Abstract
BackgroundEndocrine function in psychiatric patients may be affected by mental disorder itself as well as by antipsychotic medications.The aim of this naturalistic observational study was to determine if treatment of acute psychotic episode with antipsychotic medication affects thyroid axis hormone concentrations and if such changes are associated with symptomatic improvement.MethodsEighty six adult acute psychotic patients, consecutively admitted to a mental hospital, were recruited for the study. All patients were physically healthy and without thyroid disease. During the hospitalization period all study patients received treatment with antipsychotic medication according to clinical need. Severity of the psychotic episode was evaluated using the Brief Psychiatric Rating Scale (BPRS) and venous blood samples were drawn for analysis of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) concentrations on the day of admission and on the day of discharge from the hospital.ResultsAntipsychotic drug treatment was associated with decrease of mean FT3 (p < 0.001) and FT4 (p = 0.002) concentrations; and with increase of mean TSH (p = 0.016) concentrations. Changes in thyroid hormone concentrations were mostly predicted by baseline hormone concentrations. Individual changes were not limited to decrease in high hormone concentrations; in patients who had low FT3 or FT4 concentrations, treatment resulted in increase in concentrations. Such an increase was established in one-quarter of patients for FT3 concentrations and in one-third of patients for FT4 concentrations. Fall in FT4 concentrations negatively correlated with the improvement in the BPRS score (r = −0.235, p = 0.023).ConclusionsThe study indicates that antipsychotic treatment resulted in a decrease in mean FT3 concentrations and in an increase in mean TSH concentrations after recovery from acute psychosis. Symptomatic improvement was less evident in patients who experienced a decrease in FT4 concentrations.Trial registrationEudraCT No.2007-001541-18
Highlights
Endocrine function in psychiatric patients may be affected by mental disorder itself as well as by antipsychotic medications
We confirmed that antipsychotic treatment results in recuperation of euthyroid hyperthyroxinemia that was present at the time of admission
We think that in the drug resistant patients studied by Kelly and Conley [24] sluggishness of thyroid axis function to respond to antipsychotic drugs may have been an endocrine expression of treatment resistance
Summary
Endocrine function in psychiatric patients may be affected by mental disorder itself as well as by antipsychotic medications The aim of this naturalistic observational study was to determine if treatment of acute psychotic episode with antipsychotic medication affects thyroid axis hormone concentrations and if such changes are associated with symptomatic improvement. In our recent cross-sectional study [11], we have confirmed that patients with acute psychosis upon admission to the hospital had elevated T4 concentrations, especially patients who were free from treatment with antipsychotics. This syndrome of elevated T4 concentrations in acutely psychotic patients is coined as transient hyperthyroxinemia because it usually resolves during recovery from a psychotic episode [12,13]. The majority of schizophrenic patients appear to be euthyroid with normal thyroid stimulating hormone (TSH) concentration and normal TSH response to thyrotropin-releasing hormone (TRH) challenge [14,15]
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