Persistent elevation of prolactin for periods up to 2 years has been documented in maintenance treatment with risperidone. Very limited long-term data of pimozide, olanzapine, and quetiapine prohibit drawing conclusions for these antipsychotics. Systematic long-term observational studies, including specific questionnaires as well as physical examination, are needed to investigate prolactin-related side effects of antipsychotic treatment in children and adolescents.

Hyperprolactinemia is a common side effect in young males treated over the long term with risperidone. Young males treated with risperidone are more likely to report diminished sexual functioning than are those not treated with antipsychotics.

Objective: To investigate the long-term effects of antipsychotic (AP) treatment and AP-induced hyperprolactinemia on bone mineral density (BMD) and body composition in male adolescents with autism spectrum disorders (ASDs) and/or disruptive behavior disorder (DBD). Design: Physically healthy 10-to 20-year-old boys with ASD and/or DBD, chronically treated (nZ56; mean 52 months, range 16-126 months) or not treated (nZ47) with an AP, were recruited to this observational study. Prolactin levels and biochemical bone parameters were measured and BMD of the lumbar spine and total body, and body composition were assessed by dual-energy X-ray absorptiometry, and volumetric BMD of the lumbar spine calculated. Group differences were tested with Student's t-test, c 2 test, Fisher exact test, and logistic regression analysis. Results: Forty-nine percent of the boys treated with an AP had hyperprolactinemia. The mean volumetric lumbar spine BMD z-score was lower (PZ0.043), the total percentage of body fat z-score was higher (PZ0.042), and biochemical bone marker carboxyterminal cross-linking telopeptide of bone collagen was lower in the AP-treated boys with hyperprolactinemia than in the AP-treated boys without hyperprolactinemia. Seven to 11% of the hyperprolactinemic boys had low BMD. The mean lumbar spine and total body BMD z-scores and body composition were similar in the boys who were or were not treated with an AP. The total study population had a lower mean lean tissue mass (mean z-score K0.37, PZ0.004) and a higher percentage of total body fat (mean z-score 1.16, P!0.001) than healthy controls (normative data); biochemical bone parameters were within normal limits. Conclusion: AP-induced hyperprolactinemia in boys with ASD or DBD may have a negative effect on lumbar spine BMD. Longitudinal studies are needed to confirm this finding and further disentangle the effects of the disorder, lifestyle, treatment, and hyperprolactinemia.

Although CYP2D6 might have an effect, the presence of at least one Taq1A A1 allele of the D2DR gene did not contribute toward susceptibility to risperidone-induced hyperprolactinemia, and as a result, toward prolactin-related adverse events such as amenorrhea, galactorrhea, and sexual dysfunctioning.

Aims: This cross-sectional study investigatesthe effect of antipsychotic (AP)-induced hyperprolactinemia on testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), inhibin B, and puberty in boys with mainly autism spectrum disorders (ASD). Method: One hundred and four physically healthy 10- to 19-year-old boys with ASD or disruptive behavior disorder (DBD) were recruited between October 2006 and November 2009. Fifty-six adolescents had been treated with AP for >16 months; 48 had never been exposed to AP. Morning non-fasting levels of serum prolactin, testosterone, LH, FSH and inhibin B were obtained and Tanner pubertal stage was determined. Patients with hyperprolactinemia (n = 28) were compared to those without hyperprolactinemia (n = 76) using non-parametric or parametric tests, as appropriate. Results: Patients with AP-induced hyperprolactinemia had significantly lower testosterone levels with adjustment for age (p = 0.035) compared to patients without hyperprolactinemia and without AP treatment. The difference was not significant within the AP-treated group, and the level of testosterone was within the reference range compared to age- and gender-matched normative data. There was no between-group difference for LH, FSH, inhibin B or Tanner stages. Conclusion: AP-induced hyperprolactinemia is related to significantly lower testosterone levels in pubertal boys with ASD and DBD.

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Objectives Adults with autism often need support to detect their stress and to apply adequate coping strategies for dealing with daily stress. The personalized mobile application Stress Autism Mate (SAM) is developed for and by adults with autism to detect and cope with daily life stress. SAM measures stress four times daily, generates an overview of the patients’ stress level and gives personalized advice to reduce stress. Methods With a pre-to post-treatment design, the level of perceived stress, coping self-efficacy and self-rated quality of life (QoL) was assessed at baseline (pre-test), after the four-week intervention (post-test) and after eight-week follow-up. Data was analysed using multilevel analysis taking within subject variance into account. Results At post-test measurement, there was a significant decrease in perceived stress. At post-test as well as follow-up, a significant improvement in coping self-efficacy and improvement in self-rated QoL was seen. Conclusions The results of this pilot study suggest that the personalized mHealth tool SAM can support adults with autism in detecting stress, improving their stress coping skills and improving their self-rated quality of life. In practice, SAM can be seen as an external stress monitor that can easily be integrated in the lives of adults with autism, to detect and cope with stress.