Psychiatry Research 226 (2015) 525
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Letter to the Editor
Hyperprolactinaemia: Psychological aspects and menstrual attitudes of women with schizophrenia To the Editors: Hyperprolactinemia is one of the most frequent consequences of antipsychotic medication, and it can have many adverse clinical effects, like infertility, decreased libido, erectile dysfunction, menstrual irregularity, osteopenia and osteoporosis (Bargiota et al., 2013; Ajmal et al., 2014). Some researchers related high prolactin (PRL) levels to hostility, depression and anxiety (Kellner et al., 1984). We investigated the psychological effects and the attitudes towards menstruation among women who suffer from antipsychotic-induced hyperprolactinaemia. For this purpose, 263 women, diagnosed with schizophrenia (DSM-IV-TR), 18–45 years old, were examined. The patients were stable, under 2- to 8-week treatment with either risperidone or haloperidol or olanzapine or quetiapine. Determination of PRL levels was performed with the Chemiluminescence Immuno Assay (CLIA). Two self-report psychometric instruments were administered, the Symptom Checklist-90-R (SCL-90-R) questionnaire (Derogatis, 1992) and the Menstrual Attitude Questionnaire (MAQ) (Brooks-Gunn and Ruble, 1980). All data were analyzed, and the scales and subscales of the questionnaires were compared using the multivariate analysis of variance model (MANOVA). Hyperprolactinemia appeared to 139 out of 263 women (normal prolactin levelso25 μg/l, 1 μg/l¼43.478 pmol/l SI). A strong relationship was found between hyperprolactinaemia and the four antipsychotic agents (po0.0005). The elevation of PRL levels, caused by risperidone and haloperidol, depends on the dose for the ﬁrst agent and the duration of the treatment for both agents. A signiﬁcant association was found for the combined subscales of the SCL-90-R with respect to PRL, Pillai's Trace¼ 0.616, F (11.251)¼ 4.053, po0.0005, η2 ¼0.981. Univariate independent one-way analysis of variance (ANOVA) showed signiﬁcant effects for the PRL factor in respect of all subscales (po0.0005). There was a violation of symmetry between group variance for all variables, but Welch's test adjustments showed that it had no impact on the observed outcome. A signiﬁcant multivariate ﬁnding for the combined subscales of the MAQ in respect of the PRL factor (Pillai's Trace¼0.431, F (5.257)¼ 38.94, po0.0005, η2 ¼ 0.431) was also found. Univariate independent one-way analysis of variance (ANOVA) showed signiﬁcant main effects for the PRL factor in respect of all subscales (po0.0005). There was violation of symmetry between group variance for anticipation and prediction of the onset of menstruation and denial of any effect of menstruation, but Welch's test adjustments showed again that it had no impact on the observed outcome. Women who
developed high PRL levels show severe psychopathology, such as depression, paranoid ideation, anxiety, psychoticism and hostility, results that agree with previous studies (Kellner et al., 1984). In addition, they regard menstruation as a debilitating and bothersome effect, although it is considered to be a natural integral part of their lives. Women with hyperprolactinemia cannot predict the onset of menstruation, and they deny any effect of it on their bodies. In conclusion, PRL plays an important role in psychological manifestations and opinions of women with schizophrenia towards menstruation. Proper assessment and management of hyperprolactinemia and its implications could positively affect the course of illness and the lives of women with schizophrenia. References Ajmal, A., Joffe, H., Nachtigall, L.B., 2014. Psychotropic-induced hyperprolactinemia: a clinical review. Psychosomatics 55, 29–36. Bargiota, S.I., Bonotis, K., Messinis, I.E., Angelopoulos, N.V., 2013. The effects of antipsychotics on prolactin levels and women's menstruation. Schizophrenia Research and Treatment 2013, 502697. http://dx.doi.org/10.1155/2013/502697. Brooks-Gunn, J., Ruble, D.N., 1980. The menstrual attitude questionnaire. Psychosomatic Medicine 42, 503–512. Derogatis, L.R., 1992. SCL-90-R: Administration, Scoring & Procedures Manual-II for the R(evised) Version and Other Instruments of the Psychopathology Rating Scale Series. Clinical Psychometric Research, Inc., Baltimore, MD. Kellner, R., Buckman, M.T., Fava, G.A., Pathak, D., 1984. Hyperprolactinemia, distress, and hostility. American Journal of Psychiatry 141, 759–763.
Stavroula I. Bargiota n Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece 2nd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece E-mail address: [email protected]
Konstantinos Bonotis, Nikiforos V. Angelopoulos Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece Ioannis E. Messinis Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece Georgios Garyfallos 2nd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Available online 12 February 2015
n Correspondence to: 2nd Department of Psychiatry, Psychiatric Hospital of Thessaloniki, Lagkada, Stavroupoli 564 29, Thessaloniki, Greece. Tel.: þ 30 2313324192.
http://dx.doi.org/10.1016/j.psychres.2015.02.002 0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved.