The majority of such patients have a history of serious and usually violent offences. Almost all of these patients are detained under the Mental Health Act and are commonly subject to restriction orders [Anderson, 2008]. In these patients, changing to oral antipsychotics is often not a viable option because of a history of poor compliance and insight. If patients with a history of violence related to psychosis are going to achieve discharge it is likely to be on depot medication. Hyperprolactinaemia is a commonly seen adverse effect of antipsychotic medication [Petty, 1999] which is caused by D2 receptor Inhibitors,research,lifescience,medical drug binding [Markianos
et al. 2001]. Because all the available depots are potent D2 blockers, raised prolactin levels can be associated with depression, sexual dysfunction, amenorrhoea, galactorrhoea, breast cancer and osteoporosis [Halbreich et al. 2003; Maguire, 2002]. There is evidence to show that patients are more concerned with the sexual side effects than any other side effects [Finn et al. 1990], which is one of the main reasons why patients Inhibitors,research,lifescience,medical stop taking depot medication. In an adolescent forensic secure hospital we have had clinical experience of reducing prolactin levels and restoring sexual function in two young men with hyperprolactinaemia secondary to depot antipsychotic medication. Case 1 An 18-year-old man with a history of severe unprovoked violence directly Inhibitors,research,lifescience,medical related to
psychosis had made a good clinical response to zuclopenthixol decanoate 500 mg taken fortnightly. Prior to the prescription of depot he had been started on orodispersible olanzapine in a youth offender institute. He refused medication on a frequent basis and following transfer Inhibitors,research,lifescience,medical to hospital was prescribed
a test dose of zuclopenthixol. The dose was Hydroxychloroquine concentration titrated up to 500 mg fortnightly over 3 months. He complained of being unable to ejaculate since being on the depot and had a raised prolactin level of 492 mU/ml (normal range in men is 55.4–276). He had mild gynaecomastia. He experienced a worsening of psychotic symptoms when we attempted Inhibitors,research,lifescience,medical a dose reduction. Because of his poor insight and statements he made about wanting to stop medication we did not consider that a nondepot first would be viable. However, we discussed with him the possibility of prescribing aripiprazole in order to try and restore sexual function and he agreed to try this in addition to the zuclopenthixol decanoate injection. The ariprazole was commenced at a dose of 10 mg. His prolactin levels fell to 182 mU/ml over a period of a month and he stated that he was able to get an erection again and ejaculate. Because he refused to have further blood tests it was not possible to continue to monitor his prolactin level. We excluded other potential causes of hyperprolactinaemia. Case 2 The second case was a 17-year-old man with a psychotic illness and a history of serious violence.