Hyperprolactinemia is an underappreciated/unknown adverse effects of antipsychotics. The consequences of hyperprolactinemia compromise therapeutic adherence and can be serious. We present the consensus recommendations made by a group of experts regarding the management of antipsychotic-induced hyperprolactinemia. The current consensus was developed in 3 phases: 1, review of the scientific literature; 2, subsequent round table discussion to attempt to reach a consensus among the experts; and 3, review by all of the authors of the final conclusions until reaching a complete consensus. We include recommendations on the appropriate time to act after hyperprolactinemia detection and discuss the evidence on available options: decreasing the dose of the antipsychotic drug, switching antipsychotics, adding aripiprazole, adding dopaminergic agonists, and other type of treatment. The consensus also included recommendations for some specific populations such as patients with a first psychotic episode and the pediatric-youth population, bipolar disorder, personality disorders and the elderly population.
Background
Patients with a first episode of psychosis (FEP) are at higher risk of gaining weight and presenting metabolic disturbances, partly related to antipsychotic exposure. Previous studies suggest that treatment discontinuation might have a positive impact on weight in schizophrenia. The aim of this study is to evaluate the effect of treatment discontinuation on weight and metabolic changes in a FEP cohort.
Methods
Two-hundred and nine FEP patients and 57 healthy controls were evaluated at study entry and prospectively at 10-years follow-up. Anthropometric measures, clinical, metabolic and sociodemographic data was collected.
Results
Patients discontinuing antipsychotic treatment presented a significant lower increase in weight and better metabolic parameters’ results than those still on antipsychotic treatment at 10-years follow-up.
Conclusions
Treatment discontinuation had a positive effect on the weight and metabolic changes observed in FEP patients; however, this effect was not sufficient for reaching the complete reversal to normal levels.
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