The Relationships Between Hyperprolactinemia, Metabolic Disturbance, and Sexual Dysfunction in Patients With Schizophrenia Under Olanzapine Treatment.

Tzu-Hua Wu,Chieh-Hsin Lin,Chun-Hsin Chen,Mong-Liang Lu,Cynthia Yi-An Chen,Hsien-Yuan Lane,Kah Kheng Goh

doi:10.3389/fphar.2021.718800

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.

Highlights

Schizophrenia is a severe and chronic mental disorder that causes marked functional impairment
Sexual dysfunction was significantly related to higher prolactin levels in olanzapine-treated patients with schizophrenia, with significant differences between the sexes
Given that prolactin is under negative control by dopamine and positive control by serotonin, olanzapine has been reported to induce moderately elevated prolactin levels in patients with schizophrenia (Peuskens et al, 2014)

Summary

Introduction

Schizophrenia is a severe and chronic mental disorder that causes marked functional impairment. Antipsychotic medication is the first-line treatment for patients with schizophrenia. Antipsychotic drugs may produce unwanted side effects due to their pharmacodynamic characteristics. Antipsychotics often elevate prolactin levels by blocking dopamine D2 receptors. As a potent antagonist of dopamine D2 and serotonin 5HT2 receptors, olanzapine has fewer extrapyramidal side effects and better clinical efficacy compared with first-generation antipsychotics (Callaghan et al, 1999). Several studies reported that olanzapine was associated with elevated prolactin levels to some degree (Barata et al, 2019; Huhn et al, 2019). It is proposed that because 5-HT2 receptor stimulation can induce prolactin release, the 5-HT2 receptor antagonism of olanzapine may partially counteract its prolactin-elevating tendency through its D2 receptor antagonism (Cowen et al, 1990)

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