Schizophrenia: who is at risk? Who is a case?

Verdoux, Hélène; Cougnard, Audrey

doi:10.1097/01.yic.0000201496.23259.85

Cited by 89 publications

(72 citation statements)

References 40 publications

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“…The risk is significantly higher in patients started on SGAs. In line with published guidelines our results support the need for close monitoring of metabolic abnormalities and preferential use of metabolic neutral agents in this population as first line treatment option (Cohn and Sernyak, 2006;De Hert et al, 2006d;De Nayer et al, 2005;Marder et al, 2004;Newcomer, 2005Newcomer, , 2007a.…”

Section: Discussionsupporting

confidence: 75%

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

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: 75%

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

220

118

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“…Detailed guidelines before prescribing an atypical antipsychotic have been established (De Hert et al, 2006) and specific recommendations for safe monitoring of weight, blood pressure, blood glucose, and lipid profiles at the beginning and during antipsychotic treatment have been proposed (Newcomer, 2004;Franciosi et al, 2005;Meyer et al, 2005). Switching to an antipsychotic medication with a more appropriate risk/benefit profile has been recommended in patients who gain 5% of their baseline weight at any time during treatment (American Diabetes Association, 2004b).…”

Section: Discussionmentioning

confidence: 99%

Effects of Olanzapine and Ziprasidone on Glucose Tolerance in Healthy Volunteers

Sacher

Mossaheb

Spindelegger

et al. 2007

Neuropsychopharmacol

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Atypical antipsychotics have been linked to a higher risk for glucose intolerance, and consequentially the development of type 2 diabetes mellitus (DM2). We have therefore set out to investigate the acute effects of oral administration of olanzapine and ziprasidone on whole body insulin sensitivity in healthy subjects. Using the standardized hyperinsulinemic euglycemic clamp technique we compared whole body insulin sensitivity of 29 healthy male volunteers after oral intake of either olanzapine 10 mg/day (n ¼ 14) or ziprasidone 80 mg/day (n ¼ 15) for 10 days. A significant decrease (po0.001) in whole body insulin sensitivity from 5.7 ml/h/kg ( ¼ mean, SM ¼ 0.4 ml/h/kg) at baseline to 4.7 ml/h/kg ( ¼ mean, SM ¼ 0.3 ml/h/kg) after oral intake of olanzapine (10 mg/day) for 10 days was observed. The ziprasidone (80 mg/day) group did not show any significant difference (5.2 ± 0.3 ml/h/kg baseline vs 5.1 ± 0.3 ml/h/kg) after 10 days of oral intake. Our main finding demonstrates that oral administration of olanzapine but not ziprasidone leads to a decrease in whole body insulin sensitivity in response to a hyperinsulinemic euglycemic challenge. Our finding is suggestive that not all atypical antipsychotics cause acute direct effects on glucose disposal and that accurate determination of side effect profile should be performed when choosing an atypical antipsychotic.

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“…Especially, it is important to monitor any alteration in weight following a medication change. Pragmatic solutions for people with schizophrenia to prevent the development of diabetes should be proposed [49,50]. Baseline screening measures should be obtained before, or as soon as clinically feasible after, the initiation of any antipsychotic medication [1].…”

Section: Clinical Recommendationsmentioning

confidence: 99%

“…Fasting plasma glucose (and lipid levels and blood pressure as well) should also be assessed at regular intervals. We have shown that OGTT is able to detect abnormalities in glucose metabolism not shown by fasting measurements in numerous patients on antipsychotic medications [10,50]. For people who develop worsening glycemia while on antipsychotic therapy, it is recommended considering switching to an atypical antipsychotic medication that is associated with a lower risk of weight gain or diabetes [1].…”

Section: Clinical Recommendationsmentioning

confidence: 99%

Abnormal glucose metabolism in patients treated with antipsychotics

Scheen

Hert

2007

Diabetes & Metabolism

148

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Second-generation (atypical) antipsychotic medications are of great benefit to a wide variety of people with psychiatric disorders, especially patients with schizophrenia. However, one constellation of adverse effects is an increased risk of obesity, diabetes, and metabolic syndrome. Increasing numbers of reports concerning impaired glucose tolerance, diabetes, and ketoacidosis have raised concerns about a possible association between abnormal glucose metabolism and treatment with atypical antipsychotics, although the question is still debated because of the presence of many confounding factors. A close relationship between drug-induced weight gain and risk of diabetes has been reported, emphasizing the role of insulin resistance. However, some cases of diabetes developed independently of weight gain, rather rapidly and possibly progressing to ketoacidosis, thus arguing for a severe impairment of insulin secretion. Another debated question is whether diabetes risk is a class action or a differential action. Although not fully scientifically proven yet, available evidence suggests that clozapine and olanzapine have a higher propensity to induce diabetes and metabolic syndrome compared with other atypical antipsychotic drugs, risperidone and quetiapine. Despite more limited available data, amisulpride, aripiprazole and ziprazidone showed less likelihood of precipitating diabetes. Interestingly, reversibility of drugrelated diabetes has been reported with aripiprazole. The choice of atypical antipsychotic medication for a specific patient depends on many factors, but the likelihood of developing diabetes should become an important consideration. When prescribing an atypical antipsychotic, a commitment to careful baseline screening and follow-up monitoring is essential in order to mitigate the risk of developing diabetes and associated complications.Keywords: antipsychoticsa; schizophrenia ; diabetes ; impaired glucose tolerance ; metabolic syndrome ; review RésuméLes antipsychotiques de seconde génération, appelés aussi antipsychotiques atypiques, ont apporté une aide précieuse dans la prise en charge de nombreux patients psychiatriques, en particulier ceux avec schizophrénie. Cependant, ils semblent associés à une constellation d'effets indésirables métaboliques, avec un risque accru d'obésité, de diabète et de syndrome métabolique. Un nombre croissant de publications à propos de cas de diminution de tolérance au glucose, de diabète et d'acidocétose chez des patients traités avec des antipsychotiques atypiques plaident pour une association causale possible entre une anomalie du métabolisme du glucose et le traitement par antipsychotique atypique, même si la question reste controversée suite à la présence de nombreux facteurs confondants. Une relation étroite entre la prise de poids induite par la médication et le risque accru de diabète a été rapportée, insistant sur le rôle de l'insulinorésistance. Pourtant, certains cas de diabète se développent indépendamment de toute prise pondérale, avec une évolution...

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Schizophrenia: who is at risk? Who is a case?

Cited by 89 publications

References 40 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

Effects of Olanzapine and Ziprasidone on Glucose Tolerance in Healthy Volunteers

Abnormal glucose metabolism in patients treated with antipsychotics

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