• Users Online: 880
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 4  |  Page : 351-354

Prolactin level in patients with first-episode psychosis


1 Resident at Student Hospital Assiut University, Assiut, Egypt
2 Department of Andrology and STDs, Faculty of Medicine, Assiut University, Assiut, Egypt
3 Department of Psychiatry in Psychology and Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
4 Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt

Date of Submission29-Sep-2019
Date of Decision05-Oct-2019
Date of Acceptance20-Oct-2019
Date of Web Publication20-Nov-2020

Correspondence Address:
Fatma A.-Z W. Abd Al-Naser
Student Hospital Assiut University, Assiut
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCMRP.JCMRP_149_19

Rights and Permissions
  Abstract 


Objective
The objective of the study was to measure serum prolactin level in first-episode psychotic patients.
Design
A cross-sectional hospital-based study.
Patients and methods
This study was carried out at the Dermatology, Venereology, and Andrology Department of Assiut University Hospital, Egypt, to measure serum prolactin level in patients with first episode psychosis who did not receive any medication yet. It was carried out on 40 first episode psychotic patients and 40 age-matched control group.
Results
The study showed significant increase in serum prolactin level in antipsychotic-free patients with first-episode psychosis.
Conclusion
Men with first episode psychosis had higher prolactin level than that of control and increased duration of untreated psychosis leads to more hyperprolactinemia.

Keywords: duration of untreated psychosis, first episode psychosis, serum prolactin


How to cite this article:
W. Abd Al-Naser FA, A.-R. Mahran AM, M. El-Beeh KA, Gaber HD. Prolactin level in patients with first-episode psychosis. J Curr Med Res Pract 2020;5:351-4

How to cite this URL:
W. Abd Al-Naser FA, A.-R. Mahran AM, M. El-Beeh KA, Gaber HD. Prolactin level in patients with first-episode psychosis. J Curr Med Res Pract [serial online] 2020 [cited 2020 Dec 1];5:351-4. Available from: http://www.jcmrp.eg.net/text.asp?2020/5/4/351/301040




  Introduction Top


First episode psychosis is defined as the first presentation of a psychotic illness which include categorical diagnosis of schizophrenia, depression with psychotic features, acute and transient psychotic disorders, schizoaffective disorders, and a manic episode with psychotic features[1].

Prolactin hormone is mainly inhibited by dopamine which is synthesized in the hypothalamus and secreted into the anterior pituitary through the portal blood, where it acts on D2 receptors[2].

Prolactin is a peptide hormone secreted mainly by prolactin-producing cells (lactotroph cells) of the anterior pituitary. It is involved in many biological functions, including reproduction, pregnancy, lactation, growth, and development[3].

Psychotic symptoms can be caused by disturbance in the balance between one or more excitatory and inhibitory factors in response to reproductive hormones to the brain and consequent compensatory remodeling of synapses in specific brain areas[4].

The severity of the disease and effect on the patients depend on the duration of untreated psychosis (DUP), which is defined as the time from onset of psychosis until the start of adequate treatment. Onset of psychosis was identified differently among researches, some researches marked the onset with appearance of frank delusions and hallucination, others included the prodroma to the definition[5],[6].


  Patients and Methods Top


Study design

The study is a cross-sectional hospital-based one. It was approved by the Institutional Ethics and Research Committee of Faculty of Medicine, Assiut University, Egypt. Patient selection was done after explanation of goals and expectations. The study participants (a 40 patients with first episode psychosis) were enrolled in the study. The nature of the study was explained to each participant and informed consent was obtained.

Patients

A total of 40 patients who were diagnosed by the Psychiatric Unit, Neurological and Psychiatric Department, Assiut University Hospital as having first-episode psychosis. Diagnosis was made based on DSM-5 the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and 40 age-matched control patients attending the andrology outpatient clinic were participated in the study. All patients were subjected to full history taking. Physical examination was done. Exclusion criteria included noncooperative patients, patients with a history of systemic disease (including hypothyroidism, diabetes mellitus or other endocrine or metabolic disorder, vascular disorders and neurological disorders) or on medical treatment, history of major head trauma or injury, and substance dependence. Serum prolactin level was measured. Venous blood samples were obtained from all participants to measure the prolactin level. The level was measured by chemiluminescence immunoassay using the IMMULITE1000 system (PRL) kit (Siemens, USA). Normal value of prolactin ranges from 2.50 to 17.0 ng/ml.


  Results Top


Our study was conducted on 40 male patients with first-episode psychosis and 40 age-matched healthy male controls. Serum prolactin level was measured for each participant.

Sociodemographic characteristics of the studied cases

The mean age of first-episode psychotic patients was 33.83 ± 9.5 years, out of the 40 patients there were 25 (62.5%) smokers while 15 (37.5%) were nonsmokers.

Laboratory investigation of the studied cases

The mean of serum prolactin level of the patients was 26.06 ± 20.7 ng/ml [Table 1].
Table 1: Comparative analysis between cases and controls

Click here to view


There was statistically significant increase in serum prolactin level in patients with first-episode psychosis than the control group.

The study included six (15%) patients with a brief psychotic disorder, 11 (27.5%) patients with first episode mania with psychotic features, 23 (57.5%) patients with schizophreniform disorder. The mean duration of the disease was 3.49 ± 0.3 months [Table 2].
Table 2: Disease characteristics of the studied cases

Click here to view


Correlation between disease duration and prolactin level among cases

The study showed statistically significant positive correlation between disease duration and serum prolactin level (P = 0.042, r = 0.277)[Figure 1].
Figure 1: Correlation between disease duration and prolactin level among cases.

Click here to view



  Discussion Top


In this study, we measured serum prolactin level among 40 patients with first-episode psychosis. It revealed a mean of 26.06 ± 20.7 ng/ml, which indicates a high level of prolactin hormone among FEP patients than the control group. This is in agreement with other studies that found higher prolactin values in patients versus controls even though the patients and control both have normal values of cortisol, TSH, and ghrelin hormones[7],[8].

There are recent reports on the increased level of prolactin hormone in patients with psychotic illness who did not yet receive any medication[7],[9],[10] also in high-risk mental state for psychosis[10],[11].

It is difficult to understand the reason for the increased level of prolactin hormone in FEP patients as it could be multifactorial. It is likely that the higher serum prolactin levels in the group of patients compared with those in healthy controls is due to stress, although serum cortisol level was the same in both groups[12]. It has been found that patients with FEP have large pituitary volume which is due to the increase in the production of adrenocorticotropic hormone and prolactin hormone[13].

Psychological distress during prodromal states and emerging psychosis can increase the release of prolactin which is regulated by the thyrotropin-releasing hormone and ghrelin that might lead to hyperprolactinemia which lead to changes in structures of pituitary volume[14],[15].

It has been estimated that hyperprolactinemia that is caused by stress response plays a role in triggering the outbreak of acute psychotic symptomatology[16].

Some researchers suggest that stress increased the level of prolactin secretion which triggers dopamine release through a feedback mechanism; this increase in dopamine secretion and transmission may explain the relation between stress and psychosis[16].

The alternate relationship between prolactin and hypothalamic dopamine secretion has been proven in many studies. It could be that the increased level of dopamine is to downregulate hyperprolactinemia that is caused by stress response in psychotic patients[17].

There are recent studies that looked for genetic variants in psychotic patients who had hyperprolactinemia. They examined the functional polymorphism of the prolactin gene. They found that the G allele was significantly more common in those patients, and pointed out that this variation was similar to that reported in autoimmune diseases[18].

Another study has examined the relationship between prolactin level, prolactin receptor genes, tardive dyskinesia, and treatment response but has failed to find a significant association in either case[19].

In this study, there is positive correlation between duration of disease and serum prolactin level. These explain more SD and hyperprolactinemia with increase in the DUP. This is in agreement with the study that found significant positive correlation between DUP and pituitary volume[20]. In line with the hypothesis of a 'neurotoxicity' of untreated psychosis, the longer the symptoms and psychological distress persist, the more pronounced the changes in structures of pituitary volume[16].

There are recent studies that have reported on a significant positive correlation between prolactin levels and negative symptoms of the disease[3],[21],[22]. There is also a relationship between serum prolactin level and severity of depressive symptoms which is concluded by some researchers. Besides the health side effects of hyperprolactinemia, the presence of abnormal prolactin concentrations before antipsychotic treatment is of theoretical interest[23].

There is evidence that people with psychotic symptoms have anatomical anomalies and metabolic abnormalities outside the brain that is not related to the effect of antipsychotic treatment[24]. Although dopamine exerts a tonic inhibitory effect on the release of prolactin, serotonin appears to play an important role in the release of this hormone as well[25].


  Conclusion Top


All patients with first-episode psychosis should be assessed for prolactin level before starting antipsychotics. On the basis of our findings, clinicians should ask questions to detect hyperprolactinemia before starting treatment and during follow-up and should give patients the relevant information. Early intervention with drugs that has lower potential to elevate the prolactin level will improve the outcome and decrease the incidence of erectile dysfunction. Prolactin levels should be measured irrespective of whether symptoms of erectile dysfunction are present or not to avoid potential long-term complications of 'silent' hyperprolactinemia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Larsen TK, Friis S, Haahr U, Joa I, Johannessen JO, Melle I. Early detection and intervention in first episode schizophrenia: a critical review. Acta Psychiatrica Scandinavica 2001; 103:323–334.  Back to cited text no. 1
    
2.
Englar H, Doenlen R, Riether C, Engler A, Niemi MB, Besedovsky HO, et al. Time-dependent alterations of peripheral immune parameters after nigrostriatal dopamine depletion in a rat model of Parkinson's disease. Brain Behav Immun 2009; 23:518–526.  Back to cited text no. 2
    
3.
El Sayed El T, Abdalla AM. Evaluation of prolactin levels in male patients with first-episode schizophrenia and its correlation with psychopathology. Middle East Curr Psychiatry 2017; 24:49–54.  Back to cited text no. 3
    
4.
Stevens JR. Schizophrenia: reproductive hormones and the brain. Am J Psychiatry 2002; 159:713–719.  Back to cited text no. 4
    
5.
Joa I, Johannessen JO, Auestad B, Friis S, McGlashan T, Melle I, et al. The key to reducing duration of untreated first psychosis: information campaigns. Schizophr Bull 2008; 34:466–472.  Back to cited text no. 5
    
6.
Cuesta MJ, García de Jalón E, Campos MS, Ibáñez B, Sánchez-Torres AM, Peralta V. Duration of untreated negative and positive symptoms of psychosis and cognitive impairment in first episode psychosis. J Schizophr Res 2012; 141:222–227.  Back to cited text no. 6
    
7.
Garcia-Rizo C, Fernandez-Egea E, Oliveira C, Justicia A, Parellada E, Bernardo M, et al. Prolactin concentrations in newly diagnosed, antipsychotic-naive patients with non affective psychosis. J Schizophr Res 2012; 134:16–19.  Back to cited text no. 7
    
8.
Leticia G, Anne M, Clemente G, Emilio F, Brian J, Brian K. Prolactin concentrations in antipsychotic-naïve patients with schizophrenia and related disorders: a meta-analysis. J Schizophr Res 2016; 174:156–160.  Back to cited text no. 8
    
9.
Kahn RS, Fleischhacker WW, Boter H. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008; 371:1085–1097.  Back to cited text no. 9
    
10.
Aston J, Rechsteiner E, Bull N, Borgwardt S, Gschwandtner U. Hyperprolactinaemia in early psychosis-not only due to antipsychotics. Prog in schizophrenia. J Eur Psychiatry 2010; 17:341–347.  Back to cited text no. 10
    
11.
Ittig S, Studerus E, Heitz U, Menghini-Müller S, Beck K, Egloff L, et al. Sex differences in prolactin levels in emerging psychosis: indication for enhanced stress reactivity in women. J Schizophr Res 2017; 189:111–116.  Back to cited text no. 11
    
12.
Petros P, Stelios TT, Alexandros T, Dimitra TA, Petros S, Venetsanos M. Prolactin levels in drug-naive patients with schizophrenia and other psychotic disorders. Psych Res 2019; 276:218–222.  Back to cited text no. 12
    
13.
Pariante CM. Pituitary volume in psychosis: the first review of the evidence. J Psychopharmacol 2008; 22:76–81.  Back to cited text no. 13
    
14.
Oride A, Kanasaki H, Purwana IN, Miyazaki K. Possible involvement of mitogen-activated protein kinase phosphatase-1 (MKP-1) in thyrotropin-releasing hormone (TRH)-induced prolactin gene expression. Biochem Biophys Res Commun 2009; 382:663–667.  Back to cited text no. 14
    
15.
Messini CI, Dafopoulos K, Chalvatzas N, Georgoulias P, Anifandis G, Messinis IE. Effect of ghrelin and thyrotropin-releasing hormone on prolactin secretion in normal women. Horm Metab Res 2010; 42:204–208.  Back to cited text no. 15
    
16.
Riecher-Rossler A, Rybakowski JK, Pflueger MO, Beyrau R, Kahn RS. Hyperprolactinemia in antipsychotic-naive patients with first-episode Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res 2013; 14:226–244.  Back to cited text no. 16
    
17.
Grattan DR, Kokay IC. Prolactin: a pleiotropic neuroendocrine hormone. J Neuroendocrinol 2008; 20:752–763.  Back to cited text no. 17
    
18.
Rybakowski JK, Dmitrzak-Weglarz M, Kapelski P, Hauser J. Functional –1149G/T polymorphism of the prolactin gene in schizophrenia. Neuropsychobiology 2011; 65:41–44.  Back to cited text no. 18
    
19.
Souza RP, Meltzer HY, Lieberman JA, Voineskos AN, Remington G, Kennedy JL. Prolactin as a biomarker for treatment response and tardive dyskinesia in schizophrenia subjects: old thoughts revisited from a genetic perspective. Hum Psychopharmacol 2011; 26:21–27.  Back to cited text no. 19
    
20.
Rapp C, Canela C, Studerus E, Walter A, Aston J, Borgwardt S, et al. Duration of untreated psychosis/illness and brain volume changes in early psychosis. J Psychiatry Res 2017; 255:332–337.  Back to cited text no. 20
    
21.
Molitch ME. Medication-induced hyperprolactinemia. Mayo Clin Proc 2005; 80:1050–1057.  Back to cited text no. 21
    
22.
Ates MA, Tutuncu R, Oner I, Ercan S, Basoglu C, Algul A, et al. Relationship between plasma levels of prolactin and the severity of negative symptoms in patients with schizophrenia. Bull Clin Psychopharmacol 2015; 25:27–37.  Back to cited text no. 22
    
23.
S'opień R, S'opien A, Warenik-Szymankiewicz A. Serum prolactin concentration and severity of depression symptoms in climacteric women. Clin Exp Obstet Gynecol 2015; 42:749–751.  Back to cited text no. 23
    
24.
Miller BJ, Buckley P, Seabolt W, Mellor A, Kirkpatrick B. Meta-analysis of cytokine alterations in schizophrenia: clinical status and antipsychotic effects. Biol Psychiatry 2011; 70:663–671.  Back to cited text no. 24
    
25.
Sharma RP, Singh V, Janicak PG, Javaid JI, Pandey GN. The prolactin response to fenfluramine in schizophrenia is associated with negative symptoms. Schizophr Res 1999; 39:85–89.  Back to cited text no. 25
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed142    
    Printed4    
    Emailed0    
    PDF Downloaded10    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]