson-Angus Rating Scale, and Barnes Akathisia Rating Scale at weeks 1, 2, 4, 6, and 8.Results: Prolactin levels of patients receiving aripiprazole significantly decreased over time, demonstrating a significant time effect and a time-by-group interaction. In the aripiprazole group, 88.5% of patients at week 8 had prolactin levels normalize compared to 3.6% of patients receiving placebo. Among 11 female patients with menstrual disturbances randomly assigned to aripiprazole, seven patients regained menstruation during the study, whereas none receiving placebo did. Plasma levels of haloperidol were not significantly altered. No significant time effect and time-by-group interactions on BPRS, Scale for the Assessment of Negative Symptoms, and Simpson-Angus Rating Scale scores were noted.Conclusions: Adjunctive aripiprazole treatment reversed hyperprolactinemia in both sexes, resulting in reinstatement of menstruation in female patients, with no significant effects on psychopathology and extrapyramidal symptoms. Aripiprazole has higher affinity to dopamine D-2 receptors than haloperidol, which is the likely cause of this observation.