Beyond the "Hype" on the Association Between Metabolic Syndrome and Atypical Antipsychotics

Leon, José de

doi:10.1097/jcp.0b013e318166f533

Cited by 21 publications

(3 citation statements)

References 64 publications

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“…The aetiology of CVD in SMI is known to be multi-factorial and the lack of a difference in the prevalence of MetS between the study and the control group in this study may be explained by common determinants of MetS in the two groups. It is possible that the role of antipsychotic medication in the aetiology of MetS in SMI may be exaggerated in the psychiatric literature 5 , 17 and, key factors driving the increased prevalence of MetS in black women with SMI and black women in the general population in this study may be shared population-level risk factors for MetS, namely the rapid epidemiologic and nutritional transitions in the region, 3 low activity levels, poor socioeconomic conditions, urbanisation 18 and socio-cultural perceptions of overweight among black South African women. 19 Our results therefore support antipsychotic independent mechanisms such as genetics, hormones, societal or life-style factors to account for the higher prevalence of obesity and MetS among black women with SMI.…”

Section: Discussionmentioning

confidence: 99%

“…The study of MetS in severe mental illness (SMI) is relevant because there is an increased prevalence of MetS in SMI. 4 The cause of this increased prevalence is complex and multi-factorial, 5 with a significant contribution from antipsychotic medication. 4 From previous studies, there is a suggestion that women with SMI are at higher risk for MetS than men with SMI, 6 , 7 , 8 possibly because of an increased susceptibility to the metabolic side effects of antipsychotics.…”

Section: Introductionmentioning

confidence: 99%

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High risk of metabolic syndrome among black South African women with severe mental illness

2017

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BackgroundThere is an increased prevalence of metabolic syndrome (MetS) in individuals with severe mental illness (SMI) globally. The prevalence of MetS is higher in black women compared to black men from South Africa.AimTo compare the prevalence of MetS between black South African men and women with SMI taking antipsychotic medication. Further, this prevalence was compared to the prevalence in a matched control group of black South African men and women without SMI.SettingA general hospital psychiatric unit.MethodsA cross-sectional study was undertaken to compare the prevalence of MetS in a group of multi-ethnic participants with SMI treated with antipsychotic medication and a matched control group without SMI, applying the 2009 Joint Interim Statement (JIS) criteria. Here, we included only the black African participants to compare MetS prevalence between men and women.ResultsThere were 232 participants in the group with SMI (male 155 and female 77) and without SMI (male 156 and female 76). The prevalence of MetS was more than three times higher in women with SMI compared to men with SMI (37.7% vs. 10.3%, p < 0.001). There was no significant difference in the prevalence of MetS in men or women between the groups with and without SMI. In multivariate logistic regression analysis, female gender (odds ratio [OR] 7.66), advancing age (OR 1.08) and longer duration of illness (OR = 1.15) were significant risk factors for MetS in SMI.ConclusionIn black South Africans with SMI on antipsychotic medication, there is a higher prevalence and risk for MetS in women compared to men.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High risk of metabolic syndrome among black South African women with severe mental illness

2017

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“…Primarily, studies of an observational nature have been conducted and have provided useful information. However, using observational data to compare outcomes associated with antipsychotic polypharmacy may result in biased estimates [15]. Because the type of treatment (monotherapy or polypharmacy) was not randomly assigned in these prior studies, patients with specific characteristics, such as disease severity, could have been more likely to have been treated with polypharmacy.…”

Section: Introductionmentioning

confidence: 99%

Relapse according to antipsychotic treatment in schizophrenic patients: a propensity-adjusted analysis

et al. 2011

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ObjectiveTo compare the rate of relapse as a function of antipsychotic treatment (monotherapy vs. polypharmacy) in schizophrenic patients over a 2-year period.MethodsUsing data from a multicenter cohort study conducted in France, we performed a propensity-adjusted analysis to examine the association between the rate of relapse over a 2-year period and antipsychotic treatment (monotherapy vs. polypharmacy).ResultsOur sample consisted in 183 patients; 50 patients (27.3%) had at least one period of relapse and 133 had no relapse (72.7%). Thirty-eight (37.7) percent of the patients received polypharmacy. The most severely ill patients were given polypharmacy: the age at onset of illness was lower in the polypharmacy group (p = 0.03). Patients that received polypharmacy also presented a higher general psychopathology PANSS subscore (p = 0.04) but no statistically significant difference was found in the PANSS total score or the PANSS positive or negative subscales. These patients were more likely to be given prescriptions for sedative drugs (p < 0.01) and antidepressant medications (p = 0.03). Relapse was found in 23.7% of patients given monotherapy and 33.3% given polypharmacy (p = 0.16). After stratification according to quintiles of the propensity score, which eliminated all significant differences for baseline characteristics, antipsychotic polypharmacy was not statistically associated with an increase of relapse: HR = 1.686 (0.812; 2.505).ConclusionAfter propensity score adjustment, antipsychotic polypharmacy is not statistically associated to an increase of relapse. Future randomised studies are needed to assess the impact of antipsychotic polypharmacy in schizophrenia.

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Evaluation of Different Approaches for Confounding in Nonrandomised Observational Data: A Case-Study of Antipsychotics Treatment

Sarlon

Millier

Aballéa

et al. 2014

Community Ment Health J

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Although randomised controlled trials are regarded as the gold standard for treatments efficacy, evidence from observational studies remains relevant. To address the problem of possible confounding in these studies, investigators must employ analysis methods that adjust for confounders and lead to an unbiased estimation of the treatment effect. In this paper, the authors describe two relevant statistical methods. The first method represents the classical approach consisting of a multiple regression model including the effects of treatment and covariates. This approach considers the relation between prognostic factors and the outcome variable as a relevant criterion for adjustment. The second method is based on the propensity score, and focuses on the relation between prognostic factors and treatment assignment. These approaches were applied to a cohort of 183 French schizophrenic patients who were followed for a 2-year period (from 1998 to 2000). The probability of relapse according to antipsychotic treatment exposure was modelled using Cox regression models with the two statistical methods. Goodness-of-fit criteria were used to compare the modelling approaches. This study demonstrates that the propensity score, a predicted probability, has an important balancing property that underscores its value in strengthening the results of nonrandomised observational studies.

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Beyond the "Hype" on the Association Between Metabolic Syndrome and Atypical Antipsychotics

Cited by 21 publications

References 64 publications

High risk of metabolic syndrome among black South African women with severe mental illness

High risk of metabolic syndrome among black South African women with severe mental illness

Relapse according to antipsychotic treatment in schizophrenic patients: a propensity-adjusted analysis

Evaluation of Different Approaches for Confounding in Nonrandomised Observational Data: A Case-Study of Antipsychotics Treatment

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