| Abstract | Cilj istraživanja: Cilj ovog specijalističkog rada je identificirati povezanost hiperprolaktinemije izazvane
antipsihoticima s pojavom karcinoma dojke i karcinoma prostate i osvrnuti se na uloge koje ljekarnici
mogu imati u identifikaciji i zbrinjavanju hiperprolaktinemije kao nuspojave antipsihotika. Terapijske
probleme treba pravovremeno prepoznati i riješiti ili prevenirati jer isti mogu negativno utjecati na
željeni ishod liječenja.
Materijal i metode: U tu svrhu je napravljen sustavni i retrospektivni pregled znanstvene i stručne
literature, relevantnih dijagnostičkih priručnika, baze lijekova Agencije za lijekove i medicinske
proizvode, publikacija stručnih udruga i institucija i drugih raspoloživih izvora za ključne riječi:
antipsihotici, hiperprolaktinemija, karcinom dojke, karcinom prostate.
Rezultati: Istražen je utjecaj hiperprolaktinemije izazvane antipsihoticima na rizik od pojave karcinoma
dojke i prostate, kao i povezanost shizofrenije s povećanim mortalitetom i povećanim rizikom od
razvoja drugih tjelesnih bolesti.
Zaključak: Kod oboljelih od shizofrenije nailazimo na većinu faktora rizika od pojave malignih bolesti.
Neki od njih su prisutni zbog loših životnih navika (pušenje, alkohol, loša ishrana, niska fizička
aktivnost), a neki su nuspojava antipsihotika (hiperprolaktinemija, debljina).
U niti jednoj studiji hiperprolaktinemija izazvana antipsihoticima nije povezana s povećanim rizikom
od pojave karcinoma prostate, a povezanost s povećanim rizikom od pojave karcinoma dojke je
potvrđena u više studija.
Na povišenu razinu prolaktina u serumu najveći utjecaj imaju tipični antipsihotici (haloperidol,
flufenazin), a od atipičnih risperidon i amisulprid. Glavni simptomi hiperprolaktinemije su
ginekomastija, galaktoreja, neplodnost, neregularni menstrualni ciklusi kod žena i erektilna disfunkcija
kod muškaraca. Ti simptomi često prođu nezapaženo, pa je važno da i ljekarnici i liječnici redovito
provjeravaju s pacijentima koji uzimaju neki od tih antipsihotika da li imaju neki od tih simptoma, da bi
se spriječile komplikacije koje može izazvati neliječena hiperprolaktinemija.
U svim studijama je utvrđena veća smrtnost od karcinoma kod oboljelih od shizofrenije u odnosu na
ostalu populaciju. To je posebno izraženo kod karcinoma dojke, kod kojeg je utvrđena 20% veća
smrtnost od karcinoma dojke kod žena koje boluju od neke psihičke bolesti u odnosu na ostale žene.
Glavni razlog veće smrtnosti je, uz postojanje ostalih faktora rizika, prekasno postavljanje dijagnoze.
Da bi se tu napravio pomak, svi sudionici zdravstvenog sustava trebaju pomoći da se poveća
uključenost psihičkih bolesnika u organizirana probirna testiranja, da ih se educira o važnosti
preventivnih pregleda i da se pokušaju smanjiti faktori rizika pojave karcinoma na koje mogu
utjecati. |
| Abstract (english) | The goal of this research:
The focus of this thesis is to identify association between the antipsychotic-induced
hyperprolactinemia and the incidence of breast and prostate cancer, focusing particular on the
pharmacist’s role in identifying and treating hyperprolactinemia as antipsychotics side effects.
Therapeutic problems need to be identified and resolved or prevented to avoid potential negative
effect on the desired outcome of the treatment.
Research methods:
Systematic and retrospective review of scientific and professional literature, relevant diagnostic
manuals, Medicinal Products Database of Agency for Medicinal Products and Medical Devices of
Croatia, professional publications published by professional associations and institutions and other
available sources for keywords: antipsychotics, hyperprolactinemia, breast cancer, prostate cancer.
Results:
The effect of antipsychotic-induced hyperprolactinemia was studied as risk of breast and prostate
cancer as well as association between schizophrenia and premature mortality and increase risk of
developing other physical illnesses.
Conclusion:
We find majority of the cancer risk factors among patients with schizophrenia. Some of them are
present due to bad habits (smoking, alcohol abuse, poor diet, reduces physical activities), and some
are side effects of antipsychotic medications (hyperprolactinemia, overweight).
No study observe association between antipsychotic-induced hyperprolactinemia and risk of prostate
cancer, but several studies show association with breast risk.
The biggest influence on increase prolactin plasma concentration have typical antipsychotics
(haloperidol, fluphenazine), and from atypical risperidone and amisulpride. The most frequent
symptoms of hyperprolactinemia are: gynaecomastia, galactorrhoea, infertility, menstrual
irregularities by women and erectile dysfunction by man.
Since those symptoms could remain undetected it is crucial that pharmacists and doctors check
carefully described symptoms with patients who are taking antipsychotics. This will prevent
complications which could be caused by untreated hyperprolactinemia.
All study indicated the higher mortality from cancer for the patients with schizophrenia compared to
the general population.
It is particularly significant for breast cancer where was found 20% higher mortality rate for women
with severe mental illness then that of women without mental illness. The main reason for the higher
mortality is delayed diagnosis including existence of other cancer risk factors.
To make step forward, all health care professionals should help to involve more mental patients in an
organized screening testing, to educate them about the importance of prevention exams and try to
reduce the risk factors which can be affected. |
