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Serotonin
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Norepinephrine
GABA
Dopamine
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Nitric Oxide
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This patient takes haloperidol, which can cause elevation of prolactin levels through dopamine blockade. Antipsychotics inhibit the actions of dopamine by blocking dopaminergic receptors in the brain. Dopamine inhibits prolactin. Therefore, dopamine blockade can lead to elevated prolactin levels and accompanying signs and symptoms, such as galactorrhea and hypogonadism. Muench et al. review antipsychotic side effects. First generation antipsychotics, such as haloperidol, bind more tightly to dopaminergic receptors and, thus, are more likely to cause movement disorders. Second generation (atypical) antipsychotics bind less tightly to dopaminergic receptors. They have more anticholingeric, antihistaminic, and anti alpha-adrenergic activity and are more likely to cause metabolic problems. Inder et al. review antipsychotic-induced hyperprolactinemia. The condition may occur in up to 70% of patients treated for schizophrenia. Resulting hypogonadism can lead to sexual dysfunction, bone loss, and other side effects, in a manner correlated with serum prolactin levels. Illustration A diagrams the regulation of prolactin release. Incorrect Answers: Answers 1, 2, 3, and 5: These neurotransmitters do not play a role in the prolactin regulatory axis.
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