Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
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Ask the expert

Is it true that antipsychotic drugs can produce Parkinson's disease in the long run?

Not Parkinson's disease, but Parkinson-like symptoms. They can cause tremors or, to a certain extent, rigidity. That is because the drugs used for the treatment of schizophrenia affects the same part of the brain that is involved in Parkinson's disease. If you stop using those drugs, the symptoms can be reversed.
-Judes Poirier, PhD, Mini-Psych School 2006

My brother, who suffers from schizophrenia, has gained a lot of weight due to his meds. Any recommendations other than exercise and diet?

I don't really know what to recommend. The only thing I can say is that we are starting a trial and it will be offered to people who have not had previous treatments. It involves a medication, in combination with antipsychotics, that actually reduces weight gain. We hope it will prove useful. The trial began in Israel and we are taking part. If it works, we hope the medication will be available for use in several years. There are signs of hope!
- Ashok Malla, MD,  Mini-Psych School 2006

Why is a seriously ill person not forced to take medication, but allowed to "opt out" of medication and live a disastrous life?

As most of you know, our mental health laws across Canada (each province has its own laws, but they are very similar) are not based on medical grounds. Firstly, they're based on individual liberty. Secondly, they're based on whether or not you'll cause harm to somebody else or imminent harm to yourself. Unless those conditions are present, we cannot force people to take medication. Sometimes we feel we have enough evidence to prove that a person will deteriorate, but we may not have enough evidence to convince the judge. It's not entirely a medical decision.

What is Thorazine ?

Thorazine is a brand name of the original Chlorpromazine, a discovery for which P Deniker, H Laborit and J Delay got the Laskar Award of medicine, the most prestigious award in the medical sciences. This is the parent molecule of all antipsychotic medications which helped millions of people to live better lives despite severe mental illness like schizophrenia.

What are the dangers of high blood serum prolactin levels?

Prolactin is a hormone that promotes lactation in humans. Prolactin is highly controlled by dopamine: when dopamine is active, it inhibits prolactin secretion. Anti-psychotic medication can block dopamine, which means that there isn’t enough dopamine to block the prolactin. Some patients will experience increased prolactin levels, but this does not always translate into symptoms, such as producing milk (although this can occur).

The prolactin level itself is not a condition or a disorder, but if you have symptoms like lactation then you need to do something. There are medications that are less prolactin-promoting, and we have some medications that don’t increase prolactin at all. We even have a neuroleptic called aripiprazole that can at least partially reverse prolactin levels. So there are different strategies to deal with this; however, if you have high prolactin levels without any other symptoms, this is not something to worry about.
- Ridha Joober, MD, PhD, Mini-Psych School 2012

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