Diabetes and schizophrenia - effect of disease or drug? Results from a randomized, double-blind, controlled prospective study in first-episode schizophrenia

Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis

BACKGROUND

There is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.

AIMS

To examine the evidence base for this recommendation.

METHOD

Meta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.

RESULTS

Fifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR) = 0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD) = -0.1, 95% CI -0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD = -0.4, 95% CI -0.5 to -0.2).

CONCLUSIONS

There was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.

Considering a frame of reference for physical activity research related to the cardiometabolic risk profile in schizophrenia

This article reviews evidence that researchers and mental health service providers need to take into account four modifiable factors that affect the prevalence of the metabolic syndrome in people with schizophrenia: (a) physical activity as part of a health-related lifestyle, (b) physical fitness, (c) mental health status and (d) antipsychotic medication. The implementation of physical activity in order to prevent and treat cardiometabolic risk factors in people with schizophrenia is discussed. English language articles published until July 2009 were identified by PubMed, CINAHL, PsychINFO, and Cochrane Central Register of Controlled Trials. The search terms schizophrenia and metabolic syndrome, physical activity, health, fitness, and lifestyle were used. Physical activity interventions result in positive effects on metabolic outcomes, physical fitness, health-related behavior and mental health. Considering present knowledge, physical therapists should take into account the emotional (negative symptoms, self-esteem, self-efficacy, and stress) and physiological (cardiometabolic parameters) components of mental illness when offering physical activity interventions. The physical activity stimulus should be adapted to the individual's physical fitness level and the side effects of the antipsychotic medications. More research is needed to assist in the practical development of effective evidence-based preventive and curative strategies in psychiatric services for metabolic syndrome in persons with schizophrenia.

Weight gain in antipsychotic-naive patients: a review and meta-analysis

BACKGROUND

Weight gain is a long-recognized side-effect of antipsychotic (AP) drugs and a major health concern in the treatment of psychosis. The strength of the causal relationship between AP drug exposure and weight gain can only be gauged by a drugs trial conducted on AP-naive patients.

METHOD

We conducted a review of the literature regarding the amount of weight gain induced by APs in AP-naive patients and carried out a meta-analysis of mean weight gains.

RESULTS

We found 11 primary studies reporting the effects of APs on body weight or body mass index (BMI) in AP-naive patients. The mean body weight and BMI gains in AP-naive patients were highly significant from the first weeks of treatment. When we limited the analysis to studies conducted on patients hospitalized and without any adjunctive treatment potentially affecting weight, the resultant sample showed less heterogeneity and confirmed the final picture of weight gain at around 3.8 kg and 1.2 points BMI.

CONCLUSIONS

Weight gain associated with AP therapy in AP-naive patients occurs rapidly in the first few weeks and continues during the following months. Clinicians should be aware of the high probability of causing weight gain in AP-naive patients and should strictly monitor such patients.

Antipsychotic prescribing trends: a review of pharmaco-epidemiological studies

OBJECTIVE

To review findings from pharmaco-epidemiological studies exploring antipsychotic (AP) drugs prescribing trends.

METHOD

We retrieved original studies that explored AP prescribing trends in general population samples since 2000. For each study, we extracted information on sampling method, period, assessment of AP use and corresponding estimates (incidence rates, prevalence rates, pharmacy sales, prescription data) and diagnostic assessment.

RESULTS

Nearly all studies meeting the inclusion criteria (n = 17) showed an increase in AP prescriptions, mainly because of a dramatic rise in second-generation antipsychotics (SGAP) prescriptions. APs are often prescribed for non-psychotic disorders in adults as well as in children and adolescents.

CONCLUSION

Considering the growing number of persons from the general population exposed to APs, population studies assessing the risk/benefit ratio of SGAP use in disorders other than psychosis are necessary, particularly in children and adolescents.

Management of schizophrenia with obesity, metabolic, and endocrinological disorders

People with schizophrenia have an increased prevalence of overweight/obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome, which increases the risk for cardiovascular diseases and mortality. Part of this increased risk is attributable to the use of antipsychotic medications, especially second-generation antipsychotics. Antipsychotic drugs differ in their potential to induce weight gain, with clozapine and olanzapine exhibiting the highest weight gain liability; evidence for differing effects of antipsychotics on glucose and lipid metabolism is less convincing. Individuals with schizophrenia may develop hyperprolactinemia, with or without clinical symptoms, after starting antipsychotic medications. This effect is particularly frequent with first-generation antipsychotics and with the second-generation antipsychotic risperidone and paliperidone. Psychiatrists should be aware of metabolic and endocrine side effects of antipsychotics and should make every effort to prevent or minimize them to improve the patients' compliance and quality of life.