Şizofreni hastalarında antipsikotik kullanımına bağlı hiperprolaktinemi ve kemik metabolizma bozuklukları

Şizofreni dünya nüfusunun yaklaşık %1’ini etkileyen bir bozukluktur. Şizofreni spektrum bozuklukları (şizoid kişilik bozukluğu, şizotipal kişilik bozukluğu, şizoaffektif psikoz ve sanrısal bozukluk) da alındığında bu oran %5’e kadar yükselir. Şizofreni ve şizoafektif bozukluk hastalarında kemik metabolizmasında hasarlanma ve düşük kemik mineral yoğunluğu için yatkınlaştırıcı etkenler bozukluğun kendisine, yetersiz egzersiz ve güneş ışığına, sigara içmeye ve polidipsiye bağlı olabilir. Antipsikotik ilaçların kemik metabolizması üzerine etkileri daha çok hiperprolaktinemi ve buna bağlı ortaya çıkan hipogonadal durumla ilişkilendirilmiştir. Bu hastalarda hiperprolaktinemi daha sık gözlenirken, kemik metabolizma bozuklukları sorgulanmadığı ve rutin incelemeler arasında olmadığı için genellikle gözden kaçmaktadır; kemik metabolizma bozukluklarına olan ilgi son yıllarda artmıştır. Kemik metabolizma bozukluğu olan hasta kalsiyum ve vitamin D’nin yeterli miktarları ve diyet hakkında; düzenli kilo verdirici egzersiz, sigara, kafein ve alkolden kaçınma; yeterli güneş ışığından faydalanmanın yararı konusunda bilgilendirilmelidir. Prolaktini artıran antipsikotik ilaçlardan prolaktini daha az artıran antipsikotik ilaçlara geçiş, hormon replasman tedavisi ve bifosfanatların kullanımı önerilmektedir.

Hyperprolactinemia and bone metabolism disorders due to antipsychotics in patients with schizophrenia

Schizophrenia has influenced approximately 1% of the general population. If the schizophrenia spectrum disorders (schizoid personality disorder, schizotypal personality disorder, schizoaffective disorder and paranoid disorder) have been included, this rate would increase to 5%. Psychiatric disorders, sun light deficiency, inadequate exercise, smoking and polidipsia are predisposing factors for decreased bone mineral density and disruption in bone metabolism of patients with schizophrenia and schizoaffective disorders. The effects of antipsychotic drugs on bone metabolism are closely associated with hyperprolactinemia and hypogonadal states. Although in this group of patients hyperprolactinemia is seen commonly, bone metabolism disorders are not investigated and not included among routine procedures. That way they are usually missed out of sight. Recently, interest on bone metabolism disorders increase. Patients with bone metabolism disorder should be acknowledged that they must add calcium and vitamin D supplements to diet; regularly lose weight, do exercise, avoid cigarette, caffeine and alcohol; benefit good enough of sunshine. Using antipsychotics with no effect on prolactine levels, hormone replacement therapy and biophosphonate supplement is recommended for the treatment of this situation.

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