Review Article

Prolactin and Psychopathology in Schizophrenia: A Literature Review and Reappraisal

Table 3

Results of studies examining prolactin response to pharmacological challenges in schizophrenia.

Study and authorsAgent usedPatient sampleResults

Spoov et al., 2010 [28]Thyrotropin-releasing hormone (TRH), 12.5 mcg i.v.19 drug-naïve patients with schizophreniaProlactin response negatively correlated with poverty of speech and inattention

Spoov et al., 1991 [27]TRH, 12.5 mcg i.v.20 patients with nonaffective psychosisProlactin response to TRH positively correlated with “nonparanoid” symptoms, such as thought disorder

Cabranes et al., 1982 [78]TRHPatients with acute and chronic schizophrenia treated with chlorpromazine for 14 daysIncreased prolactin response to TRH following chlorpromazine treatment

Brambilla et al., 1976 [79]TRH, 500 mcg i.v.20 patients with chronic hebephrenic schizophrenia, off medication for at least 10 days; 8 healthy controlsEnhanced prolactin responses to TRH in patients, despite normal basal prolactin levels

Naber et al., 1980 [80]TRH, 0.2 mg and luteinizing-hormone releasing hormone (LHRH), 0.025 mg22 patients with chronic schizophrenia (10 male, 12 female) receiving antipsychotics for 6–21 yearsAttenuated prolactin response to TRH with long-term treatment; no relation between TRH response and psychopathology

Mokrani et al., 2000 [13]Clonidine, 0.35–0.375 mg depending on body weight134 drug-free in-patients—31 schizophrenia, 16 schizoaffective, 87 major depression—and 22 controlsBlunted prolactin response to clonidine in patients with paranoid schizophrenia, compared to controls and patients with disorganized schizophrenia

Sharma et al., 1999 [25]Fenfluramine, 60 mg orally35 drug-free patients—28 schizophrenia, 7 schizoaffectiveSignificant positive correlation between prolactin response to fenfluramine and negative symptoms, as measured by the BPRS

Monteleone et al., 1999 [30]Fenfluramine, 30 mg orally16 drug-free patients with schizophrenia; 16 matched controlsGreater prolactin response to fenfluramine in patients with resistant schizophrenia as per Kane’s criteria

Abel et al., 1996 [26]d-Fenfluramine13 drug-naïve patients with schizophrenia; 13 matched controlsGreater prolactin response in patients; positive correlation of prolactin response with affective symptoms—anxiety, guilt, and depression—measured on the BPRS

Lerer et al., 1988 [14]Fenfluramine, 60 mg orally10 drug-free patients with “chronic schizophrenia”; 10 matched controlsBlunted prolactin response to fenfluramine in patients

Krystal et al., 1993 [81]m-Chlorophenylpiperazine (m-CPP), 0.1 mg/kg i.v.12 drug-free patients with schizophrenia; 15 controlsLower baseline prolactin in patients; no difference in m-CPP response; m-CPP triggered positive symptoms in patients

Iqbal et al., 1991 [15]m-CPP, 0.25 mg/kg orally7 male patients with schizophrenia; 8 male controlsBlunted prolactin response to m-CPP in patients; m-CPP worsened positive symptoms in this group

Markianos et al., 2002 [82]Clomipramine 25 mg i.v.25 male patients with schizophrenia, pre- and posttreatment with clozapine or olanzapineSignificant increases in prolactin following clomipramine; this response was blocked by both drugs

Cowen et al., 1985 [83]L-tryptophan, 7.5 g i.v.18 patients with schizophrenia on treatment and healthy controlsIncreased prolactin response to L-tryptophan in patients

Nerozzi et al., 1990 [84]Growth hormone-releasing hormone (GHRH), 1 mcg/kg18 drug-free male patients with schizophrenia; 18 matched controlsTransient increase in prolactin following GHRH; no difference between the two groups

Cantalamessa et al., 1985 [85]Gonadotrophin-releasing hormone (GnRH)11 male patients with “acute schizophrenia”Increased prolactin in 2 of 11 patients following GnRH

Keks et al., 1990, 1992 [16, 17]Haloperidol, 0.5 mg i.v.44 drug-free male patients with “acute schizophrenia”; 28 healthy controlsBlunted prolactin response to haloperidol in patients; basal prolactin positively correlated with the BPRS depression score. Maximal blunting seen in patients diagnosed with schizophrenia as per Kraepelin’s criteria

Copolov et al., 1990 [18]Low-dose haloperidol, i.v.46 male in-patients with psychosis (27 schizophrenia, 7 affective, 12 other psychoses); 28 male controlsLower prolactin response in patients with schizophrenia than in controls, even after correcting for age

Kulkarni et al., 1990 [29]Haloperidol, 0.5 mg i.v.24 drug-free male patients with psychosisSignificant inverse correlation between prolactin response and the severity of delusions

Keks et al., 1987 [19]Haloperidol, 0.5 mg i.v.14 drug-free male patients with schizophrenia; 14 matched controlsBlunted and slow prolactin response to haloperidol in patients

Nerozzi et al., 1990 [20]Domperidone, 20 mg16 drug-free male patients with schizophrenia or schizophreniform disorder; 16 male controlsBlunted prolactin response to domperidone in all patients, more prominently in the schizophreniform group. Basal prolactin was comparable to controls

Nerozzi et al., 1992 [86]Domperidone, 20 mg17 elderly, drug-free male patients with schizophrenia; 8 age-matched male controlsIncreased prolactin response to domperidone in patients; comparable baseline prolactin

Monteleone et al., 1985 [21]#Sodium valproate, 800 mg18 women with “chronic schizophrenia”; 20 healthy womenValproate suppressed prolactin in normal women, but failed to do so in those with schizophrenia

Scheinin et al., 1985 [22]#Apomorphine, 0.005 mg/kg s.c. and 0.015 mg/kg i.v.11 patients with schizophrenia on medication; 8 controlsApomorphine significantly decreased prolactin in controls but not in patients

Whalley et al., 1984 [87]#Apomorphine, 0.75 mg19 drug-free patients with psychosis; 9 healthy controlsIncreased suppression of prolactin by apomorphine in patients with schizophrenia compared to controls

Ferrier et al., 1984 [31]Apomorphine, 0.75 mg s.c.Unmedicated patients with acute and chronic schizophrenia; healthy controlsNo difference in the response to apomorphine across groups; however, basal prolactin was negatively correlated with the severity of positive symptoms

Rotrosen et al., 1978 [23]Apomorphine and L-dopaUnmedicated patients with chronic schizophrenia; healthy controlsSlightly blunted suppression of prolactin in patients compared to controls with apomorphine; greater suppression in patients than controls with L-dopa

Kolakowska et al., 1981 [88]Apomorphine 0.05–0.1 mg/kg17 patients with schizophrenia on treatmentNo relationship between antipsychotic dose and apomorphine-induced prolactin suppression

Tsuchiya 1984 [24]Experimental stressPatients with schizophrenia, hypomania, depression, and alcohol dependence; healthy controlsStress-induced prolactin release significantly greater in patients with schizophrenia than in controls

Study uses an agent that inhibits prolactin release.