May 2010

Borderline Personality Disorder: A Role for Medication?
Antipsychotics, including aripiprazole (Abilify) and olanzapine (Zyprexa), as well as mood stabilizers, such as topiramate (Topamax) and lamotrigine (Lamictal), alleviate some symptoms of borderline personality disorder, but the effects of antidepressants on this condition are variable.

Morphine to Prevent PTSD
Early treatment with morphine following an injury may reduce the risk of posttraumatic stress disorder (PTSD).

Risperidone-Induced Hyperprolactinemia Lowers BMD in Boys
Both risperidone (Risperdal and others), through its effects on prolactin concentrations, and selective serotonin reuptake inhibitors (SSRIs) can lower bone mineral density in boys.

Priapism with Antipsychotics
Antipsychotic medications with a high affinity for the α1-adrenal receptor, such as chlorpromazine (Thorazine), quetiapine (Seroquel), and ziprasidone (Geodon), may be more likely to cause priapism than those with a low affinity.

In Brief
Spouses of People with Dementia Have Higher Risk of Depression; Modafinil (Provigil) Effective for Treating Fatigue in HIV+ Patients

Citalopram and Escitalopram Overdoses
Overdoses with both citalopram (Celexa and others) and escitalopram (Lexapro) can cause serious toxicity.

Risperidone-Induced Hyperprolactinemia Lowers BMD in Boys

May 2010

Among second-generation antipsychotics, risperidone (Risperdal and others) is most likely to increase prolactin concentrations. Hyperprolactinemia in turn can reduce bone mineral density (BMD). Risperidone is commonly prescribed for children and adolescents. It is indicated for the treatment of schizophrenia in adolescents aged 13 to 17 years; for the short-term treatment of acute manic or mixed episodes associated with bipolar I disorder in children and adolescents aged 10 to 17 years; and for the treatment of irritability associated with autistic disorder in children and adolescents aged 5 to 16 years. Calarge and others investigated the effects of risperidone on BMD in young males.1

In a naturalistic study, the authors enrolled 83 boys, aged 7 to 17 years, who carried a wide range of diagnoses and had been taking risperidone for 6 months to 8 years. Many were taking other psychotropic medications in addition to risperidone.

About half of the patients had hyperprolactinemia, which was associated with a higher risperidone dose. More than half of the patients were concomitantly taking selective serotonin reuptake inhibitors (SSRIs), which had no independent effect on prolactin concentrations but may have contributed to lower BMD. Serum prolactin was associated with decreased BMD at the ultradistal radius.

The authors conclude that risperidone-induced hyperprolactinemia and SSRIs might independently hinder bone mineralization in boys, which could prevent a child from reaching his genetically determined peak bone mass. Children typically take these medications for many years, and the consequence could be increased risk of fractures and osteoporosis.

1Calarge CA, Zimmerman B, Xie D, Kuperman S, Schlechte JA: A cross-sectional evaluation of the effect of risperidone and selective serotonin reuptake inhibitors on bone mineral density in boys. J Clin Psychiatry 2010;71:338-347.