Treatment of psychotic symptoms has traditionally involved conventional
antipsychotics. While efficacious, their side-effects have been problematic and the approval by the Food and Drug Administration of the newer
antipsychotics with improved side-effects profiles heralded important advances in treating
psychoses.
Prolactin elevation has been associated with all classical and some atypical
antipsychotics. We present cases where elevation of
prolactin concentrations secondary to
antipsychotic treatment was associated with delusions of pregnancy.
Risperidone was the
antipsychotic employed and elevation of
prolactin concentrations were noted each time. The delusions abated and
prolactin concentrations decreased when the
drug was discontinued. Rechallenge with
risperidone resulted in re-elevation of
prolactin levels along with recurrent delusions. Substituting
risperidone with another
antipsychotic (either
olanzapine or
quetiapine) also led to abatement of the delusions and lowering of
prolactin. Although no direct psychotogenic effects of
prolactin are known, it is contended that delusions of pregnancy reported during
antipsychotic treatment might be associated with rising
prolactin concentrations.