Gerald A. Maguire, MD, PhD, CDE, FACE
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Antipsychotic agents differ in efficacy and side effects such as movement disorders and prolactin elevation
because of varying mechanisms of action. A revised nomenclature for antipsychotic agents, which
categorizes the drugs according to efficacy, risk of movement disorders, and risk of prolactin elevation, is
described. Prolactin elevation, a potential side effect of some antipsychotic medications, is underdiagnosed
but can have serious short-term and long-term consequences. Short-term problems include menstrual irregularities,
sexual dysfunction, and depression. Long-term problems related to prolactin elevation include
decreased bone density and osteoporosis, relapse of psychosis because of poor compliance due to sexual
dysfunction or depression, and perhaps cancer, although more research in this area is needed. Despite the
serious nature of these effects, prolactin elevation is seldom detected because clinicians often fail to inquire
about sexual function or other symptoms that signal that a patient’s prolactin may be elevated. These are
problems that patients may not bring up with clinicians unless they are asked. Therefore, when patients are
taking antipsychotic medications, clinicians should regularly inquire about sexual dysfunction, depression,
menstrual disturbances, galactorrhea, and gynecomastia.
J Clin Psychiatry 2002;63(suppl 4):56-62
© Copyright 2002 Physicians Postgraduate Press, Inc.