Improved Body Weight and Metabolic Outcomes in Overweight or Obese Psychiatric Patients Switched to Amisulpride From Other Atypical Antipsychotics

Lin, Chao-Cheng; Bai, Ya‐Mei; Wang, Daqing; Chen, Tzu-Ting; Chen, Jen-Yeu; Chen, Shiow‐Yi; Gau, Susan Shur‐Fen; Liou, Ying‐Jay

doi:10.1097/jcp.0b013e3181bf613e

Cited by 21 publications

(24 citation statements)

References 55 publications

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“…According to a previous meta-analysis of head-to-head comparisons of the metabolic side effects of atypical antipsychotics,37 olanzapine produces more weight gain and a greater increase in cholesterol and glucose than other atypical antipsychotics. However, aripiprazole among atypical antipsychotics has shown a relatively lower risk of MetS than other antipsychotics 383940. In line with these reports, the prevalence of MetS was highest in our clozapine group and the patients who had been prescribed aripiprazole had the second lowest prevalence of MetS.…”

Section: Discussionsupporting

confidence: 87%

Prevalence of Metabolic Syndrome in Patients with Schizophrenia in Korea: A Multicenter Nationwide Cross-Sectional Study

Lee

Kwon

Kim

et al. 2017

Psychiatry Investig

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ObjectiveWe designed a nationwide study with limited exclusion criteria to investigate the prevalence of metabolic syndrome (MetS) in Korea and its relationship with antipsychotic medications.MethodsThis multicenter, cross-sectional, and observational study included patients diagnosed with schizophrenia or schizoaffective disorder. Sixteen hospitals enrolled 845 patients aged 18 to 65 years prescribed any antipsychotic medication between August 2011 and August 2013. MetS was diagnosed using the criteria of the modified Adult Treatment Panel III of the National Cholesterol Education Program with the Korean abdominal obesity definition (waist circumference ≥85 cm in women, ≥90 cm in men).ResultsThe prevalence of MetS in all patients was 36.5% and was significantly higher in men than women (men, 40.8%; women, 32.2%) and was significantly correlated with age [odds ratio (OR) 1.02] and duration of illness (OR 1.03). The prevalence of MetS across antipsychotic drugs in the major monotherapy group was as follows: 18.8% for quetiapine, 22.0% for aripiprazole, 33.3% for both amisulpride and paliperidone, 34.0% for olanzapine, 35% for risperidone, 39.4% for haloperidol, and 44.7% for clozapine.ConclusionThe prevalence of MetS is very high in patients with schizophrenia or schizoaffective disorder. Screening and monitoring of MetS is also strongly recommended.

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Section: Discussionsupporting

confidence: 87%

Prevalence of Metabolic Syndrome in Patients with Schizophrenia in Korea: A Multicenter Nationwide Cross-Sectional Study

Lee

Kwon

Kim

et al. 2017

Psychiatry Investig

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“…While some have just followed up patients on the same antipsychotics that they have been receiving at baseline,[106107111113] a few have reported the change in prevalence rate after change in antipsychotic. [112114116117] Some of the studies have evaluated the effect of various antipsychotics by randomizing the study sample to different antipsychotic medications. [109110118] While most of the studies have included adult patients, two studies longitudinally evaluated MetS in pediatric population.…”

Section: Prevalence Of Metabolic Syndrome In Schizophreniamentioning

confidence: 99%

Metabolic Syndrome in Schizophrenia

Malhotra¹,

Grover²,

Chakrabarti³

et al. 2013

Indian Journal of Psychological Medicine

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To review the data with respect to prevalence of metabolic syndrome (MetS) and its correlates in schizophrenia. For this review, electronic search engines PUBMED, Sciencedirect, and Google Scholar were used. Available data suggests that most of the studies have been of cross-sectional design. Prevalence rates of MetS have varied from 11% to 69% in medicated patients, and 4-26% in drug naive patients in cross-sectional evaluations. Longitudinal studies have shown the prevalence rates to range from 0% to 14% at the baseline in drug naive patients, which increase to as high as 52.4% by 3 months of antipsychotic medication treatment. The prevalence rates of MetS in patients with schizophrenia are much higher than that seen in general population or healthy controls. Though there is no causal association with any demographic or clinical variables, the risk increases with increase in age. Among antipsychotics, there seems to be an association between MetS and atypical antipsychotics like clozapine and olanzapine. Therefore, the psychiatrists should be more vigilant regarding the presence of MetS in these high risk groups. Research on biological correlates of MetS in schizophrenia is still in its primitive stage, however, these is some evidence to suggest an association of MetS with adiponectin levels, hematological indices, methylenetetrahydrofolate reductase (MTHFR) and Alpha-1A adrenergic receptor (ADRA1A) gene. These areas hold promise, and targeting these with appropriate interventions may help us to prevent the occurrence of MetS in patients with schizophrenia in future.

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“…Likewise, a number of short-term [92-96] and long-term [97-99] studies have shown a significant decrease in weight and other cardiometabolic risk factors in patients switched to a lower weight and metabolic risk antipsychotic. For example, in a one-year study [99], patients switching from a first-generation antipsychotic to ziprasidone did not show any relevant change in weight or triglyceride levels.…”

Section: Strategies To Reduce Antipsychotic Associated Weight Gain Anmentioning

confidence: 99%

Management of antipsychotic-related weight gain

Maayan

Correll

2010

Expert Review of Neurotherapeutics

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Despite variations across individuals and agents, antipsychotics are associated with clearly documented weight gain and adverse metabolic effects. Although increased appetite/caloric intake and various receptors, hormones and peptides have been implicated, biological mechanisms contributing to the increase in weight and glucose and lipid abnormalities with antipsychotics are largely unknown. This has hampered the creation of antipsychotics that are free of cardiometabolic effects, even in antipsychotic-naïve/early-phase patients, as well as the development of strategies that can prevent or drastically diminish the adverse cardiometabolic effects. In general, three strategies can reduce the cardiometabolic risk of antipsychotics: 1) switching to a less orexigenenic/metabolically adverse antipsychotic, 2) adjunctive behavioral treatments and 3) adjunctive pharmacologic interventions. However each of these strategies has only been modestly effective. Among different behavioral interventions (N=14, n=746), group and individual treatment, dietary counseling and cognitive-behavioral therapy seem to be similarly effective. Among 15 different pharmacologic strategies (N=35 , n=1,629), only metformin, fenfluramine, sibutramine, topiramate and reboxetine were more effective than placebo, with the most evidence being available for metformin, yet without any head-to-head trials comparing individual pharmacologic interventions. Even in the most successful trials, however, the risk reduction was modest. Weight was not decreased to a pre-treatment level, and despite superiority compared to placebo, weight gain still often occurred, particularly in antipsychotic-naïve patients and when interventions were “preventively” co-initiated with antipsychotics. Future research should focus on combining treatment modalities or agents and on exploring novel mechanism-based interventions.

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Improved Body Weight and Metabolic Outcomes in Overweight or Obese Psychiatric Patients Switched to Amisulpride From Other Atypical Antipsychotics

Cited by 21 publications

References 55 publications

Prevalence of Metabolic Syndrome in Patients with Schizophrenia in Korea: A Multicenter Nationwide Cross-Sectional Study

Prevalence of Metabolic Syndrome in Patients with Schizophrenia in Korea: A Multicenter Nationwide Cross-Sectional Study

Metabolic Syndrome in Schizophrenia

Management of antipsychotic-related weight gain

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