Clinical, Biochemical and Genetic Variables Associated With Metabolic Syndrome in Patients With Schizophrenia Spectrum Disorders Using Second-Generation Antipsychotics: A Systematic Review

Abstract

Background: Individuals with severe mental illness experience increased morbidity and mortality compared to the general population. Adverse effects of antipsychotics, including weight gain, may contribute to the development of metabolic syndrome (MetS), which is associated with increased risks of all-cause and cardiovascular disease mortality. We aim to provide a comprehensive overview of clinical, biochemical and genetic factors associated with MetS among patients with schizophrenia spectrum disorders using second-generation antipsychotics (SGA).Methods: A literature search was performed in Pubmed and Embase to identify all cohort studies, cross-sectional studies and clinical trials investigating associations with MetS in patients with schizophrenia spectrum disorders using SGAs. We extracted and enumerated clinical, biochemical and genetic factors reported to be associated with MetS. We defined factors associated with MetS as factors being reported as associated with MetS in two or more studies.Results: 58 studies were included in this review (n = 12,123). In total, 62 factors were found to be associated with increased risk of MetS. Thirty one out of 58 studies investigated factors that were reported as associated with MetS in two or more studies. With regard to clinical factors, we found gender, higher age, concomitant use of mood stabilizers, higher baseline and current BMI, earlier SGA exposure, higher dose, longer duration of treatment, psychosis and tobacco smoking to be significantly associated with MetS. Furthermore, the biochemical factors hypo-adiponectinemia, elevated levels of C-reactive protein (CRP) and higher white blood cell (WBC) count were identified as factors associated with MetS. Among pharmacogenetic factors, the rs1414334 C-allele of the HTR2C-gene was associated with MetS in patients using SGA.Conclusion: In this systematic review investigating clinical, biochemical and genetic factors associated with MetS in patients using SGAs we found that higher age, higher baseline BMI, higher current BMI and male as well as female gender were positively associated with MetS across all antipsychotics. This study may set the stage for the application of clinical, biochemical and genetic factors to predict the risk of developing MetS in patients using SGAs. Future research is needed to determine which patients using SGAs are at risk to develop MetS in clinical practice.

Associations between the number of antipsychotics prescribed and metabolic parameters in Japanese patients with schizophrenia

“…Thus, our results may have been influenced by selection bias. Third, we did not adjust for other potential confounding factors, such as duration of illness, concomitant use of other psychotropics (e.g., mood stabilizers), smoking status, and symptom severity 21,28 . Fourth, the data on physical illnesses and the use of medications to treat physical illnesses were not available.…”

Metabolic Side Effects of Olanzapine in Patients With Psychotic Disorders in Oman: A Retrospective Cohort Study

“…Nevertheless, the present findings appear to echo the plethora of published systematic reviews. 4,45,46 In the literature, waist circumference has been established to be a sine qua non for defining MetS. However, as patients were missing waist circumference in their electronic patient files, a BMI of ≥30 kg/m 2 , which has been shown to correlate with increased abdominal obesity, 10,11 was used as a proxy for increased abdominal obesity.…”

Analyze the Influencing Factors and Predictability of Metabolic Syndrome in Schizophrenic Patients Treated with Olanzapine through Decision Tree Model

“…yếu tố chu vi vòng eo của bệnh nhân có điểm cắt (<89 cm) khá tương đồng với tiêu chí vòng eo trong 5 tiêu chí của HCCH theo tiêu chuẩn NCEP ATP III [5]. Tương tự, ở nghiên cứu này của chúng tôi tuổi <36 là yếu tố ảnh hưởng có ý nghĩa tới xuất hiện HCCH, đây cũng là điểm cắt có sự tương đồng với công bố trước đây về yếu tố ảnh hưởng tới HCCH trên bệnh nhân TTPL [3,12]. Tuy nhiên, yếu tố còn lại là nồng độ triglycerid huyết tương, điểm cắt đang là <3,1 mmol/l, cao hơn so với tiêu chí của NCEP ATP III đề xuất (≥ 1,7 mmol/l).…”

“…Phân tích yếu tố ảnh hưởng và khả năng dự đoán hội chứng chuyển hóa ở bệnh nhân tâm thần phân liệt điều trị olanzapin thông qua mô hình cây quyết định Kiều Mai Anh 1,3 , Nguyễn Thanh Tuyền 2 , Nguyễn Hữu Chiến 2,4 , Nguyễn Xuân Bách 4 , Phạm Thu Hương 5 , Nguyễn Chí Thành 5 , Nguyễn Thành Hải Tóm tắt: Hội chứng chuyển hóa (HCCH) là vấn đề thường gặp trong thực hành sử dụng olanzapin, có thể dẫn đến hậu quả là các rối loạn tim mạch nghiêm trọng, việc xác định yếu tố ảnh hưởng hay yếu tố dự báo để đưa ra biện pháp xử trí kịp thời khi kê đơn đóng vai trò quan trọng nhằm tối ưu độ an toàn khi sử dụng thuốc trên bệnh nhân tâm thần phân liệt (TTPL) có chỉ định olanzapin. Đối tượng và phương pháp nghiên cứu: các bệnh nhân điều trị nội trú thỏa mãn tiêu chuẩn lựa chọn và loại trừ vào viện từ 10/12/2015 đến 30/06/2019 tại Bệnh viện Tâm thần Trung ương 1.…”