A 45-year-old woman returns to her psychiatrist for her routine biweekly appointment two months after being hospitalized for an episode of major depressive disorder, recurrent, severe with psychotic features. During her hospitalization, she was started on two medications, an antidepressant and an antipsychotic, and she has continued these medications daily as an outpatient. At her appointment, she complains to her physician that she has missed her menstrual period for two months. She also complains of tenderness in her breasts, and an occasional small amount of milky discharge from her breasts onto her blouse. When questioned further, she also admits to low libido over the past month. Which of the following medications is most likely responsible for this constellation of symptoms?
A. Olanzapine
B. Paroxetine
C. Quetiapine
D. Risperidone
E. Sertraline
ok then DD, even though any of the antipsychotics can cause hyperprolact...
The correct answer is D.
Although risperidone is an atypical antipsychotic, it is like conventional antipsychotics in its ability to cause significant elevations in plasma prolactin levels. In the tuberoinfundibular dopamine pathway, dopamine inhibits the release of prolactin from the anterior pituitary. Conventional antipsychotics and risperidone can cause hyperprolactinemia due to their dopamine antagonism in this pathway, releasing the tonic dopamine inhibition. Clinical manifestations of hyperprolactinemia may include galactorrhea, sexual dysfunction, menstrual irregularities including amenorrhea, infertility, and weight gain.
Olanzapine (choice A) is an atypical antipsychotic agent that causes minimal, if any, elevation in prolactin concentrations. It would be very unlikely that routine doses of olanzapine would cause symptoms of hyperprolactinemia.
Paroxetine (choice B) is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression and certain anxiety disorders. It would not induce hyperprolactinemia causing the above clinical manifestations.
Quetiapine (choice C) is an atypical antipsychotic that causes minimal, if any, elevation in prolactin concentrations.
Sertraline (choice E) is an SSRI and would not cause hyperprolactinemia