Impact of antipsychotics on prolactin and its associations with neurocognition in patients with schizophrenia.

BACKGROUND AND

OBJECTIVES

Cognitive impairment is a core feature of schizophrenia (SCZ). Previous studies suggest a close relationship between prolactin and neurocognition. However, antipsychotics have a great impact on prolactin dysregulation. This study investigates how antipsychotics modulate prolactin and its associations with neurocognition in SCZ patients.

METHODS

A total of 425 SCZ patients were recruited from psychiatric hospitals. Neurocognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status. Blood samples were collected after an overnight fast to measure prolactin levels. Analyses were conducted using moderated regression models with two moderators: prolactin-raising antipsychotics and hyperprolactinemia.

RESULTS

The prolactin-raising group showed significantly higher prolactin levels than the prolactin-sparing group. Prolactin levels showed significant negative associations with immediate memory and delayed memory. Moreover, the association between prolactin levels and immediate memory was modulated by prolactin-raising antipsychotics and the interaction between prolactin-raising antipsychotics and hyperprolactinemia. Specifically, the negative association was significant only in patients taking prolactin-raising antipsychotics, especially when their prolactin levels exceeded the threshold of hyperprolactinemia.

CONCLUSIONS

These findings underscore the need for regular serum prolactin monitoring in patients receiving prolactin-raising antipsychotics, particularly those with confirmed hyperprolactinemia. Clinicians should exercise particular caution when prescribing such agents to patients with memory impairment and consider prolactin-sparing alternatives where clinically appropriate.