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Personality disorders by numbers

Australian & New Zealand Journal of Psychiatry, 51(11) vitamin D: factors that are common in the general population and even more common in a population with serious mental illness (SMI). More recently, some clinicians have expressed concern regarding the potential relationship between chronically elevated prolactin levels and breast cancer; however, there remains no conclusive evidence that antipsychotics and increased prolactin contribute to the pathogenesis of breast cancer (Ajmal et al., 2014; De Hert et al., 2016). Furthermore, the results are merely correlative, from which causation cannot be extrapolated (De Hert et al., 2016). Rather lifestyle factors similar to those implicated in osteoporosis with the addition of nulliparity for females: factors which are overly represented in an SMI population are more detrimental (De Hert et al., 2016). In the context of schizophrenia and antipsychotic use, this unnecessary testing of prolactin levels when not indicated by symptomatology is a waste of both time and resources. Both of which would be better utilized by a thorough history taken with regard to hyperprolactinemia symptoms as well as trying to motivate clients to consider and implement healthier lifestyle practices that contribute to a myriad of chronic illnesses that are overly represented in an SMI population. Furthermore, this unnecessary testing may lead to the unwarranted switching of antipsychotics to prolactin-sparing agents or the addition dopamine agonists, both of which can have a detrimental impact to the patient’s mental health and stability. Therefore, it is asserted that even if prolactin levels increase from baseline up to 2000 μg/L, if the patient is not exhibiting symptoms of hyperprolactinemia, nothing should be done. Beyond this level, further investigation is indicated.