ECE2006 Symposia The endocrinology of psychiatric disease (4 abstracts)
The neuroendocrine aspects of schizophrenia generally receive little attention. This is in marked contrast to depressive disorders, where neuroendocrine issues are central to discussions of pathophysiology and treatment. Although the nature of neuroendocrine dysfunction is less well characterized in schizophrenia than major depression, a number of neuroendocrine abnormalities have been described. Hypercortisolemia has been extensively documented in patients with schizophrenia, particularly during acute exacerbations, with persistent hypercortisolemia being associated with ventricular enlargement and poor outcome. Similarly, abnormalities in thyroid function, the hypothalamo-pituitary-gonadal axis, neurotensin, growth hormone, prolactin and other neuroendocrine parameters have also been described in schizophrenia. While the precise neuroendocrine profile of schizophrenia is incompletely characterized, the impact of antipsychotic medications employed in its treatment on various endocrine parameters is better understood. Different first- and second- generation antipsychotics (FGAs and SGAs) variably contribute to hyperprolactinemia, insulin resistance, and other neuroendocrine abnormalities. A critical overview of neuroendocrine abnormalities in schizophrenia will be provided and the differential impact of different antipsychotics in contributing to neuroendocrine dysfunction discussed. All FGAs and some SGAs (risperidone and amisulpride) cause hyperprolactinemia and associated adverse effects; mechanisms underlying hyperprolactinemia associated with antipsychotics and associated clinical problems will be summarized. Weight gain is emerging as the most prominent long-term side effect associated with SGAs; its prevalence, clinical importance, and underlying mechanisms will be reviewed. The prevalence and significance of diabetes mellitus and hyperlipidemia in the context of antipsychotic treatment will be reviewed and clinical measures to address the problem considered. It is important to appreciate the importance of different neuroendocrine adverse effects associated with antipsychotic use, however, and recognize differences in neuroendocrine side-effect profiles associated with agents so that we can use them optimally.