Insulin Resistance and Increased Leptin Concentrations in Noncompliant Schizophrenia Patients but Not in Antipsychotic-Naive First-Episode Schizophrenia Patients

Arranz, Belén; Rosel, Pilar; Ramı́rez, Nicolás; Dueñas, Rosa; Fernández, Paloma; Sánchez, J.M. Hernández; Navarro, Miguel; San, Luis

doi:10.4088/jcp.v65n1007

Cited by 142 publications

(104 citation statements)

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“…However, hypercortisolemia is not typically observed in patients with schizophrenia during chronic antipsychotic treatment (53), so this study possibly overestimated the degree of insulin resistance and hyperglycemia that can be expected to persist past the acute psychotic episode and (or) agitated condition that led to hospitalization. This group also reported increased intraabdominal fat in drug-naive patients, in contrast to other larger samples showing no differences in drug-naive patients (54)(55)(56). However, this patient sample had an uncharacteristically long period of untreated illness and a higher mean age than most reported samples of first-episode patients (57).…”

Section: Insulin Resistance Diabetes and Antipsychotic Treatmentmentioning

confidence: 68%

The Metabolic Effects of Antipsychotic Medications

2006

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Objectives: To review current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and type 2 diabetes mellitus (T2DM) and to examine the relation of adiposity to medical risk. Methods:We identified relevant publications through a search of MEDLINE from the years 1975 to 2006, using the following primary search parameters: "diabetes or hyperglycemia or glucose or insulin or lipids" and "antipsychotic." Meeting abstracts and earlier nonindexed articles were also reviewed. We summarized key studies in this emerging literature, including case reports, observational studies, retrospective database analyses, and controlled experimental studies.Results: Treatment with different antipsychotic medications is associated with variable effects on body weight, ranging from modest increases (for example, less than 2 kg) experienced with amisulpride, ziprasidone, and aripiprazole to larger increases during treatment with agents such as olanzapine and clozapine (for example, 4 to 10 kg). Substantial evidence indicates that increases in adiposity are associated with decreases in insulin sensitivity in individuals both with and without psychiatric disease. The effects of increasing adiposity, as well as other effects, may contribute to increases in plasma glucose and lipids observed during treatment with certain antipsychotics. Conclusion:Treatment with certain antipsychotic medications is associated with metabolic adverse events that can increase the risk for metabolic syndrome and related conditions such as prediabetes, T2DM, and cardiovascular disease. Limitations· Currently, knowledge of the cost-effectiveness of different interventions to lower metabolic risk is limited. · Questions remain concerning how to implement clinical strategies that would improve quality and disparities of care in mental illness. · Future studies are needed to identify the mechanisms that allow medications to cause adiposity and changes in insulin sensitivity.

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Section: Insulin Resistance Diabetes and Antipsychotic Treatmentmentioning

confidence: 68%

The Metabolic Effects of Antipsychotic Medications

2006

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“…Some (Ryan et al, 2003) but not all (Arranz et al, 2004, Zhang et al, 2004a more recent studies have confirmed this finding. Reasons for elevated glucose parameters in psychotic illness may include unhealthy lifestyle (Zhang et al, 2004a;McEvoy and Brown, 1999;Ryan et al, 2004) in the early stages of schizophrenia as well as genetic factors: diabetes occurs in up to 30% of the relatives of those with schizophrenia (Mukherjee et al, 1989).…”

Section: Introductionmentioning

confidence: 73%

Early treatment-related changes in diabetes and cardiovascular disease risk markers in first episode psychosis subjects

Graham

Cho

Brownley

et al. 2008

Schizophrenia Research

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Objective-To examine prospective changes in cardiovascular disease (CVD) and type-2 diabetes risk factors in young adult first episode psychotic (FEP) patients treated with second generation antipsychotic medications.Methods-At baseline, fasting serum and anthropometric measures were obtained from 45 FEP patients and 41 healthy adults (controls) of similar age, ethnicity and sex; sixteen of the FEP patients remained on the same antipsychotic medication and were available for a second blood draw at 24 weeks of treatment. Serum was assayed for glucose, insulin, triglycerides, total cholesterol and high and low density lipoproteins (HDL, LDL), adiponectin, leptin, interleukin 6, E-selectin and VCAM-1. Wilcoxon nonparametric tests were used to compare risk markers between the FEP and control group at baseline and to evaluate pre-post treatment changes within the FEP group.Results-At baseline, the distributions of risk marker values were similar between the two groups and the percentages of FEP patients and healthy controls who were overweight/obese, dyslipidemic, hyperglycemic, and hyperinsulinemic did not differ. At 24 weeks, compared to baseline, FEP patients showed significant increases in BMI (p=0.0002), glucose (p=0.0449), insulin (p=0.0161), cholesterol (p=0.0129), leptin (p=0.0215), and E-selectin (p=0.0195), and a decrease in adiponectin (p=0.0371).Conclusions-Among patients with first episode psychosis, 6-month treatment with second generation antipsychotics is associated with the exacerbation of pre-existing and emergence of new CVD and diabetes risk factors.

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“…14,16,31 Nevertheless, this has not been confirmed by a controlled study by Arranz et al., 19 who demonstrated that reduced sensitivity to insulin and hyperinsulinemia found in schizophrenic patients are related not to the diagnosis itself, but to previous use of antipsychotics.…”

Section: Hyperglycemia and Diabetesmentioning

confidence: 98%

“…9 Finally, it is known that weight gain caused by antipsychotics, lithium and valproic acid occurs even in the presence of high leptin levels, which is a hormone associated with feeling of satiety; it has been suggested that such drugs could reduce hypothalamus sensitivity to the action of this hormone. 7,9,16,18,19 5…”

Section: Etiologic Factorsmentioning

confidence: 99%

Efeitos adversos metabólicos de antipsicóticos e estabilizadores de humor

Teixeira¹,

Rocha

2006

Rev. psiquiatr. Rio Gd. Sul

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INTRODUÇÃO: Um aumento na incidência de obesidade e diabetes melito entre pacientes psiquiátricos foi observado ainda na década de 60, como resultado indesejável do uso de antipsicóticos. Nos anos 80 e 90, a reabilitação da clozapina, a síntese dos demais antipsicóticos atípicos e a disseminação do uso do lítio e do ácido valpróico chamaram novamente a atenção para os efeitos metabólicos desses medicamentos. Este estudo tem por objetivo revisar a literatura médica a respeito dos efeitos adversos metabólicos associados ao uso de antipsicóticos e estabilizadores de humor. MÉTODO: Foi realizada uma extensa pesquisa nas bases de dados MEDLINE e LILACS até outubro de 2005. CONCLUSÃO: Os efeitos adversos metabólicos permanecem como problemas importantes da psicofarmacologia. Ganho de peso clinicamente relevante ocorre com freqüência em pacientes em uso de antipsicóticos e estabilizadores de humor, principalmente naqueles em uso de clozapina, olanzapina, lítio e ácido valpróico. A clozapina e a olanzapina associam-se também a uma maior incidência de diabetes melito e dislipidemias, seja devido ao ganho de peso, seja por ação deletéria direta sobre o metabolismo da glicose. A incidência de obesidade e outros distúrbios metabólicos é menor com a risperidona, se comparada à olanzapina ou à clozapina. Carbamazepina associa-se a menor ganho de peso, se comparada ao lítio ou ao ácido valpróico. Drogas como o haloperidol, a ziprasidona, o aripiprazol e a lamotrigina não estão associadas a ganho importante de peso ou a maior incidência de diabetes melito e são alternativas para pacientes mais propensos a desenvolver tais efeitos adversos.

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Insulin Resistance and Increased Leptin Concentrations in Noncompliant Schizophrenia Patients but Not in Antipsychotic-Naive First-Episode Schizophrenia Patients

Cited by 142 publications

References 0 publications

The Metabolic Effects of Antipsychotic Medications

The Metabolic Effects of Antipsychotic Medications

Early treatment-related changes in diabetes and cardiovascular disease risk markers in first episode psychosis subjects

Efeitos adversos metabólicos de antipsicóticos e estabilizadores de humor

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