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Differential effects of typical and atypical antipsychotic medication on plasma prolactin levels
1996
100. DIFFERENTIAL EFFECTS OF TYPICAL AND ATYPICAL ANTIPSYCHOTIC MEDICATION ON PLASMA PROLACTIN LEVELS H. LeeI, lA. Lieberman I, B. Sheitman I, A.R. Koreen', M. Kroenig", A. Mendelowitz", D. Umbricht', J.M.J. Alvir', & T. Cooper DlOL rSYCIIIATRY 1996:39:500-666 102. THE RELATIONSHIP BETWEEN CLOZAPINE DOSE AND PLASMA LEVEL AND SIDE EFFECTS A.H. Kalali I , R. Bera', B. Gulasekararrr', S. Hayes'', Y. Jin', J. Costa'', J. Oldroyd', T. Cooper', & S.G. Potkin l 529 'Hillside Hospital. Long Island Jewish Medical Center, 75-59 263rd St. Glen Oaks. NY 11004; 2Nathan Klein Research Facility. Orangeburg. NY Previous studies have found that prolactin levels are elevated following treatment with typical antipsychotic rncdlcation (Meltzer et al 1978). but are not significanlly elevated witb clozapine (l.leberman ct al 1986). Animal studies suggest that the putative atypical agent rispcrldone produces u more marked increase in prolactin level than an equivalent dosase of a typlcal agent (Bowden ct al 1992). Thepurpose of thisstudy was to examine the differences in prolactin response following treatment with fluphenazine, rispcridone and clozaplne in a group of treatment naive patients in theirfirsl episode of psychosis. Forty-nine patients who mel DSM-IIl-R criteria for schizophrenia (n=30) or schlzosffective disorder (n= 19)were entered intothestudy. Twenty-four patients (15M. 9F) were treated with nllphenazine (5-20 mglday}, 14 patients (GM, SF) with clozapine (titrated to ISO mglday by day 9) and [I (SM.6F) with rispcridone (6 mslday by dlly 3). Blood wasdrawn for plasma prolactin assay at baseline, weeks I, 2,3, 4.5. 6, and 8 of treatment. Results will be presented and the relevance of risperldone's S-HT2Idopamine D2 antagonist profile will be discussed, 101. Pl3EDICTING CLINICAL RESPONSE TO CLOZAPINE TREATMENT BY PLASMA LEVEL R. BeraI, A.H. Kalali l , B. Gulasekaram'', S. Hnyes, Y. Jin', J. Costa", J. Oldroyd', T. Cooper', & S.O. Perkin' lDepartmenl of Psychiatry and Human Behavior, University of California Irvine Medical Center, Orange. CA 92668; 2Melropolillln Stale Hospital. Norwalk. CA; :lThc Nathan S, Kline Institute for Psychiatric Research. Orangeburg, NY Therelationship between plasma levcl ofclozaplne lind clinical response, and whether an increase in plasma level in non-responders would enhance the response rate was examined. Fifty-eight treatment resistant schizophrenic patients completed a 12 week fixed-dose, double blind mal. Steady-state plasma clozaplne concentratlons varied more than 4S fold aner Iixed-dcsc treatment (400 mglda)·). Discriminant function analysis determined that n plasma revet of 420 nglmL optimally distinguished responders from non-responders. At week 4 only 8% of those patients witha plasma level below 420 nglmL responded compared with 60% of those who had a plasma level above 420 nglmL. When plasma levels were Increased above 420 nglmL (by II double-blind random assignment procedure), non-responders increased their response rate to 73% if theirplasma levelexceeded 420 nglmL ttt week 12. compared to 29% if week 12 levels remained below 420 nglmL (pCLOZAPINE ON TARDIVE DYSKINESIA AMONG "TREATMENT~REFRACTORY" PATIENTS WITH SCHIZOPHRENIA C. Nair, G. Abraham, J. de Leon, J.K. Stanilla, R.C. Josiassen, & G. Simpson Medical College or Pennsylvania/Norristown Stnte Hospital Ctlnlcal kesearch Center, Norristown, PA 19401 Clczaplne has been reported to improve tardive dyskinesia (Simpson 1978). 23 OSM-IIIR "ueannent-refractory" schizophrenics (mean age 46:8.5 years) received 100,300.and600 mgsof'clozaplnc (ClZ) for 16 weeks each in a double-blind randomized cross-over design. Patients were evaluated on il weekly basis across II naturalistic baseline (Bt) of 4 weeks; haloperidol (HLP) IOmg for4 weeks and3 eLZ phasd: Arter 16 weeks on the initial elZ dose. palienls were randomly crossed over 10 theother two doses for 4 months each. Abbreviated Dyskinesia Rating Scale (ADRS) ralings were done weekly during naturalistic baseline, HLP, and the first CLZ dose phase, Thcrenrter, monthly ratlngs were dam: in the Iwo subsequent crossover phases, Mean ADRS Total Scores were: BL= 23.2±S.4; HLP= 26.2±6.7; loomg ClZ" 26')::!: 10.5; 300mg CLZ= 23.4±8.8; 600mg CLZ= 21.7±6.5. Thc Total ADRS scores at 600mg elZ dose was slgnificantly lower when compared to HLP (p<0.03) and loomgeLZ (p
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