Therapeutic Effect Of Aripiprazole At Different Doses On Risperidone-induced Hyperprolactinemia

Objective:Most of the anti-psychiatric drugs have the effects of blocking dopamine receptor,and cause increased serum PRL levels in clinical application.Risperidone,a new type anti-psychiatric drug,has significant antipsychotic effect on patients of schizophrenia.However,as a DA receptor antagonist,risperidone can increase the serum PRL level though the nodule-funnel pathway.Aripiprazole is a partial agonist of D2 receptors,also has antipsychotic effects.Theoretically,aripiprazole can reverse HPRL caused by other antipsychotics,and domestic and foreign studies have reported that aripiprazole can be used to treat HPRL caused by antipsychotics,but the appropriate dose of lowering HPRL has not been clearly determined.The purpose of this study is to explore the effects of aripiprazole at different doses on HPRL caused by risperidone.This study will provide the experimental evidence for clinicians in reduction of drug side effects.Method:From January 2016 to January 2018,60 inpatient and outpatient cases of schizophrenia were selected from Hebei Provincial Mental Health Center.These patients aged 18-45 years have been treated with Risperidone for more than 4 weeks.The patients enrolled meet the diagnostic criteria of the International Classification of Diseases(ICD-10)for schizophrenia(10th revision).The patients were divided into three groups randomly after signing the informed consent form: low dose group(2.5 mg/d),medium dose group(10 mg/d),and high dose group(15 mg/d).The number of patients in each group was 20 cases.This treatment lasted for 8 weeks,and all patients were clinically observed for 8 weeks.The observed time points were baseline,4 weekend,and 8 weekend form treatment.From the morning of each observation time,5ml blood from the elbow vein was extracted to detect the serum PRL level;The positive and negative symptoms scales(PANSS)were used to evaluate the subjects’ positive symptoms,negative symptoms,psychopathy,and total score to determine the efficacy of the drug.The adverse reactions of the subjects after the application of antipsychotics were assessed using the adverse reactions scale form(TESS).Result:There was no significant difference in serum PRL levels between groups in low dose group,medium dose group and high dose group compared to baseline level(P>0.05).There was no significant difference in serum PRL levels measured in the middle dose group and high dose group at the fourth weekend of treatment(P>0.05).The difference between the serum PRL level data and the low dose group values is statistically significant(P<0.05).At the 8th weekend,the value of serum PRL in the medium dose group was statistically significant compared with the low dose group(P<0.05).The difference in serum PRL values measured in the high dose group compared to the low dose group was statistically significant(P<0.05).There was no statistically significant difference between the medium dose group and the high dose group(P>0.05).The serum PRL levels in the low-dose group were statistically significant compared to the baseline at the fourth and eighth weekend of treatment(P<0.05)The serum PRL levels in the medium-dose group were measured at the fourth and eighth weekend of treatment,and the difference was statistically significant compared with the baseline(P<0.05).The serum PRL values measured at the observation points after treatment in the high dose group were statistically significant compared to the baseline(P<0.05).In the baseline,treatment weekend 4 and treatment weekend 8,the total score of PANSS scales in the low dose group,medium dose group,and high dose group 3 groups was not statistically significant(P>0.05).There was no significant difference in the scores of positive factor,negative factor and psychopathology in PANSS scale(P>0.05).No serious adverse effects were observed in low dose group,medium dose group and high dose group.The TESS score in the low dose group,medium dose group and high dose group was not statistically significant compared to the baseline(P>0.05);At the 4th weekend,the TESS score in the high-dose group was not statistically significant compared with the low-dose group and the medium-dose group(P>0.05);At the 8th weekend,the TESS score of the high dose group was statistically significant compared to the low dose group and the medium dose group(P<0.05).The prevalence of sleepiness in high dose group was significantly higher than in low dose group and medium dose group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of nausea,dry mouth,insomnia,sit-ins,constipation,and muscle tremor in the three dose groups(P>0.05).Conclusion:1.Aripiprazole at low dose,medium dose and high dose decreased the serum PRL level.Aripiprazole at the middle dose has similar effects with the high dose and larger than the low dose.2.Aripiprazole at the high dose caused an increase in the side effects.3.The optimal dose of arisperidone on HPRL was 10 mg/d.