Cabergoline-Induced Psychosis in a Patient With Undiagnosed Depression

Bilal, Louai; Ching, Christopher R. K.

doi:10.1176/appi.neuropsych.11110348

Cited by 17 publications

(11 citation statements)

References 3 publications

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“…This is likely an under-reported association, as patients may not be forthcoming in the absence of direct questioning and because of publication bias (clinicians aware of this possibility may not consider it worth presenting). Table 2 summarizes these case reports, with the majority occurring in women taking cabergoline (37,38,39,40,41,42,43,44,45,46). The severity of hyperprolactinemia ranged from 45 to 9400 ng/mL, some patients had prolactinomas and some had a NFA with stalk effect hyperprolactinemia.…”

Section: Psychiatric Disorders Other Than Icds During Treatment With mentioning

confidence: 99%

Psychological effects of dopamine agonist treatment in patients with hyperprolactinemia and prolactin-secreting adenomas

Ioachimescu

Fleseriu

Hoffman

et al. 2019

European Journal of Endocrinology

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Background: Dopamine agonists (DAs) are the main treatment for patients with hyperprolactinemia and prolactinomas. Recently, an increasing number of reports emphasized DAs' psychological side effects, either de novo or as exacerbations of prior psychiatric disease. Methods: Review of prospective and retrospective studies (PubMed 1976, September 2018) evaluating the psychological profile of DA-treated patients with hyperprolactinemia and prolactinomas. Case series and case reports of psychiatric complications were also reviewed. Results: Most studies were cross-sectional and had a control group of healthy volunteers or patients with nonfunctioning pituitary adenomas. There were few prospective studies, with/without control group, that included small numbers of patients. Compared with controls, patients with hyperprolactinemia generally had worse quality of life, anxiety, depression and certain personality traits. Patients receiving DAs had higher impulsivity scores than normoprolactinemic controls. Impulse control disorders (ICDs) were reported in both genders, with hypersexuality mostly in men. Multiple ICDs were sometimes reported in the same patient, usually reversible after DA discontinuation. In case reports, DA therapy was temporally associated with severe depression, manic episodes or psychosis, which improved after discontinuation and administration of psychiatric medications. Gender type of DA, dose and duration of therapy did not correlate with occurrence of psychiatric pathology. Conclusion: Patients with hyperprolactinemia receiving DAs may develop changes in mood and behavior regardless of prior psychiatric history. Increased awareness for ICDs, depression, mania and other types of psychosis is needed by all physicians who prescribe DAs. Larger prospective controlled clinical studies are needed to delineate prevalence, risk stratification and management.

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Section: Psychiatric Disorders Other Than Icds During Treatment With mentioning

confidence: 99%

Psychological effects of dopamine agonist treatment in patients with hyperprolactinemia and prolactin-secreting adenomas

Ioachimescu

Fleseriu

Hoffman

et al. 2019

European Journal of Endocrinology

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“…To our knowledge, such an acute psychiatric crisis has been reported in 13 patients who had either a micro-or a macroprolactinoma treated with DAs. In four cases, the underlying psychosis was already diagnosed and treated and relapsed at the time of DA treatment (10,11,12,13); in seven cases, psychosis was revealed at this time (21,22,23,24,25,26). However, as all the cases were published in psychiatry literature, there might be a publication bias overestimating the proportion of psychosis and relapses.…”

Section: Discussionmentioning

confidence: 97%

Efficacy and safety of dopamine agonists in patients treated with antipsychotics and presenting a macroprolactinoma

Allard

Albarel

Bertherat

et al. 2020

European Journal of Endocrinology

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Context In patients treated with antipsychotics, the rare occurrence of a macroprolactinoma represents a therapeutic challenge. Objective Our aim was to evaluate the efficacy and psychiatric safety of dopamine agonists (DAs) prescribed for large macroprolactinomas in patients with psychosis treated with antipsychotics. Design This was a multicenter (France and Belgium) retrospective study. Patients Eighteen patients treated with antipsychotics were included. Results Under DA, median PRL levels decreased from 1247 (117–81 132) to 42 (4–573) ng/mL (P = 0.008), from 3850 (449–38 000) to 141 (60–6000) ng/mL (P = 0.037) and from 1664 (94–9400) to 1215 (48–5640) ng/mL (P = 0.56) when given alone (n = 8), before surgery (n = 7), or after surgery (n = 6), respectively. The prolactinoma median largest diameter decreased by 28% (0–57) in patients under DAs alone (P = 0.02) but did not change when given after surgery. Optic chiasm decompression was achieved in 82% of patients. Five patients (28%) were admitted for psychotic relapse while receiving DAs (but three of them had stopped antipsychotic treatment at that time). A more severe underlying psychosis, rather than the DA treatment itself, may explain such psychiatric admissions. Conclusion Even if the DA efficacy on PRL levels and tumor volume in patients with macroprolactinoma under antipsychotic drugs is less impressive than that typically observed, it may be considered satisfactory for half of our patients, particularly in cases of optic chiasm compression. Psychotic exacerbation was unusual in these patients, occurring mostly in those with the most severe psychotic forms. DAs may therefore be used as antitumor treatment for macroprolactinoma in patients with visual involvement, severe headaches or invasion into the skull base who receive antipsychotics.

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“…ICDs are characterized by difficulties in resisting urges to engage in behaviors that are excessive and/ or ultimately harmful to oneself or others and can include gambling, kleptomania, intermittent explosive disorder, compulsive sexual behavior and compulsive buying (126).…”

Section: Do Dopamine Agonists Cause Psychiatric Disorders?mentioning

confidence: 99%

“…Few reports have been published focusing on ICDs and other psychiatric disorders in prolactinoma patients treated with CAB (123-133). These reports have described disorders such as a first episode of mania (123,129); mania with psychotic features in a subject with bipolar disorder after starting CAB (125); psychosis in a patient with undiagnosed depression (126); compulsive gambling one year after starting CAB (130); gambling and compulsive sexual behavior just after starting CAB (131); psychosis in a patient without a previous history of psychiatric disorder three months after starting CAB (132); and depression and compulsive buying (133).…”

Section: Do Dopamine Agonists Cause Psychiatric Disorders?mentioning

confidence: 99%

Controversial issues in the management of hyperprolactinemia and prolactinomas – An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

Vilar¹,

Abucham²,

Albuquerque³

et al. 2018

Archives of Endocrinology and Metabolism

102

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Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

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Cabergoline-Induced Psychosis in a Patient With Undiagnosed Depression

Cited by 17 publications

References 3 publications

Psychological effects of dopamine agonist treatment in patients with hyperprolactinemia and prolactin-secreting adenomas

Psychological effects of dopamine agonist treatment in patients with hyperprolactinemia and prolactin-secreting adenomas

Efficacy and safety of dopamine agonists in patients treated with antipsychotics and presenting a macroprolactinoma

Controversial issues in the management of hyperprolactinemia and prolactinomas – An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

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