Major Changes in Glucose Metabolism, Including New-Onset Diabetes, Within 3 Months After Initiation of or Switch to Atypical Antipsychotic Medication in Patients With Schizophrenia and Schizoaffective Disorder

Winkel, Ruud van; Hert, Marc De; Wampers, Martien; Eyck, Dominique Van; Hanssens, Linda; Scheen, André; Peuskens, Joseph

doi:10.4088/jcp.v69n0320

Cited by 91 publications

(65 citation statements)

References 32 publications

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“…Our data on metabolic changes were in alignment with recent prospective studies in first-episode patents (Attux et al, 2007;Perez-Iglesias et al, 2008;Saddichha et al, 2007;Srisurapanont et al, 2007) and confirmed the differences between SGA in their liability to induce metabolic changes (Cohn and Sernyak, 2006;L'Italien et al, 2007;Newcomer, 2005;van Winkel et al, 2008).…”

Section: Discussionsupporting

confidence: 76%

Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: A retrospective chart review

Hert

Schreurs

Sweers

et al. 2008

Schizophrenia Research

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220

118

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The presence of the metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of MetS in patients with schizophrenia at the onset of the disorder and specifically no data on patients treated in the era when only first-generation antipsychotics were available.Methods: Data from a historic cohort of consecutively admitted first-episode patients with schizophrenia treated with first-generation antipsychotics (FGAs) were compared with an age and sex matched series of consecutive first-episode patients treated only with second-generation antipsychotics (SGAs). Rates of MetS were compared at baseline and after on average 3 years of treatment exposure.Results: At first episode there was no difference in the prevalence of MetS between the historic and the current cohort. Rates of MetS increased over time in both groups, but patients started on SGAs had a three times higher incidence rate of MetS (Odds Ratio 3.6, CI 1.7-7.5). The average increase in weight and body mass index was twice as high in patients started on SGA. The difference between the FGA and SGA group was no longer significant when patients started on clozapine and olanzapine were excluded. Conclusion:Rates of MetS at the first episode of schizophrenia today are not different from those of patients 15 to 20 years ago. This finding counters the notion that the high rates of metabolic abnormalities in patients with schizophrenia currently reported are mainly due to lifestyle changes over time in the general population. Some SGAs have a significantly more negative impact on the incidence of MetS compared to FGAs in first-episode patients.

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Section: Discussionsupporting

confidence: 76%

Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: A retrospective chart review

Hert

Schreurs

Sweers

et al. 2008

Schizophrenia Research

Self Cite

220

118

View full text Add to dashboard Cite

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“…This increase in lipids has been confirmed in other studies with olanzapine across indications and is supported by animal data (Ader et al 2005). Metabolic problems are associated with the use not only of olanzapine, but also of the other atypical antipsychotics clozapine and quetiapine (van Winkel et al 2008). The primary salience of the metabolic syndrome derives from its links to cardiovascular risk factors, and the attendant mortality risks of longterm treatment with atypical agents (Ray et al 2009).…”

Section: Olanzapinementioning

confidence: 99%

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania

Grunze

Vieta

Goodwin

et al. 2009

The World Journal of Biological Psychiatry

316

247

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These updated guidelines are based on a first edition that was published in 2003, and have been edited and updated with the available scientific evidence until end of 2008. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute mania in adults. The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database clinicaltrials.gov, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientific rigor was categorised into six levels of evidence (AÁF). As these guidelines are intended for clinical use, the scientific evidence was finally asigned different grades of recommendation to ensure practicability.

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“…However, higher levels of insulin-resistance were found in clozapine-treated patients compared to subjects from the general population matched for BMI and waist, indicating that illness-related or treatment-related factors may further increase insulin resistance in overweight patients with schizophrenia (Wu et al, 2007). A recent study in patients with schizophrenia that focused on the early changes in glucose metabolism after initiation of an atypical antipsychotic suggested that glucose dysregulation may develop as early as within three months after initiation (van Winkel et al, 2008). These dysregulations may involve adipocyte hormones such as adiponectin, as was suggested by a recent study by Bai and colleagues who found that independent of age and BMI, serum adiponectin was a biomarker for the metabolic syndrome in clozapine-treated patients with schizophrenia (Bai et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional evaluation of adiponectin plasma levels in patients with schizophrenia and schizoaffective disorder

Hanssens

Winkel

Wampers

et al. 2008

Schizophrenia Research

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Abstract:Background: In recent years, several studies showed increased rates of hyperglycaemia, diabetes, dyslipidemia, metabolic syndrome as well as cardiovascular disease in schizophrenic patients. The underlying mechanism, however, is poorly understood. Adiponectin is a recently identified adipocyte-derived protein, with low adiponectin levels being associated with metabolic abnormalities such as obesity, insulin resistance and type 2 diabetes. Methods: Fasting adiponectin levels were assessed in a cross-sectional sample of 386 patients with schizophrenia or schizoaffective disorder. All patients were on monotherapy of second-generation antipsychotics (SGA) and underwent an extensive metabolic screening including an oral glucose tolerance test (OGTT). Results: Adiponectin plasma levels were inversely correlated with BMI, and differed significantly between patients with normal weight, overweight or obesity (p<0.05). Patients who met criteria for the metabolic syndrome, according to adapted National Cholesterol Educational Program -Adult Treatment Panel criteria (NCEP-ATP III) (29.3%), had significantly lower adiponectin levels than patients not meeting metabolic syndrome criteria (p<0.0001). Patients without glucose abnormalities (78%) had significantly higher adiponectin levels than patients with diabetes (5.7%) (p<0.05). After controlling for components of metabolic syndrome and sex, antipsychotic medication independently influenced adiponectin levels (p< 0.0001), with the lowest mean levels in patients on clozapine and olanzapine. Conclusions: Adiponectin levels in schizophrenic patients mirror what is observed in the general population, with the lowest levels in the most metabolically comprised subjects. However, antipsychotic medication may also influence adiponectin regulation independently, a finding that should be confirmed in longitudinal studies.

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Major Changes in Glucose Metabolism, Including New-Onset Diabetes, Within 3 Months After Initiation of or Switch to Atypical Antipsychotic Medication in Patients With Schizophrenia and Schizoaffective Disorder

Cited by 91 publications

References 32 publications

Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: A retrospective chart review

Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: A retrospective chart review

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania

A cross-sectional evaluation of adiponectin plasma levels in patients with schizophrenia and schizoaffective disorder

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