Epidemiology, diagnostics and treatment of antipsychotic-induced hyperprolactinemia
Yunilainen O.A. ¹, Starostina E.G. ², Dzeranova L.K. ³, Baranov P.A. ⁴, Dedov I.I. <sup>3

1</sup> Scientific center of mental health, Moscow
² M.F. Vladimirskiy Moscow Regional Clinical and Research Institute, Moscow
³ Endocrinology research center, Moscow
⁴ Russian Medical Academy of Postgraduate Education, Moscow

True prevalence of antipsychotic-induced hyperprolactinemia (AIH) is unknown. Efficacy and safety of medical treatment for AIH remains disputable.
Aim: To study epidemiology of AIH with evaluation of the effects of various antipsychotics on prolactin levels and to assess efficacy and safety of cabergolin in the treatment of AIH.
Materials and methods: This was a cross-sectional screening study with consecutive recruitment of 244 in-patients in a psychiatric hospital (140 women and 104 men aged from 19 to 45 years), in whom total and bioactive prolactin levels were measured, irrespective on presence or absence of AIH-related symptoms. Efficacy and safety of cabergolin was assessed in a non-randomized prospective controlled (“naturalistic”) study in 84 patients with AIH. Quality of life was assessed with SF 36 questionnaire, side effects of antipsychotics and sexual dysfunction with UKU and PRSexDQ questionnaires.
Results: AIH prevalence by unselected screening was 53% (64% among women and 38% among men). Macroprolactinemia was absent in men and found only in 4% of women with AIH. Clinically asymptomatic AIH in men was more frequent than in women (37% vs 16%, р=0,03). Risperidone and sulpirid were the most potent prolactin inducers, whereas the effects of fluphenazine, periciazine, chlorprotixene, perphenazine, quetiapine and clozapine on prolactin levels were negligible. Treatment of AIH with cabergolin was effective in 95% of patients. The effective cabergolin dose was in the range from 0,25 to 3 mg once weekly (median, 0,5 [0,5-1,25] mg). Normalization of prolactin levels required from 4 to 44 weeks of treatment (median, 14 [4-22] weeks) and was associated with amelioration of sexual problems in both genders and restoration of regular menstrual cycle in women, as well as with improvement in some SF36 domains. With total exposure to cabergolin of 534 patient-weeks, there were no exacerbations of mental disorders. 
Conclusions: AIH prevalence assessed by screening is 1,5-fold higher that that assessed by referrals. We proposed an algorithm for switching of antipsychotics in case of AIH. Cabergolin treatment is clinically and hormonally effective in the majority of AIH patients and is associated with significant improvement of health status and quality of life.. Long-term cabergolin therapy does not result in any deterioration in the course of mental disorders. 
Key words: prolactin, antipsychotic, screening, treatment, cabergolin, quality of life.

For citation: Yunilainen O.A., Starostina E.G., Dzeranova L.K. et al. Epidemiology, diagnostics and treatment of antipsychotic-induced hyperprolactinemia // RMJ. 2017. № 1. P. 30–36.