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Cai L, Chen G, Yang H, Bai Y. Efficacy and safety profiles of mood stabilizers and antipsychotics for bipolar depression: a systematic review. Int Clin Psychopharmacol 2023:00004850-990000000-00058. [PMID: 36947416 DOI: 10.1097/yic.0000000000000449] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The whole picture of psychotropics for bipolar depression (BPD) remains unclear. This review compares the differences in efficacy and safety profiles among common psychotropics for BPD. MEDLINE, EMBASE, and PsycINFO were searched for proper studies. The changes in the depressive rating scale, remission/response rates, nervous system adverse events (NSAEs), gastrointestinal adverse events (GIAEs), metabolic parameters, and prolactin were compared between medication and placebo or among medications with the Cohen's d or number needed to treat/harm. The search provided 10 psychotropics for comparison. Atypical antipsychotics (AAPs) were superior to lithium and lamotrigine at alleviating acute depressive symptoms. Lithium was more likely to induce dry mouth and nausea. Cariprazine and aripiprazole seemed to be associated with an increased risk of akathisia and upper GIAEs. Lurasidone was associated with an increased risk of developing akathisia and hyperprolactinemia. Olanzapine, olanzapine-fluoxetine combination (OFC), and quetiapine were associated with an increased risk of NSAEs, metabolic risk, dry mouth, and constipation. Cariprazine, lurasidone, OFC, or quetiapine was optimal monotherapy for BPD. Further studies are needed to assess the efficacy and safety of lamotrigine for treating BPD. Adverse events varied widely across different drug types due to variations in psychopharmacological mechanisms, dosages, titration, and ethnicities.
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Affiliation(s)
| | - Guanjie Chen
- Teaching Management Office, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
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Misera A, Łoniewski I, Palma J, Kulaszyńska M, Czarnecka W, Kaczmarczyk M, Liśkiewicz P, Samochowiec J, Skonieczna-Żydecka K. Clinical significance of microbiota changes under the influence of psychotropic drugs. An updated narrative review. Front Microbiol 2023; 14:1125022. [PMID: 36937257 PMCID: PMC10014913 DOI: 10.3389/fmicb.2023.1125022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Relationship between drugs and microbiota is bilateral. Proper composition thus function of microbiota is a key to some medications used in modern medicine. However, there is also the other side of the coin. Pharmacotherapeutic agents can modify the microbiota significantly, which consequently affects its function. A recently published study showed that nearly 25% of drugs administered to humans have antimicrobial effects. Multiple antidepressants are antimicrobials,. and antibiotics with proven antidepressant effects do exist. On the other hand, antibiotics (e.g., isoniaside, minocycline) confer mental phenotype changes, and adverse effects caused by some antibiotics include neurological and psychological symptoms which further supports the hypothesis that intestinal microbiota may affect the function of the central nervous system. Here we gathered comprehensively data on drugs used in psychiatry regarding their antimicrobial properties. We believe our data has strong implications for the treatment of psychiatric entities. Nevertheless the study of ours highlights the need for more well-designed trials aimed at analysis of gut microbiota function.
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Affiliation(s)
- Agata Misera
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Igor Łoniewski
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
- Sanprobi sp. z o.o. sp.k., Szczecin, Poland
| | - Joanna Palma
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Monika Kulaszyńska
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Wiktoria Czarnecka
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Paweł Liśkiewicz
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Muntané G, Vázquez-Bourgon J, Sada E, Martorell L, Papiol S, Bosch E, Navarro A, Crespo-Facorro B, Vilella E. Polygenic risk scores enhance prediction of body mass index increase in individuals with a first episode of psychosis. Eur Psychiatry 2023; 66:e28. [PMID: 36852609 PMCID: PMC10044301 DOI: 10.1192/j.eurpsy.2023.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Individuals with a first episode of psychosis (FEP) show rapid weight gain during the first months of treatment, which is associated with a reduction in general physical health. Although genetics is assumed to be a significant contributor to weight gain, its exact role is unknown. METHODS We assembled a population-based FEP cohort of 381 individuals that was split into a Training (n = 224) set and a Validation (n = 157) set to calculate the polygenic risk score (PRS) in a two-step process. In parallel, we obtained reference genome-wide association studies for body mass index (BMI) and schizophrenia (SCZ) to examine the pleiotropic landscape between the two traits. BMI PRSs were added to linear models that included sociodemographic and clinical variables to predict BMI increase (∆BMI) in the Validation set. RESULTS The results confirmed considerable shared genetic susceptibility for the two traits involving 449 near-independent genomic loci. The inclusion of BMI PRSs significantly improved the prediction of ∆BMI at 12 months after the onset of antipsychotic treatment by 49.4% compared to a clinical model. In addition, we demonstrated that the PRS containing pleiotropic information between BMI and SCZ predicted ∆BMI better at 3 (12.2%) and 12 months (53.2%). CONCLUSIONS We prove for the first time that genetic factors play a key role in determining ∆BMI during the FEP. This finding has important clinical implications for the early identification of individuals most vulnerable to weight gain and highlights the importance of examining genetic pleiotropy in the context of medically important comorbidities for predicting future outcomes.
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Affiliation(s)
- Gerard Muntané
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut de Biologia Evolutiva (UPF-CSIC), Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Javier Vázquez-Bourgon
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Medicina y Psiquiatría, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
| | - Ester Sada
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Lourdes Martorell
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Sergi Papiol
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Elena Bosch
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut de Biologia Evolutiva (UPF-CSIC), Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Arcadi Navarro
- Institut de Biologia Evolutiva (UPF-CSIC), Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.,Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.,Barcelonaβeta Brain Research Center, Fundació Pasqual Maragall, Barcelona, Spain
| | - Benedicto Crespo-Facorro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío, Seville, Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Srour A, Eltorki Y, Malik H, Alabdulla MA, Hassan MH, Ahmed Al Subaiey M, Michael Haddad P. Patients' and primary carers' views on clozapine treatment for schizophrenia: A cross-sectional study in Qatar. Saudi Pharm J 2023; 31:214-221. [PMID: 36942276 PMCID: PMC10023528 DOI: 10.1016/j.jsps.2022.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Subjective views of clozapine treatment among patients with schizophrenia in the Middle East and North African MENA Region have not previously been assessed. Globally, few studies have assessed the views of carers to clozapine treatment. We conducted a cross-sectional survey, using a clinician administered structured interview, of patients with schizophrenia/schizoaffective disorder prescribed clozapine in Qatar, and their primary carers. Participants were asked to rate clozapine against prior their antipsychotic treatment in terms of specific benefits and side effects. Forty-two patients and 33 carers participated in the study. Of the patients, two thirds were male, approximately half were Qatari and the mean age was 33.9 years. Patients and carers rated clozapine as superior to prior antipsychotic treatment on all 7 potential benefits inquired about. The greatest perceived benefit was improved mood. Patients rated clozapine as less likely to cause extrapyramidal side effects but more likely to cause 18 other potential side effects compared to prior antipsychotic treatment, with the greatest difference being for nocturnal salivation, increased appetite, and constipation. Nearly half of patients (48 %) and two thirds of carers (64 %) stated that they would have preferred to start clozapine earlier in their illness. Sixty percent of patients and 37 % of carers regarded the information that they had received from health professionals on clozapine as inadequate. Less than half of patients and approximately-two thirds of carers had adequate knowledge of haematological monitoring for clozapine. Generally, there were significantly positive correlation between patients and carers regarding the overall side effects of clozapine treatment. Likewise, improvement in hearing voices paranoid thoughts correlated with improved quality of life. In summary, the results show that patients and carers appreciate the benefits of clozapine despite its side effects being problematic. The results support clozapine being offered earlier in treatment and services providing more information on clozapine to patients and carers.
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Affiliation(s)
- Ahmad Srour
- Department of Psychiatry, Hamad Medical Corporation, Qatar
| | - Yassin Eltorki
- Department of Psychiatry, Hamad Medical Corporation, Qatar
- College of Pharmacy, Qatar University, Qatar
- Corresponding author at: Clinical Pharmacy Specialist, Mental Health Service, Pharmacy Department Hamad Medical Corporation, P.O.Box 3050, Doha, Qatar.
| | - Humayun Malik
- Department of Psychiatry, Hamad Medical Corporation, Qatar
| | - Majid A Alabdulla
- Department of Psychiatry, Hamad Medical Corporation, Qatar
- College of Medicine, Qatar University, Qatar
| | | | | | - Peter Michael Haddad
- Department of Psychiatry, Hamad Medical Corporation, Qatar
- College of Medicine, Qatar University, Qatar
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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55
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Campforts B, Drukker M, Crins J, van Amelsvoort T, Bak M. Association between antipsychotic medication and clinically relevant weight change: meta-analysis. BJPsych Open 2023; 9:e18. [PMID: 36651070 PMCID: PMC9885350 DOI: 10.1192/bjo.2022.619] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous meta-analyses have shown that almost all antipsychotics are associated with weight gain. However, mean weight gain is not informative about clinically relevant weight gain or weight loss. AIMS To provide further insight into the more severe body weight changes associated with antipsychotic use, we assessed the proportion of patients with clinically relevant weight gain (CRWG) and clinically relevant weight loss (CRWL), defined as ≥7% weight gain and ≥7% weight loss. METHOD We searched PubMed, Embase and PsycInfo for randomised controlled trials of antipsychotics that reported CRWG and CRWL in study populations aged 15 years or older. We conducted meta-analyses stratified by antipsychotic and study duration using a random-effects model. We performed meta-regression analyses to assess antipsychotic-naive status and psychiatric diagnosis as modifiers for CRWG. PROSPERO: CRD42020204734. RESULTS We included 202 articles (201 studies). Almost all included antipsychotics were associated with CRWG. For CRWL, available data were too limited to draw firm conclusions. For some antipsychotics, CRWG was more pronounced in individuals who were antipsychotic-naive than in individuals switching to another antipsychotic. Moreover, a longer duration of antipsychotic use was associated with more CRWG, but not CRWL. For some antipsychotics, CRWG was higher in people diagnosed with schizophrenia, but this was inconsistent. CONCLUSIONS Switching antipsychotic medication is associated with both weight gain and weight loss, but the level of CRWG is higher than CRWL in antipsychotic-switch studies. CRWG was more pronounced in antipsychotic-naive patients, highlighting their vulnerability to weight gain. The impact of diagnosis on CRWG remains inconclusive.
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Affiliation(s)
- Bea Campforts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joost Crins
- Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Priyamkari A, Kakunje A, Nimgaonkar VL, Deshpande S, Bhatia T, Wood J, Kini G. An open-label study of oral acetazolamide for the prevention of antipsychotic associated weight gain. Ind Psychiatry J 2023; 32:150-157. [PMID: 37274570 PMCID: PMC10236665 DOI: 10.4103/ipj.ipj_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 06/06/2023] Open
Abstract
Background Weight gain associated with atypical antipsychotic medications need to be well managed. We set out: 1. To test the effect of acetazolamide on weight gain associated with antipsychotics 2. To assess improvement in psychotic symptoms using the Brief Psychiatric Rating Scale score on patients receiving acetazolamide. Methods and Materials This open-label study conducted after institutional ethical clearance from December 2018 to August 2020 included 34 drug-naive patients or patients on antipsychotic risperidone or olanzapine for less than one month. They were divided into two groups of 17 each as a case group (treatment as usual + acetazolamide) and a control group (treatment as usual) who were followed up for eight weeks. The patient's physical characteristics were recorded at baseline and during follow-ups. The Brief psychiatric rating scale (BPRS) and clinical global impression (CGI) scores were compared for the cases and controls. Results The study showed non-significant reduction in the weight (-0.57 ± 1.06 kg), body mass index (BMI) (-0.23 ± 0.76 kg/m2) and abdominal circumference (-0.47 ± 1.37 cm) in the patients receiving oral acetazolamide at the end of two months as compared to controls where there was significant increase in the weight (+2.62 ± 1.09 kg), BMI (+1.03 ± 0.44 kg/m2) and abdominal circumference (+2.21 ± 1.33 cm, P = 0.001). Similarly, the BPRS and CGI scores were significantly reduced in both arms, with satisfaction rates better among the cases compared to controls. Conclusion There was a non-significant reduction in the weight, body mass index, abdominal circumference, and brief psychiatric rating scale scores in patients treated with acetazolamide.Ethics committee protocol number: - 2018/244CTRI India registration number: CTRI/2019/05/018884.
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Affiliation(s)
- Anupama Priyamkari
- Department of Psychiatry, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
| | - Anil Kakunje
- Department of Psychiatry, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
| | | | - Smita Deshpande
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Banga Bandhu Sheikh Mujib Road, New Delhi, India
| | - Triptish Bhatia
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Banga Bandhu Sheikh Mujib Road, New Delhi, India
| | - Joel Wood
- Department of Psychiatry, University of Pittsburgh, O’Hara St Pittsburgh PA, United States of America
| | - Ganesh Kini
- Department of Psychiatry, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
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Stelmach A, Guzek K, Rożnowska A, Najbar I, Sadakierska-Chudy A. Antipsychotic drug-aripiprazole against schizophrenia, its therapeutic and metabolic effects associated with gene polymorphisms. Pharmacol Rep 2023; 75:19-31. [PMID: 36526889 PMCID: PMC9889418 DOI: 10.1007/s43440-022-00440-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Second-generation antipsychotics are widely used for the treatment of schizophrenia. Aripiprazole (ARI) is classified as a third-generation antipsychotic drug with a high affinity for dopamine and serotonin receptors. It is considered a dopamine-system stabilizer without severe side effects. In some patients the response to ARI treatment is inadequate and they require an effective augmentation strategy. It has been found that the response to the drug and the risk of adverse metabolic effects can be related to gene polymorphisms. A reduced dose is recommended for CYP2D6 poor metabolizers; moreover, it is postulated that other polymorphisms including CYP3A4, CYP3A5, ABCB1, DRD2, and 5-HTRs genes influence the therapeutic effect of ARI. ARI can increase the levels of prolactin, C-peptide, insulin, and/or cholesterol possibly due to specific genetic variants. It seems that a pharmacogenetic approach can help predict drug response and improve the clinical management of patients with schizophrenia.
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Affiliation(s)
- Adriana Stelmach
- Department of Genetics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzinskiego 1, 30-705, Krakow, Poland
| | - Katarzyna Guzek
- Department of Genetics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzinskiego 1, 30-705, Krakow, Poland
| | - Alicja Rożnowska
- Department of Genetics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzinskiego 1, 30-705, Krakow, Poland
| | - Irena Najbar
- Centre of Education, Research and Development, Babinski University Hospital, Krakow, Poland
| | - Anna Sadakierska-Chudy
- Department of Genetics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzinskiego 1, 30-705, Krakow, Poland.
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Christensen SM, Varney C, Gupta V, Wenz L, Bays HE. Stress, psychiatric disease, and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS 2022; 4:100041. [PMID: 37990662 PMCID: PMC10662113 DOI: 10.1016/j.obpill.2022.100041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2023]
Abstract
Background Previous Obesity Medicine Association (OMA) Clinical Practice Statements (CPS) included topics such as behavior modification, motivational interviewing, and eating disorders, as well as the effect of concomitant medications on weight gain/reduction (i.e., including psychiatric medications). This OMA CPS provides clinicians a more focused overview of stress and psychiatric disease as they relate to obesity. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Topics in this CPS include the relationship between psychological stress and obesity, including both acute and chronic stress. Additionally, this CPS describes the neurobiological pathways regarding stress and addiction-like eating behavior and explores the relationship between psychiatric disease and obesity, with an overview of psychiatric medications and their potential effects on weight gain and weight reduction. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on stress and psychiatric disease is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Knowledge of stress, addiction-like eating behavior, psychiatric disease, and effects of psychiatric medications on body weight may improve the care obesity medicine clinicians provide to their patients with obesity.
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Affiliation(s)
- Sandra M. Christensen
- Integrative Medical Weight Management, 2611 NE 125th St., Suite 100B, Seattle, WA, 98125, USA
| | - Catherine Varney
- University of Virginia School of Medicine, Department of Family Medicine, University of Virginia Bariatric Surgery, PO BOX 800729, Charlottesville, VA, 22908, USA
| | - Vivek Gupta
- 510 N Prospect Suite 301, Redondo Beach, California, 90277, USA
| | - Lori Wenz
- St. Mary's Bariatric and Metabolic Surgery Clinic, 2440 N 11th St, Grand Junction, CO, 81501, USA
- Comprehensive Weight Management, Cayucos, CA, USA
| | - Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Cuda S, Censani M, Kharofa R, O'Hara V, Conroy R, Williams DR, Paisley J, Browne AF, Karjoo S, Browne NT. Medication-induced weight gain and advanced therapies for the child with overweight and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS 2022; 4:100048. [PMID: 37990664 PMCID: PMC10662101 DOI: 10.1016/j.obpill.2022.100048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details medication-induced weight gain and advanced therapies for the child with overweight or obesity. Methods The scientific information and clinical guidance in this CPS are based on scientific evidence, supported by the medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement addresses medication-induced weight gain and advanced therapies for the child with overweight or obesity. Conclusions This OMA Clinical Practice Statement on medication induced-weight gain and advanced therapies for the child with overweight or obesity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications. This CPS also addresses treatment recommendations. This section is designed to help the provider with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Roohi Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | | | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason AvenueSpringfield, MA, 01107, USA
| | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street Lawrenceburg, IN, 47025-2048, USA
| | | | - Sara Karjoo
- Johns Hopkins All Children's Hospital Pediatric Gastroenterology 501 6th Ave S St. Petersburg, FL, 33701, USA
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Nakagawa N, Suzuki M. Efficacy of Olanzapine for Symptom Relief in Cancer Patients. J Pain Palliat Care Pharmacother 2022; 36:216-222. [PMID: 36250742 DOI: 10.1080/15360288.2022.2126059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Olanzapine is an atypical antipsychotic and is widely used for prophylaxis of chemotherapy-induced nausea and vomiting in cancer patients. Previous studies have suggested its potential efficacy for the relief of various symptoms in cancer patients, especially gastrointestinal and psychiatric symptoms. We retrospectively reviewed the prescription of olanzapine to cancer patients at our hospital. Between 2008 and 2020, olanzapine was prescribed to 41 patients for relief of symptoms associated with cancer other than prophylaxis of chemotherapy-induced nausea and vomiting. Of those patients, symptom relief was seen in 53.7%. Notably, olanzapine was effective in 13 of 14 patients with chemotherapy-induced nausea and vomiting refractory to guideline-recommended prophylaxis. Of 16 patients in whom this symptom was not relieved by olanzapine, 13 (81.3%) continued taking olanzapine even after it was judged ineffective. No treatment-related adverse events were seen in this study. Our observation implies good efficacy of olanzapine for refractory chemotherapy-induced nausea and vomiting and a tendency to continue olanzapine even in those for whom it was ineffective.
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Affiliation(s)
- Natsuki Nakagawa
- Department of Respiratory Medicine, Kanto Central Hospital, Tokyo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Kanto Central Hospital, Tokyo, Japan
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Gangopadhyay A, Ibrahim R, Theberge K, May M, Houseknecht KL. Non-alcoholic fatty liver disease (NAFLD) and mental illness: Mechanisms linking mood, metabolism and medicines. Front Neurosci 2022; 16:1042442. [PMID: 36458039 PMCID: PMC9707801 DOI: 10.3389/fnins.2022.1042442] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/21/2022] [Indexed: 09/26/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world and one of the leading indications for liver transplantation. It is one of the many manifestations of insulin resistance and metabolic syndrome as well as an independent risk factor for cardiovascular disease. There is growing evidence linking the incidence of NAFLD with psychiatric illnesses such as schizophrenia, bipolar disorder and depression mechanistically via genetic, metabolic, inflammatory and environmental factors including smoking and psychiatric medications. Indeed, patients prescribed antipsychotic medications, regardless of diagnosis, have higher incidence of NAFLD than population norms. The mechanistic pharmacology of antipsychotic-associated NAFLD is beginning to emerge. In this review, we aim to discuss the pathophysiology of NAFLD including its risk factors, insulin resistance and systemic inflammation as well as its intersection with psychiatric illnesses.
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Affiliation(s)
| | | | | | | | - Karen L. Houseknecht
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
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Fondjo LA, Osei O, Owiredu WKBA, Obirikorang C, Senu E, Owusu‐Antwi R, Brefo EFJ. Assessment of vitamin D levels and adipokines mediated obesity among psychiatric patients on treatment and treatment naïve: A comparative cross-sectional study. Health Sci Rep 2022; 5:e858. [PMID: 36248351 PMCID: PMC9547132 DOI: 10.1002/hsr2.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/20/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background and aims Antipsychotic treatment may contribute to low vitamin D levels and have impact on direct anti-inflammatory activity such as adiponectin activity and indirect proinflammatory activity such as leptin and resistin activity. However, vitamin D levels and adipokines mediated effect on weight gain and increased adiposity are not well evaluated. This study, therefore, assessed vitamin D and adipokines-mediated obesity among Ghanaian psychiatric patients. Methods This comparative cross-sectional study was conducted at psychiatric unit of Komfo Anokye Teaching Hospital, Kumasi, Ghana. Anthropometric measurements, sociodemographic and previous medical history were taken from 300 antipsychotics treatment naïve and active patients. Obesity was classified using World Health Organization (WHO) body mass index (BMI)-specific cut-offs. Blood samples were collected for serum vitamin D and adipokines (adiponectin, leptin, and resistin) analysis using enzyme-linked immunosorbent assay. Statistical analyses were done using SPSS version 26.0 and GraphPad Prism version 8.0. Results We observed higher prevalence of obesity among treatment active psychiatric patients (40.7%) compared to treatment naïve group (16.8%). Vitamin D insufficiency and deficiency prevalence were significantly higher among the treatment active group (25.3%; 39.5%; p < 0.001) and associated with increased odds of obesity (91.8%; cOR = 91.84, 95% confidence interval [CI]: 24.94-338.13). Moreover, adiponectin (84.2%: cOR = 14.15, 95% CI: 5.52-36.27), leptin (55.6% cOR = 2.20, 95% CI: 1.04-4.67), and resistin (79.4%: cOR = -8.34, 95% CI: 3.39-20.55) were significantly associated with increased odds of obesity among treatment active psychiatric. Furthermore, treatment active psychiatric patients exhibited inverse correlation for adiponectin and leptin with BMI (r = -0.62; -0.24), and WHtR (r = -0.53; -0.24); however, a moderate positive correlation for resistin with BMI (r = 0.80), HC (r = 0.67), and WHtR (r = 0.65). Conclusion Obesity is more prevalent in psychiatric patients on antipsychotics such as Olanzapine and Clozapine. Obesity among treatment active psychiatric patients is associated with vitamin D insufficiency and deficiency, low adiponectin and leptin levels but higher resistin level.
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Affiliation(s)
- Linda A. Fondjo
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Olivia Osei
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - William K. B. A. Owiredu
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ebenezer Senu
- Department of Molecular Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ruth Owusu‐Antwi
- Department of Behavioral Sciences School of Medicine and DentistryKwame Nkrumah University of Science and Technology, KATHKumasiGhana
- Psychiatry DepartmentKomfo Anokye Teaching HospitalKumasiGhana
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Jürgens G, Kaas-Hansen BS, Nordentoft M, Werge T, Andersen SE. Is the CYP2D6 Genotype Associated with Antipsychotic-Induced Weight Gain? J Pers Med 2022; 12:jpm12101728. [PMID: 36294867 PMCID: PMC9605494 DOI: 10.3390/jpm12101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/26/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Antipsychotic-induced weight gain (AIWG) is a serious adverse effect. Studies have linked genetically-predicted CYP2D6 metabolic capacity to AIWG. The evidence, however, is ambiguous. We performed multiple regression analyses examining the association between genetic-predicted CYP2D6 metabolic capacity and AIWG. Analyses were based on previously unpublished data from an RCT investigating the clinical utility of routine genotyping of CYP2D6 and CYP2C19 in patients with schizophrenia. A total of 211 patients, corresponding to 71% of the original study population, were included. Our analyses indicated an effect of genetically predicted CYP2D6 metabolic capacity on AIWG with significant weight gain in both CYP2D6 poor metabolizers (PMs) (4.00 kg (95% CI: 0.80; 7.21)) and ultrarapid metabolizers (UMs) (6.50 kg (95% CI: 1.03; 12.0)). This finding remained stable after adjustment for covariates (PMs: 4.26 kg (0.88; 7.64), UMs: 7.26 kg (1.24; 13.3)). In addition to the CYP2D6 metabolic capacity, both baseline body mass index (−0.24 (95% CI: −0.44; −0.03)) and chlorpromazine equivalents per day (0.0041 (95% CI: 0.0005; 0.0077)) were statistically significantly associated with weight change in the adjusted analysis. Our results support that the genetically predicted CYP2D6 metabolic capacity matters for AIWG.
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Affiliation(s)
- Gesche Jürgens
- Clinical Pharmacology Unit, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-93-56-60-38
| | - Benjamin Skov Kaas-Hansen
- Department of Intensive Care, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, 2900 Hellerup, Denmark
| | - Thomas Werge
- Mental Health Centre Sct. Hans, 4000 Roskilde, Denmark
| | - Stig Ejdrup Andersen
- Clinical Pharmacology Unit, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Nerland S, Stokkan TS, Jørgensen KN, Wortinger LA, Richard G, Beck D, van der Meer D, Westlye LT, Andreassen OA, Agartz I, Barth C. A comparison of intracranial volume estimation methods and their cross-sectional and longitudinal associations with age. Hum Brain Mapp 2022; 43:4620-4639. [PMID: 35708198 PMCID: PMC9491281 DOI: 10.1002/hbm.25978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022] Open
Abstract
Intracranial volume (ICV) is frequently used in volumetric magnetic resonance imaging (MRI) studies, both as a covariate and as a variable of interest. Findings of associations between ICV and age have varied, potentially due to differences in ICV estimation methods. Here, we compared five commonly used ICV estimation methods and their associations with age. T1-weighted cross-sectional MRI data was included for 651 healthy individuals recruited through the NORMENT Centre (mean age = 46.1 years, range = 12.0-85.8 years) and 2410 healthy individuals recruited through the UK Biobank study (UKB, mean age = 63.2 years, range = 47.0-80.3 years), where longitudinal data was also available. ICV was estimated with FreeSurfer (eTIV and sbTIV), SPM12, CAT12, and FSL. We found overall high correlations across ICV estimation method, with the lowest observed correlations between FSL and eTIV (r = .87) and between FSL and CAT12 (r = .89). Widespread proportional bias was found, indicating that the agreement between methods varied as a function of head size. Body weight, age, sex, and mean ICV across methods explained the most variance in the differences between ICV estimation methods, indicating possible confounding for some estimation methods. We found both positive and negative cross-sectional associations with age, depending on dataset and ICV estimation method. Longitudinal ICV reductions were found for all ICV estimation methods, with annual percentage change ranging from -0.293% to -0.416%. This convergence of longitudinal results across ICV estimation methods offers strong evidence for age-related ICV reductions in mid- to late adulthood.
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Affiliation(s)
- Stener Nerland
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- NORMENTUniversity of OsloOsloNorway
| | - Therese S. Stokkan
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- NORMENTUniversity of OsloOsloNorway
| | - Kjetil N. Jørgensen
- NORMENTUniversity of OsloOsloNorway
- Department of PsychiatryTelemark HospitalSkienNorway
| | - Laura A. Wortinger
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- NORMENTUniversity of OsloOsloNorway
| | - Geneviève Richard
- NORMENT, Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Dani Beck
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- NORMENTUniversity of OsloOsloNorway
| | - Dennis van der Meer
- School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lars T. Westlye
- NORMENT, Division of Mental Health and AddictionOslo University HospitalOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Ole A. Andreassen
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- NORMENT, Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Ingrid Agartz
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- NORMENTUniversity of OsloOsloNorway
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm RegionStockholmSweden
| | - Claudia Barth
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- NORMENTUniversity of OsloOsloNorway
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Meyer JM, Simmons A, Jiang Y, Graham C, Yagoda S, McDonnell D. Olanzapine/samidorphan combination consistently mitigates weight gain across various subgroups of patients. CNS Spectr 2022; 28:1-4. [PMID: 36226902 DOI: 10.1017/s1092852922000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A combination of olanzapine and the opioid receptor antagonist samidorphan (OLZ/SAM) has been approved in the United States for the treatment of adults with schizophrenia or adults with bipolar I disorder. In a phase 3 study in adults with schizophrenia (ENLIGHTEN-2), OLZ/SAM treatment was associated with significantly less weight gain compared with olanzapine. Prespecified subgroup analyses explored the consistency of the weight mitigation effect of OLZ/SAM vs olanzapine across demographic subgroups in ENLIGHTEN-2. METHODS The multicenter, randomized, double-blind ENLIGHTEN-2 study (NCT02694328) included outpatients aged 18-55 years with a diagnosis of schizophrenia based on DSM-5 criteria, a body mass index (BMI) of 18 to 30 kg/m2, and stable body weight (self-reported change ≤5% for ≥3 months before study entry). Patients were randomized 1:1 to receive OLZ/SAM or olanzapine for 24 weeks. Co-primary endpoints (previously reported) were percent change in body weight and proportion of patients with at least 10% weight gain from baseline at week 24. Prespecified exploratory subgroup analyses by sex, age, self-reported race, and baseline BMI were conducted. RESULTS At week 24, treatment with OLZ/SAM resulted in numerically less percent weight gain than with olanzapine across all subgroups evaluated. The proportion of patients with at least 10% weight gain was smaller in each subgroup treated with OLZ/SAM vs olanzapine. CONCLUSION In these exploratory subgroup analyses from the ENLIGHTEN-2 study, weight-mitigating effects of OLZ/SAM vs olanzapine were observed consistently across patient subgroups and were in line with results from the overall study population.
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Affiliation(s)
- Jonathan M Meyer
- University of California San Diego School of Medicine, La Jolla, CA, USA
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Türkoğlu Dikmen SN, Yüksel A, Bahadir-Yilmaz E. The effect of medication adherence on psychosocial adjustment to body weight, image, and self-esteem in patients with schizophrenia. Perspect Psychiatr Care 2022; 58:2505-2512. [PMID: 35388488 DOI: 10.1111/ppc.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The present study aimed to evaluate the effect of medication adherence on psychosocial adjustment to body weight, image, and self-esteem in patients with schizophrenia. DESIGN AND METHODS This cross-sectional and correlational study consisted of 154 patients with schizophrenia registered in a Community Mental Health Center. FINDINGS The patients had moderate psychosocial adjustment to body weight, image, and self-esteem, and 56.5% had poor medication adherence. There was a significant positive correlation between participants' medication adherence and psychosocial adjustment to body weight, image, and self-esteem. PRACTICE IMPLICATIONS Psychiatric nurses should support patients regarding medication adherence, and psychosocial adjustment to body weight, image, and self-esteem.
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Affiliation(s)
| | - Arzu Yüksel
- Department of Psychiatric Nursing, Faculty of Health Sciences, Aksaray University, Aksaray, Turkey
| | - Emel Bahadir-Yilmaz
- Department of Psychiatric Nursing, Faculty of Health Sciences, Giresun University, Giresun, Turkey
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67
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Koning E, Vorstman J, McIntyre RS, Brietzke E. Characterizing eating behavioral phenotypes in mood disorders: a narrative review. Psychol Med 2022; 52:2885-2898. [PMID: 36004528 PMCID: PMC9693712 DOI: 10.1017/s0033291722002446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023]
Abstract
Mood disorders, including depressive and bipolar disorders, represent a multidimensional and prevalent group of psychiatric illnesses characterized by disturbances in emotion, cognition and metabolism. Maladaptive eating behaviors in mood disorders are diverse and warrant characterization in order to increase the precision of diagnostic criteria, identify subtypes and improve treatment strategies. The current narrative review synthesizes evidence for Eating Behavioral Phenotypes (EBP) in mood disorders as well as advancements in pathophysiological conceptual frameworks relevant to each phenotype. Phenotypes include maladaptive eating behaviors related to appetite, emotion, reward, impulsivity, diet style and circadian rhythm disruption. Potential treatment strategies for each phenotype are also discussed, including psychotherapeutic, pharmacological and nutritional interventions. Maladaptive eating behaviors related to mood disorders are relevant from both clinical and research perspectives, yet have been somewhat overlooked thus far. A better understanding of this aspect of mood disorders holds promise to improve clinical care in this patient group and contribute to the subtyping of these currently subjectively diagnosed and treated disorders.
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Affiliation(s)
- Elena Koning
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Jacob Vorstman
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Elisa Brietzke
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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Pham H, Warlick H, Bermudez R, Nguyen Q, Rey JA. Olanzapine/Samidorphan: A New Option for the Treatment of Adults With Schizophrenia or Bipolar I Disorder. J Pharm Technol 2022; 38:304-313. [PMID: 36046346 PMCID: PMC9420915 DOI: 10.1177/87551225221114281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023] Open
Abstract
Objective To review the pharmacology, pharmacokinetics, and efficacy and safety data of a combination of olanzapine and samidorphan (OLZ/SAM) for the treatment of schizophrenia and bipolar I disorder, which mitigates the possible unwanted side effects of weight gain associated with olanzapine (OLZ). Data Sources The review was done with a bibliographic survey of studies using MEDLINE/PubMed (January 1999-May 2021) database using the keywords olanzapine and samidorphan. Abstracts, scientific posters, and information from the manufacturer's product labeling were evaluated for inclusion. Inclusion criteria: phase 2, phase 3, and open-labeled studies that evaluated the use of OLZ/SAM for the treatment of schizophrenia and bipolar I disorder. Data Synthesis We have included one phase 2 dose-ranging exploratory study, two phase 3 efficacy and safety studies, and several open-label extension studies without a comparator. For the treatment of schizophrenia, OLZ/SAM and OLZ alone were analyzed in 2 randomized, double-blind comparison studies of approximately 960 patients. Analysis indicated that OLZ (5-20 mg)/SAM (10 mg) significantly mitigated the side effect of weight gain compared with OLZ alone (control) while maintaining antipsychotic efficacy. For bipolar I disorder, OLZ/SAM was approved as an acute treatment for manic or mixed episodes, as well as an adjunct to valproate or lithium for manic/mixed episodes based on bridging strategy allowed by the Food and Drug Administration. Relevance to Patient Care and Clinical Practice The combination of olanzapine and samidorphan demonstrated efficacy for the treatment of schizophrenia with a dosage range of 5 to 20 mg OLZ to a 10-mg fixed dose of samidorphan. Advantages of this drug combination include once-daily dosing, favorable tolerability, and most importantly, mitigation of weight gain, which may encourage adherence, when compared with OLZ alone. Conclusion The new combination treatment of OLZ/SAM is a unique antipsychotic formulation to provide the recognized efficacious treatment of OLZ, while mitigating the weight gain and possibly the weight-related adverse effects secondary to OLZ monotherapy.
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Affiliation(s)
- Huy Pham
- Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Halford Warlick
- Nova Southeastern University College of Osteopathic Medicine, Davie, FL, USA
| | | | - Quan Nguyen
- Memorial Healthcare System, Hollywood, FL, USA
| | - Jose A. Rey
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Davie, FL, USA
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El Hayek SA, Shatila MA, Adnan JA, Geagea LE, Kobeissy F, Talih FR. Is there a therapeutic potential in combining bupropion and naltrexone in schizophrenia? Expert Rev Neurother 2022; 22:737-749. [PMID: 36093756 DOI: 10.1080/14737175.2022.2124369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION A sustained-release tablet composed of a combination of the dopamine and norepinephrine reuptake inhibitor bupropion (BUP) and the µ-opioid receptor antagonist naltrexone (NAT) is marketed under the brand name Contrave by Orexigen Therapeutics for appetite control. Minimal literature is available regarding the use of combination bupropion and naltrexone (BUPNAT) in individuals with schizophrenia. AREAS COVERED In this review, we propose a theoretical model where BUPNAT may have a therapeutic effect in the treatment of schizophrenia. We explore the pathways targeted by the constituent drugs BUP and NAT and summarize the literature on their efficacy and possible adverse effects. We then look at the potential use of BUPNAT in schizophrenia. EXPERT OPINION Research has hinted that BUP's dopaminergic properties affect the same striatal pathways involved in schizophrenia. NAT, via opioid receptor antagonism, indirectly increases striatal dopamine release by disinhibiting nicotinic acetylcholine receptors. As such, we hypothesize that BUPNAT can have a therapeutic effect in schizophrenia, particularly on negative symptoms. We also suggest that it may ameliorate comorbidities frequently seen in this group of patients, including obesity, smoking, and substance use. Further research and clinical data are needed to elucidate the potential clinical benefits of BUPNAT in the treatment of schizophrenia.
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Affiliation(s)
- Samer A. El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Malek A. Shatila
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jana A. Adnan
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Luna E. Geagea
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Farid R. Talih
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
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Ghusn W, Bouchard C, Frye MA, Acosta A. Weight-centric treatment of depression and chronic pain. OBESITY PILLARS 2022; 3:100025. [PMID: 37990725 PMCID: PMC10661995 DOI: 10.1016/j.obpill.2022.100025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2023]
Abstract
Background Depression and chronic pain are two major chronic non-communicable diseases (CNCD). Considering the bidirectional relationship between obesity and CNCD, it is of the utmost importance to understand the effect of medications utilized to treat these diseases on body weight. Methods This is a clinical review on the effect of medications for depression and chronic pain on body weight. We searched PubMed, Scopus, MEDLINE, and Google Scholar databases for studies on the topic from January 1, 1950 to April 1, 2022 in English language. Additionally, we present expert opinions in the fields of obesity, depression and chronic pain, providing a weight-centric approach to treat depression and chronic pain. Results Several antidepressant and chronic pain medications are associated with weight gain. Selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidases, mirtazapine and trazodone are common antidepressants that can increase body weight while bupropion is significantly associated with weight loss. Gabapentin and pregabalin are common chronic pain medications that are linked to weight gain. On the other hand, topiramate is associated with significant weight loss. Obesity, depression and chronic pain experts recommend avoiding medications that can increase body weight if another effective alternative is available. Conclusion By shifting prescribing practices toward a weight-conscious approach (i.e., switching from weight gain medications to weight loss/neutral), it is possible to mitigate the incidence of drug-induced weight gain.
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Affiliation(s)
- Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Mark A. Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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de Boer N, Cahn W. Antipsychotic-induced weight gain: Is the weight over? New guidelines needed. Acta Psychiatr Scand 2022; 146:185-189. [PMID: 35951775 DOI: 10.1111/acps.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nini de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Jeon SJ, Kwon H, Bae HJ, Gonzales EL, Kim J, Chung HJ, Kim DH, Ryu JH, Shin CY. Agmatine relieves behavioral impairments in Fragile X mice model. Neuropharmacology 2022; 219:109234. [PMID: 36057317 DOI: 10.1016/j.neuropharm.2022.109234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/25/2022] [Accepted: 08/21/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Fragile X syndrome (FXS) is the most common heritable form of neurodevelopmental disorder, which is caused by the loss of fragile X mental retardation protein (FMRP) expression. Despite the unceasing efforts to develop therapeutic agents against FXS based on the pathophysiological changes observed in animal models of FXS and human patients, therapeutic candidates including mGluR signaling modulators have failed to provide sufficient effects. Based on the recent successful demonstration of an endogenous polyamine, agmatine, to improve the autism-like symptoms in the valproic acid animal model of autism, we investigated the effects of agmatine against FXS symptoms using Fmr1 knockout (KO) mice. METHODS We used male Fmr1 KO mice for behavioral tests such as marble burying, open-field test, memory tasks, social interaction tests and startle response to confirm the symptoms of FXS. We also checked the electrophysiological profile of neural activity in agmatine-treated Fmr1 KO mice. RESULTS Agmatine reversed the compulsion, learning and memory deficits, hyperactivity, aberrant social interaction, and communication deficit in Fmr1 KO mice while it normalized the aberrant LTP and LTD in the hippocampus. CONCLUSIONS The results highlight the potential of agmatine's novel disease-ameliorating effects in FXS, which warrants further studies to ascertain whether these findings translate into clinical effects in FXS patients.
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Affiliation(s)
- Se Jin Jeon
- Department of Pharmacology and Department of Advanced Translational Medicine, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea; Department of Integrative Biotechnology, College of Science and Technology, Sahmyook University, Seoul, 01795, Republic of Korea
| | - Huiyoung Kwon
- Department of Pharmacology and Department of Advanced Translational Medicine, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea
| | - Ho Jung Bae
- Department of Life and Nanopharmaceutical Science, College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Edson Luck Gonzales
- Department of Pharmacology and Department of Advanced Translational Medicine, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea
| | - Junhyeong Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Hye Jin Chung
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Dong Hyun Kim
- Department of Pharmacology and Department of Advanced Translational Medicine, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea
| | - Jong Hoon Ryu
- Department of Life and Nanopharmaceutical Science, College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Chan Young Shin
- Department of Pharmacology and Department of Advanced Translational Medicine, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea.
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Antipsychotic-like effects of fasudil, a Rho-kinase inhibitor, in a pharmacologic animal model of schizophrenia. Eur J Pharmacol 2022; 931:175207. [PMID: 35987254 DOI: 10.1016/j.ejphar.2022.175207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022]
Abstract
Current antipsychotics used to treat schizophrenia have associated problems, including serious side effects and treatment resistance. We recently identified a significant association of schizophrenia with exonic copy number variations in the Rho GTPase activating protein 10 (ARHGAP10) gene using genome-wide analysis. ARHGAP10 encodes a RhoGAP superfamily member that is involved in small GTPase signaling. In mice, Arhgap10 gene variations result in RhoA/Rho-kinase pathway activation. We evaluated the pharmacokinetics of fasudil and hydroxyfasudil using liquid chromatography-tandem mass spectrometry in mice. The antipsychotic effects of fasudil on hyperlocomotion, social interaction deficits, prepulse inhibition deficits, and novel object recognition deficits were also investigated in a MK-801-treated pharmacological mouse schizophrenia model. Fasudil and its major metabolite, hydroxyfasudil, were detected in the brain at concentrations above their respective Ki values for Rho-kinase after intraperitoneal injection of 10 mg kg-1 fasudil. Fasudil improved the hyperlocomotion, social interaction deficits, prepulse inhibition deficits, and novel object recognition deficits in MK-801-treated mice in a dose-dependent manner. Following oral administration of fasudil, brain hydroxyfasudil was detected at concentration above the Ki value for Rho-kinase whilst fasudil was undetectable. MK-801-induced hyperlocomotion was also improved by oral fasudil administration. These results suggest that fasudil has antipsychotic-like effects on the MK-801-treated pharmacological mouse schizophrenia model. There are two isoforms in Rho-kinase, and further investigation is needed to clarify the isoforms involved in the antipsychotic-like effects of fasudil in the MK-801-treated mouse schizophrenia model.
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Gandhi AA, Wilson TA, Sisley S, Elsea SH, Foster RH. Relationships between food-related behaviors, obesity, and medication use in individuals with Smith-Magenis syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 127:104257. [PMID: 35597045 DOI: 10.1016/j.ridd.2022.104257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/01/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Smith-Magenis syndrome (SMS) is a complex neurodevelopmental disorder that includes obesity and food-seeking/satiety-related behaviors. AIMS This study examined associations between food-related/hyperphagic behaviors, weight, and medication use in individuals with SMS. METHODS/PROCEDURES Caregivers of individuals with SMS in the Parents and Researchers Interested in SMS (PRISMS) Patient Registry completed a demographic/medication questionnaire, the Hyperphagia Questionnaire for Clinical Trials, and the Food Related Problems Questionnaire. OUTCOMES/RESULTS Among 49 participants (Mage = 16.41 ± 12.73 years, range = 4-69 years, 55% girls/women), individuals with SMS with overweight/obesity (n = 22) had worse overall food-related problems including greater impaired satiety (p < 0.05), maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.01), and hyperphagia (p < 0.01) compared to individuals of normal/underweight (n = 27). Those taking anti-depressants/anxiolytics (n = 16) had greater maladaptive eating behaviors (p < 0.05), hyperphagic behaviors (p < 0.05), and hyperphagic severity (p < 0.05) than those not taking anti-depressants/anxiolytics (n = 33). Boys/men with SMS had greater maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.05), and hyperphagic drive (p < 0.01) than girls/women with SMS. CONCLUSIONS/IMPLICATIONS Maladaptive food-related behaviors were higher in individuals with SMS with overweight/obesity, taking anti-depressants/anxiolytics, or who were male. Medications in this population should be chosen with weight-related side effects in mind.
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Affiliation(s)
- Anusha A Gandhi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Theresa A Wilson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stephanie Sisley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Children's Nutrition Research Center, Houston, TX 77030, USA
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Rebecca H Foster
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
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Long-term treatment of antipsychotics and combined therapy with other psychotropic medications inducing weight gain in patients with non-affective psychotic disorder: Evidence from GROUP, a longitudinal study. Psychiatry Res 2022; 314:114680. [PMID: 35753222 DOI: 10.1016/j.psychres.2022.114680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/02/2022] [Accepted: 06/11/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Antipsychotics (APs) can cause weight gain. Little is known about changes in weight when APs are combined with other psychotropics. This study examines the weight change in patients undergoing long-term treatment with APs or with AP combined with other psychotropics. METHODS Patients with non-affective psychotic disorder from the GROUP study were divided into three groups: AP medication group (APm) (n = 100), AP in combination with other psychotropics (APc) (n = 73), and medication-free (Meds-free) (n = 100). Weight change was examined at inclusion and after three years using a paired-sample t-test. An Independent-sample t-test was performed to evaluate weight change among patients taking clozapine, olanzapine, and quetiapine and individuals not taking these medications. Linear regression was performed to evaluate the association between covariates and weight. RESULTS Patients in the APm group [mean = 1.800 kg, t(99)=2.849, 95% CI(0.546, 3.054), p = 0.005] and the APc group [mean = 1.877 kg, t(72)=2.688, 95% CI(0.485, 3.268), p = 0.009] showed significant weight gain. Patients taking clozapine, olanzapine or quetiapine showed significant weight gain compared to those not taking these medications [mean difference=1.707 kg, t(271)= 2.061, 95% CI(0.077, 3.337), p = 0.040)]. CONCLUSION Patients receiving APs and APs with other psychotropics gain weight during long-term treatment. It is possible that weight gain is mainly driven by APs.
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Goh KK, Chen CYA, Wu TH, Chen CH, Lu ML. Crosstalk between Schizophrenia and Metabolic Syndrome: The Role of Oxytocinergic Dysfunction. Int J Mol Sci 2022; 23:ijms23137092. [PMID: 35806096 PMCID: PMC9266532 DOI: 10.3390/ijms23137092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
The high prevalence of metabolic syndrome in persons with schizophrenia has spurred investigational efforts to study the mechanism beneath its pathophysiology. Early psychosis dysfunction is present across multiple organ systems. On this account, schizophrenia may be a multisystem disorder in which one organ system is predominantly affected and where other organ systems are also concurrently involved. Growing evidence of the overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, such as an association with cognitive dysfunction, altered autonomic nervous system regulation, desynchrony in the resting-state default mode network, and shared genetic liability, suggest that metabolic syndrome and schizophrenia are connected via common pathways that are central to schizophrenia pathogenesis, which may be underpinned by oxytocin system dysfunction. Oxytocin, a hormone that involves in the mechanisms of food intake and metabolic homeostasis, may partly explain this piece of the puzzle in the mechanism underlying this association. Given its prosocial and anorexigenic properties, oxytocin has been administered intranasally to investigate its therapeutic potential in schizophrenia and obesity. Although the pathophysiology and mechanisms of oxytocinergic dysfunction in metabolic syndrome and schizophrenia are both complex and it is still too early to draw a conclusion upon, oxytocinergic dysfunction may yield a new mechanistic insight into schizophrenia pathogenesis and treatment.
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Affiliation(s)
- Kah Kheng Goh
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (K.K.G.); (C.Y.-A.C.); (C.-H.C.)
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Cynthia Yi-An Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (K.K.G.); (C.Y.-A.C.); (C.-H.C.)
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
| | - Tzu-Hua Wu
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Hsin Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (K.K.G.); (C.Y.-A.C.); (C.-H.C.)
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (K.K.G.); (C.Y.-A.C.); (C.-H.C.)
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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Chua MWJ. An Old Ally to Address the 'Triple Threat'. Am J Med 2022; 135:678-679. [PMID: 34808101 DOI: 10.1016/j.amjmed.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
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Tondt J, Bays HE. Concomitant medications, functional foods, and supplements: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS 2022; 2:100017. [PMID: 37990714 PMCID: PMC10661915 DOI: 10.1016/j.obpill.2022.100017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/03/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of the body weight effects of concomitant medications (i.e., pharmacotherapies not specifically for the treatment of obesity) and functional foods, as well as adverse side effects of supplements sometimes used by patients with pre-obesity/obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS outlines clinically relevant aspects of concomitant medications, functional foods, and many of the more common supplements as they relate to pre-obesity and obesity. Topics include a discussion of medications that may be associated with weight gain or loss, functional foods as they relate to obesity, and side effects of supplements (i.e., with a focus on supplements taken for weight loss). Special attention is given to the warnings and lack of regulation surrounding weight loss supplements. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on concomitant medications, functional foods, and supplements is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity. Implementation of appropriate practices in these areas may improve the health of patients, especially those with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Justin Tondt
- Department of Family and Community Medicine, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501, USA
| | - Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, University of Louisville School of Medicine, Louisville, KY, 40213, USA
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Khandker R, Shepherd J, Chekani F, Qureshi Z, Bailey H, Berry M, Wright J, Massey L. Atypical Treatment Switches in Schizophrenia Patients: Drivers and Associated Outcomes. Neuropsychiatr Dis Treat 2022; 18:1057-1067. [PMID: 35611118 PMCID: PMC9124468 DOI: 10.2147/ndt.s358392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To describe and compare demographics and outcomes among patients with schizophrenia who have switched atypical treatments versus non-switchers. Methods Data were extracted from the Adelphi Schizophrenia Disease Specific Programme™ conducted from January to May 2014 in the United States. Participating physicians provided information on their next 10 consulting schizophrenia patients aged ≥ 18 years; the same patients were invited to voluntarily complete a patient self-completion form (PSC). Patients were considered switchers (S) or non-switchers (NS) based on their physician-provided treatment history. S were patients who had switched, stopped or added an atypical treatment within the last 2 years. NS had no treatment changes within the last 2 years or were receiving their first-line treatment (for ≥ 3 months). Demographics, clinical characteristics and outcomes among S and NS were compared using both descriptive and multivariate statistics. Results One-hundred fifty physicians provided data on 1003 patients with schizophrenia (395 S, 608 NS); 500 patients completed a PSC (170 S, 330 NS). When compared with NS, S were more likely to be unemployed (p=0.0060), have a caregiver (p<0.0001), have greater activity impairment as assessed by Work and Productivity Activity Impairment (p=0.0031), be hospitalized for schizophrenia (p<0.0001) and have had a greater mean number of hospitalizations in the last 12 months (p=0.0012). NS vs S were more likely to have much or very much improved illness (p<0.0001) and less severe disease (p<0.0001) as assessed by Clinical Global Impression. Conclusion Despite switching drugs, some schizophrenia patients continue to have high levels of disease burden, suggesting that currently available therapies are insufficiently effective in these patients.
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Wu H, Siafis S, Hamza T, Schneider-Thoma J, Davis JM, Salanti G, Leucht S. Antipsychotic-Induced Weight Gain: Dose-Response Meta-Analysis of Randomized Controlled Trials. Schizophr Bull 2022; 48:643-654. [PMID: 35137229 PMCID: PMC9077426 DOI: 10.1093/schbul/sbac001] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Weight gain is among the most important side-effects of antipsychotics. It is, however, unclear whether it is associated with antipsychotic doses. We aimed to fill this gap with a dose-response meta-analysis. METHODS We searched multiple electronic databases (last update search June 2021) for all fixed-dose studies that investigated 16 second-generation antipsychotics and haloperidol in adults with acute exacerbation of schizophrenia or with negative symptoms. We estimated the dose-response curves by conducting random-effects dose-response meta-analyses. We used the restricted cubic spline to model the dose-response relationship. The primary outcome was mean weight gain in kg from baseline to endpoint, the secondary outcome was the number of patients with clinically important weight gain. FINDINGS Ninety-seven studies with 333 dose arms (36 326 participants) provided data for meta-analyses. Most studies were short-term with median duration of 6 weeks (range 4 to 26 weeks). In patients with acute exacerbation, amisulpride, aripiprazole, brexpiprazole, cariprazine, haloperidol, lumateperone, and lurasidone produced mild weight gain in comparison to placebo (mean difference at any dose≤1 kg), while more significant weight gain was observed by all other drugs. For most drugs, dose-response curves showed an initial dose-related increase in weight which plateaued at higher doses, while for others there was no plateau and some even had bell-shaped curves, meaning less weight gain to be associated with higher doses. INTERPRETATION Second-generation antipsychotics do not only differ in their propensity to produce weight gain, but also in the shapes of their dose-response curves. This information is important for dosing decisions in clinical practice.
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Affiliation(s)
- Hui Wu
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tasnim Hamza
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA
- Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychiatry, Department of Psychosis Studies, King’s College London, London, UK
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Jebeile H, Kelly AS, O'Malley G, Baur LA. Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol 2022; 10:351-365. [PMID: 35248172 PMCID: PMC9831747 DOI: 10.1016/s2213-8587(22)00047-x] [Citation(s) in RCA: 285] [Impact Index Per Article: 142.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.
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Affiliation(s)
- Hiba Jebeile
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Aaron S Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Grace O'Malley
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Louise A Baur
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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Alphs L, Brown B, Turkoz I, Baker P, Fu DJ, Nuechterlein KH. The Disease Recovery Evaluation and Modification (DREaM) study: Effectiveness of paliperidone palmitate versus oral antipsychotics in patients with recent-onset schizophrenia or schizophreniform disorder. Schizophr Res 2022; 243:86-97. [PMID: 35247794 DOI: 10.1016/j.schres.2022.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
We report primary results of the Disease Recovery Evaluation and Modification (DREaM) study, a randomized, open-label, delayed-start trial designed to compare the effectiveness of paliperidone palmitate (PP) versus oral antipsychotics (OAP) in delaying time to first treatment failure (TtFTF) in participants with recent-onset schizophrenia or schizophreniform disorder. DREaM included: Part I, 2-month oral run-in; Part II, 9-month disease progression phase (PP or OAP); Part III, 9 months of additional treatment (PP/PP; OAP rerandomized: OAP/OAP or OAP/PP). PP/PP and OAP/OAP comprised the 18-month extended disease progression (EDP) analysis. A total of 235 participants were randomized to PP (n = 78) or OAP (n = 157) in Part II. No statistically significant differences in TF between treatment groups were identified during Part II (PP 29.5%, OAP 24.8%; P = 0.377), Part III (PP/PP 14.3%, OAP/PP 15.8%, OAP/OAP 28.6%; P = 0.067) or the EDP analysis (PP/PP 28.6%, OAP/OAP 44.4%; NNT = 6; P = 0.080). Using a modified definition of TF excluding treatment supplementation with another antipsychotic, a common approach to managing dose adjustments, significant differences were observed between treatment groups in Part III (PP/PP 4.1%, OAP/PP 14.0%, OAP/OAP 27.0%; P = 0.002) and EDP (PP/PP 14.3%, OAP/OAP 42.9%; P = 0.001). Safety results were consistent with the known safety profile of PP. Although significant treatment differences were not observed during the first 9 months of DREaM, numerical differences favoring PP emerged in the last 9 months and significant differences were observed when TF criteria were limited to their most impactful components. These results highlight the potential benefit of initiating PP early in the course of schizophrenia and provide valuable insights for future clinical trials in recent-onset schizophrenia or schizophreniform disorder. Clinicaltrials.gov identifier: NCT02431702.
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Affiliation(s)
- Larry Alphs
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | - Brianne Brown
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Ibrahim Turkoz
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Pamela Baker
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Dong-Jing Fu
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Keith H Nuechterlein
- Departments of Psychiatry and Psychology, University of California at Los Angeles, 150 Medical Plaza Driveway, Los Angeles, CA 90095, USA.
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Poojari PG, Khan S, Shenoy S, Shetty S, Bose S, Pai K, Acharya LD, Thunga G. A narrative review of metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Obesity Prevention is the Key to a Nation’s Health. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The overweight and obesity is increasing problem for the health care system and for the health of the general population. The number of overweight people with varying degrees of obesity is growing in most countries around the world each year, a third of the world’s population suffers from this condition.
According to scientists, lack of sleep, stress, use of certain pharmacological drugs can lead to obesity. The causes and factors of weight gain are varied, not only in personal life, such as eating habits and physical activity, but also include factors that can not be controlled, such as environmental factors, socio-economic factors, genetic factors and more.
Obesity is a major risk factor for many diseases such as diabetes, cardiovascular disease, stroke and some cancers.
Obesity prevention should be one of the top priorities for the health care system. Preventive measures aimed to prevent the development of overweight and obesity have three levels of intervention: primary, secondary and tertiary. The purpose of the primary prevention is to minimize weight gain and prevent the development of overweight or obesity. Secondary prevention aimes to reduce the impact of the existing disease. Tertiary prevention concentraits on reduction of the complications that have developed as a result of the disease.
To prevent overweight and obesity, doctors advise to limit the caloric content of diet by reducing the consumption of fats and sugars; increase the consumption of fruits and vegetables, as well as whole grains and nuts; perform regular exercise.
Regular weighing by health professionals can help identify patterns and factors that contribute to weight gain. The success of obesity therapy depends on the patient’s trust to his doctor and the knowledge of the clinician in this area.
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Huo T, Li Q, Cardel MI, Bussing R, Winterstein AG, Lemas DJ, Xu H, Woodard J, Mistry K, Scholle S, Muller KE, Shenkman EA. Enhancing Quality Measurement With Clinical Information: A Use Case of Body Mass Index Change Among Children Taking Second Generation Antipsychotics. Acad Pediatr 2022; 22:S140-S149. [PMID: 35339240 PMCID: PMC9092621 DOI: 10.1016/j.acap.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/02/2021] [Accepted: 11/21/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). We also sought to illustrate how clinical data can be used to identify children most at-risk for SGAP-induced weight gain, which cannot be done using process-focused measures. METHODS Electronic health record (EHR) data and Medicaid claims were linked from 2013 to 2019. We quantified sociodemographic differences between children with and without pre- and post-BMI values. We developed a linear regression model of post-BMI to examine pre-post changes in BMI among 4 groups: 1) BH/SGAP+ children had behavioral health conditions and were taking SGAP; 2) BH/SGAP- children had behavioral health conditions without taking SGAP; 3) children with asthma; and 4) healthy children. RESULTS Of 363,360 EHR-Medicaid linked children, 18,726 were BH/SGAP+. Roughly 4% of linked children and 8% of BH/SGAP+ children had both pre and post values of BMI required to assess quality of SGAP monitoring. The percentage varied with gender and race-ethnicity. The R2 for the regression model with all predictors was 0.865. Pre-post change in BMI differed significantly (P < .0001) among the groups, with more BMI gain among those taking SGAP, particularly those with higher baseline BMI. CONCLUSION Meeting the 2030 Centers for Medicare and Medicaid Services goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked EHR and claims data allows identifying children at higher risk for SGAP-induced weight gain.
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Affiliation(s)
- Tianyao Huo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla.
| | - Qian Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla; WW International, Inc (MI Cardel), New York, NY
| | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida (R Bussing), Gainesville, Fla
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida (AG Winterstein), Gainesville, Fla
| | - Dominick J Lemas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Hongzhi Xu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Jennifer Woodard
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Kamila Mistry
- Agency for Healthcare Research and Quality (K Mistry), Rockville, Md
| | - Sarah Scholle
- National Committee for Quality Assurance (S Scholle), Washington, DC
| | - Keith E Muller
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
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86
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Faden J, Serdenes R, Citrome L. Olanzapine-samidorphan combination tablets for the treatment of schizophrenia and bipolar I disorder - what is it, and will it be used? Expert Rev Neurother 2022; 22:365-376. [PMID: 35354374 DOI: 10.1080/14737175.2022.2060742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Although olanzapine remains one of the most efficacious antipsychotic medications for the treatment of schizophrenia, there are significant tolerability concerns related to its weight and metabolic profile. Olanzapine-samidorphan combination tablets (OLZ/SAM), branded as Lybalvi, is a newly FDA approved formulation aimed at attenuating antipsychotic induced weight gain via modulation of the endogenous opioid system with samidorphan, while retaining the robust antipsychotic efficacy of olanzapine. AREAS COVERED : We reviewed the published literature of OLZ/SAM for the management of schizophrenia using the US National Library of Medicine's PubMed.gov resource. Topics covered in this narrative review include the pharmacokinetics, pharmacodynamics, tolerability, and efficacy of OLZ/SAM. EXPERT OPINION : OLZ/SAM is an effective and well tolerated pharmacologic option in mitigating olanzapine induced weight gain while retaining olanzapine's efficacy. It has a limited effect on metabolic laboratory parameters and cumulatively tends to limit weight gain rather than promote weight loss. Additional research will be needed to determine its effectiveness compared to alternative strategies to attenuate antipsychotic induced weight gain.
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Affiliation(s)
- Justin Faden
- Lewis Katz School of Medicine at Temple University, Philadelphia PA 19125, USA
| | - Ryan Serdenes
- Lewis Katz School of Medicine at Temple University, Philadelphia PA 19125, USA
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87
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Khandker R, Chekani F, Limone B, Thiel E. Cardiometabolic outcomes among schizophrenia patients using antipsychotics: the impact of high weight gain risk vs low weight gain risk treatment. BMC Psychiatry 2022; 22:133. [PMID: 35183142 PMCID: PMC8857781 DOI: 10.1186/s12888-022-03746-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Evaluate the prevalence of cardiometabolic conditions among schizophrenia patients before and incidence after initiation of high (HWGR) and low weight gain risk (LWGR) antipsychotic (AP) regimens. METHODS A retrospective observational cohort study was conducted using administrative claims data from the IBM® MarketScan Commercial and Multi-State Medicaid Databases. Patients with > 1 medical claim with a diagnosis for schizophrenia and newly initiating AP therapy between 1/1/11-6/30/16 were included. Baseline characteristics were assessed in the 12-months before AP initiation; outcomes over 24-months following AP initiation. Patients were characterized by the AP regimen initiated at the index date. Adherence was defined by a medication possession ratio > 0.8 (medication on hand for 80% of follow-up). Multivariate modeling identified predictors of index AP weight gain risk profile and post-index dyslipidemia. RESULTS Two thousand seven hundred forty-eight commercially-insured and 8,748 Medicaid patients met the inclusion criteria. A majority of patients initiated on atypical AP and approximately 30% were adherent to their index AP regimen. Within both payers, patients indexing on LWGR AP regimens were more likely to have pre-index diagnoses of cardiometabolic conditions including hypertension, dyslipidemia, and diabetes. Significant predictors of post-index dyslipidemia included AP adherence and pre-index diabetes. Within both payers, odds of initiating HWGR AP regimens were higher among patients with evidence of drug abuse. CONCLUSIONS There is unmet need for reducing cardiometabolic consequences for patients on AP therapy and this analysis provides evidence that cardiometabolic conditions often develop during early stages of AP therapy. However, this does not appear to be related to the weight gain risk profile of the AP regimen.
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Affiliation(s)
- Rezaul Khandker
- grid.417993.10000 0001 2260 0793Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033 USA
| | - Farid Chekani
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA.
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88
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Doane MJ, Bessonova L, Friedler HS, Mortimer KM, Cheng H, Brecht T, O’Sullivan AK, Cummings H, McDonnell D, Meyer JM. Weight gain and comorbidities associated with oral second-generation antipsychotics: analysis of real-world data for patients with schizophrenia or bipolar I disorder. BMC Psychiatry 2022; 22:114. [PMID: 35164737 PMCID: PMC8842889 DOI: 10.1186/s12888-022-03758-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/31/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Many second-generation antipsychotics (SGAs) are associated with weight gain and cardiometabolic effects. Antipsychotic-associated weight gain is linked to treatment interruptions, potentially increasing risk of relapse and hospitalization. This retrospective study assessed clinically significant weight gain (CSWG), treatment interruptions, and development of cardiometabolic conditions in patients with schizophrenia (SZ) or bipolar I disorder (BD-I) following initiation of oral SGAs with moderate to high weight gain risk. METHODS Patients with no prior use of moderate to high weight gain risk oral SGAs were identified from patient-level medical/pharmacy claims and electronic medical records (January 2013-February 2020; OM1 Real-World Data Cloud). Those with ≥ 1 weight measurement in both the 12 months preceding and 3 months after SGA initiation (index date) were analyzed for continuous changes in weight, CSWG (≥ 7% and ≥ 10% increases from baseline), treatment interruptions (switches/discontinuations), and development of cardiometabolic conditions. RESULTS Median follow-up times in the SZ (n = 8174) and BD-I (n = 9142) cohorts were 153.4 and 159.4 weeks, respectively; 45.5% and 50.7% were obese at baseline. Mean (SD) percent weight increase during treatment was 3.3% (7.2) and 3.7% (7.0) for patients with SZ and BD-I, respectively, and was highest for underweight/normal weight patients (SZ: 4.8% [8.1]; BD-I: 5.5% [8.7]). More than 96% had treatment interruptions during follow-up, primarily discontinuations. CSWG and treatment interruptions occurred within a median of 13 and 14 weeks after treatment initiation, respectively. Of patients with CSWG and treatment interruptions, approximately 75% did not return to baseline weight during follow-up. Among those without baseline cardiometabolic conditions, 14.7% and 11.3% of patients with SZ or BD-I, respectively, developed ≥ 1 condition over 12 months post-index. Incidence was generally highest among those who were overweight/obese at baseline and those who experienced CSWG. CONCLUSIONS In this analysis of real-world data, both weight gain and treatment interruptions occurred early in treatment for patients with SZ or BD-I. Treatment-associated weight gain persisted despite switching or discontinuing index treatment. Additionally, cardiometabolic morbidity increased within 12 months of treatment initiation. Patients with SZ or BD-I are at greater risk than the general population for cardiometabolic conditions; weight gain associated with SGAs may exacerbate these health risks.
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Affiliation(s)
- Michael J. Doane
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 825 Winter St., Waltham, MA 02451-1420 USA
| | - Leona Bessonova
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 825 Winter St., Waltham, MA 02451-1420 USA
| | | | | | | | | | - Amy K. O’Sullivan
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 825 Winter St., Waltham, MA 02451-1420 USA
| | - Hannah Cummings
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 825 Winter St., Waltham, MA 02451-1420 USA
| | - David McDonnell
- grid.472773.20000 0004 0384 2510Alkermes Pharma Ireland Ltd., Dublin, Ireland
| | - Jonathan M. Meyer
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego School of Medicine, CA La Jolla, USA
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89
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Nagy LR, Rice T, Coffey BJ. Combined Topiramate and Metformin Pharmacotherapy for Second-Generation Antipsychotic-Induced Weight Gain in Pediatric Bipolar Disorder and Aggression. J Child Adolesc Psychopharmacol 2022; 32:72-76. [PMID: 35166568 DOI: 10.1089/cap.2022.29215.bjc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lauren R Nagy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Timothy Rice
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara J Coffey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Behavioral Health Hospital, Miami, Florida, USA
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90
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Sudarshan Y, Cheung BMY. Hypertension and psychosis. Postgrad Med J 2022:postgradmedj-2021-141386. [PMID: 37294717 DOI: 10.1136/postgradmedj-2021-141386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
Abstract
Hypertension, a prevalent component of metabolic syndrome (MetS), is a well-known risk factor for cardiovascular diseases (CVD). Psychosis is a feature in the schizophrenia spectrum. Meta-analysis suggests that the prevalence of hypertension in schizophrenia and related disorders is 39%. This may be explained by a unidirectional association between hypertension and psychosis, in that psychosis can be a causative factor of hypertension via antipsychotic medication, inflammation and irregular autonomic nervous system activity through multiple mechanisms. Obesity is a side effect of antipsychotic medication and is a risk factor for hypertension. Obesity leads to raised blood pressure, atherosclerosis, increased triglyceride concentration and decreased high-density lipoprotein concentration. Inflammation accompanies hypertension and obesity. In recent years, the role of inflammation in the onset of psychosis has been increasingly recognised. It underlies the immune dysregulation observed in both schizophrenia and bipolar disorder. Interleukin-6, a marker and driver of inflammation, is related to obesity and plays a role in the pathogenesis of MetS and hypertension. The lack of preventive care of hypertension and other MetS risk factors for patients on antipsychotic medication is reflected in the high incidence of CVD in this population. It is important to detect and treat MetS and hypertension in patients with psychosis in order to reduce cardiovascular morbidity and mortality in this population.
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Affiliation(s)
- Yauvani Sudarshan
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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91
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Mukherjee S, Skrede S, Milbank E, Andriantsitohaina R, López M, Fernø J. Understanding the Effects of Antipsychotics on Appetite Control. Front Nutr 2022; 8:815456. [PMID: 35047549 PMCID: PMC8762106 DOI: 10.3389/fnut.2021.815456] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 12/16/2022] Open
Abstract
Antipsychotic drugs (APDs) represent a cornerstone in the treatment of schizophrenia and other psychoses. The effectiveness of the first generation (typical) APDs are hampered by so-called extrapyramidal side effects, and they have gradually been replaced by second (atypical) and third-generation APDs, with less extrapyramidal side effects and, in some cases, improved efficacy. However, the use of many of the current APDs has been limited due to their propensity to stimulate appetite, weight gain, and increased risk for developing type 2 diabetes and cardiovascular disease in this patient group. The mechanisms behind the appetite-stimulating effects of the various APDs are not fully elucidated, partly because their diverse receptor binding profiles may affect different downstream pathways. It is critical to identify the molecular mechanisms underlying drug-induced hyperphagia, both because this may lead to the development of new APDs, with lower appetite-stimulating effects but also because such insight may provide new knowledge about appetite regulation in general. Hence, in this review, we discuss the receptor binding profile of various APDs in relation to the potential mechanisms by which they affect appetite.
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Affiliation(s)
- Sayani Mukherjee
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Silje Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Section of Clinical Pharmacology, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Edward Milbank
- NeurObesity Group, Department of Physiology, Center for Research in Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, Madrid, Spain.,SOPAM, U1063, INSERM, University of Angers, SFR ICAT, Bat IRIS-IBS, Angers, France
| | | | - Miguel López
- NeurObesity Group, Department of Physiology, Center for Research in Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | - Johan Fernø
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
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92
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Abbas MM, Soto P, Ramalingam L, El-Manzalawy Y, Bensmail H, Moustaid-Moussa N. Sex Differences in Fish Oil and Olanzapine Effects on Gut Microbiota in Diet-Induced Obese Mice. Nutrients 2022; 14:349. [PMID: 35057526 PMCID: PMC8780445 DOI: 10.3390/nu14020349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 02/05/2023] Open
Abstract
Children are prescribed second-generation antipsychotic (SGA) medications, such as olanzapine (OLZ) for FDA-approved and "off-label" indications. The long-term impact of early-life SGA medication exposure is unclear. Olanzapine and other SGA medications are known to cause excessive weight gain in young and adult patients, suggesting the possibility of long-term complications associated with the use of these drugs, such as obesity, diabetes, and heart disease. Further, the weight gain effects of OLZ have previously been shown to depend on the presence of gut bacteria and treatment with OLZ, which shifts gut bacteria toward an "obesogenic" profile. The purpose of the current study was to evaluate changes in gut bacteria in adult mice following early life treatment with OLZ and being fed either a high-fat diet or a high-fat diet supplemented with fish oil, which has previously been shown to counteract gut dysbiosis, weight gain, and inflammation produced by a high-fat diet. Female and male C57Bl/6J mice were fed a high fat diet without (HF) or with the supplementation of fish oil (HF-FO) and treated with OLZ from postnatal day (PND) 37-65 resulting in four groups of mice: mice fed a HF diet and treated with OLZ (HF-OLZ), mice fed a HF diet and treated with vehicle (HF), mice fed a HF-FO diet and treated with OLZ (HF-FO-OLZ), and mice fed a HF-FO diet and treated with vehicle (HF-FO). Following euthanasia at approximately 164 days of age, we determined changes in gut bacteria populations and serum LPS binding protein, an established marker of gut inflammation and dysbiosis. Our results showed that male HF-FO and HF-FO-OLZ mice had lower body weights, at sacrifice, compared to the HF group, with a comparable body weight across groups in female mice. HF-FO and HF-FO-OLZ male groups also exhibited lower serum LPS binding protein levels compared to the HF group, with no differences across groups in female mice. Gut microbiota profiles were also different among the four groups; the Bacteroidetes-to-Firmicutes (B/F) ratio had the lowest value of 0.51 in the HF group compared to 0.6 in HF-OLZ, 0.9 in HF-FO, and 1.1 in HF-FO-OLZ, with no differences in female mice. In conclusion, FO reduced dietary obesity and its associated inflammation and increased the B/F ratio in male mice but did not benefit the female mice. Although the weight lowering effects of OLZ were unexpected, FO effects persisted in the presence of olanzapine, demonstrating its potential protective effects in male subjects using antipsychotic drugs.
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Affiliation(s)
- Mostafa M. Abbas
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA 17822, USA; (M.M.A.); (Y.E.-M.)
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha 5825, Qatar
| | - Paul Soto
- Department of Nutritional Sciences, Obesity Research Institute, Texas Tech University, Lubbock, TX 79409, USA; (P.S.); (L.R.)
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70803, USA
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Latha Ramalingam
- Department of Nutritional Sciences, Obesity Research Institute, Texas Tech University, Lubbock, TX 79409, USA; (P.S.); (L.R.)
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY 13210, USA
| | - Yasser El-Manzalawy
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA 17822, USA; (M.M.A.); (Y.E.-M.)
| | - Halima Bensmail
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha 5825, Qatar
| | - Naima Moustaid-Moussa
- Department of Nutritional Sciences, Obesity Research Institute, Texas Tech University, Lubbock, TX 79409, USA; (P.S.); (L.R.)
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93
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Giusti L, Bianchini V, Aggio A, Mammarella S, Salza A, Necozione S, Alunno A, Ferri C, Casacchia M, Roncone R. Twelve-month outcomes in overweight/obese users with mental disorders following a multi-element treatment including diet, physical activity, and positive thinking: The real-world "An Apple a Day" controlled trial. Front Psychiatry 2022; 13:903759. [PMID: 36081460 PMCID: PMC9445251 DOI: 10.3389/fpsyt.2022.903759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
The present study aimed to evaluate the 12-month effectiveness of a real-world weight loss transdiagnostic intervention in overweight/obese participants affected by mental disorders under psychopharmacological treatment. We conducted a real-world, controlled, pragmatic outpatient trial. We allocated 58 overweight/obese adults under psychopharmacological treatment from a mental health outpatient unit and 48 overweight/obese adults from a cardiovascular prevention outpatient unit, and assigned them to an intervention or treatment usual as condition (TAU) enriched by life-style advice. Participants in both intervention groups took part in a diet programme (the modified OMNIHeart dietary protocol) and monitoring of regular aerobic activity. A brief group programme ("An Apple a Day" Metacognitive Training, Apple-MCT) was added in the intervention group of participants affected by mental disorders. The primary outcome was weight loss. Secondary outcomes included anthropometric, clinical, and metabolic variables. Psychopathology and health-related quality of life were also evaluated in the psychiatric sample. At 12 months, both intervention groups showed a more marked mean decrease in weight (6.7 kg, SD: 3.57) than the TAU group (0.32 kg, SD: 1.96), and a statistically significant improvement in metabolic variables compared with the control groups. Furthermore, the participants affected by mental disorders included in the intervention group reported improved health-related quality of life. Our findings suggest the need to implement integrated interventions based on a dietary protocol, physical activity, and modification of cognitive style in overweight/obese users with mental disorders.
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Affiliation(s)
- Laura Giusti
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Bianchini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Annalisa Aggio
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Silvia Mammarella
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna Salza
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Necozione
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessia Alunno
- Division of Internal Medicine and Nephrology, School of Internal Medicine-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Division of Internal Medicine and Nephrology, School of Internal Medicine-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Casacchia
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rita Roncone
- University Unit Rehabilitation Treatment, Early Interventions in Mental Health-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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94
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Haghshenas M, Arman S. Metabolic effects of adding Topiramate on Aripiprazole in bipolar patients aged between 6-18 years, a randomized, double-blind, placebo-controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:23. [PMID: 35419064 PMCID: PMC8995310 DOI: 10.4103/jrms.jrms_672_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/26/2021] [Accepted: 12/11/2021] [Indexed: 11/04/2022]
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95
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Coughlin JW, Steffen KJ, Sockalingam S, Mitchell JE. Psychotropic Medications in Metabolic and Bariatric Surgery: Research Updates and Clinical Considerations. Curr Psychiatry Rep 2022; 24:89-98. [PMID: 35076886 DOI: 10.1007/s11920-022-01317-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW We review evidence for assessing and monitoring psychotropic medications in metabolic and bariatric surgery (MBS) patients. We describe weight gain side effects, potential perioperative risks, pharmacokinetic changes that occur after MBS, and conclude with clinical recommendations. RECENT FINDINGS Research on psychiatric medication use and post-MBS weight outcomes is lacking and inconsistent; however, there is consistent evidence that, though variable, psychiatric medication use is associated with weight gain. Several meta-analyses and reviews provide guidance on lowering risk when appropriate. Perioperative lithium toxicity and SSRI discontinuation syndrome also warrant consideration, as do potential post-operative pharmacokinetic changes. In the absence of data for each psychiatric drug classification, close symptom monitoring and, where appropriate, serum concentration monitoring are recommended. MBS patients are a psychiatrically vulnerable population, and many are on psychiatric medications. Given potential weight/metabolic side effects, perioperative complications, and post-operative pharmacokinetic changes that occur with psychotropic medication use, providers should stay well informed on psychiatric medication management considerations.
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Affiliation(s)
- Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, MD, 21224, Baltimore, USA.
| | - Kristine J Steffen
- North Dakota State University, College of Health Professions, ND, 58103, Fargo, USA.,Sanford Center for Biobehavioral Research, ND, 58103, Fargo, USA
| | - Sanjeev Sockalingam
- University Health Network Bariatric Surgery Program Centre for Addiction and Mental Health University of Toronto, ON, M6J 1H4, Toronto, Canada
| | - James E Mitchell
- Sanford Center for Biobehavioral Research, ND, 58103, Fargo, USA.,University of North Dakota School of Medicine and Health Sciences, ND, 58103, Fargo, USA
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96
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Hakami AY, Felemban R, Ahmad RG, Al-Samadani AH, Salamatullah HK, Baljoon JM, Alghamdi LJ, Ramadani Sindi MH, Ahmed ME. The Association Between Antipsychotics and Weight Gain and the Potential Role of Metformin Concomitant Use: A Retrospective Cohort Study. Front Psychiatry 2022; 13:914165. [PMID: 35686187 PMCID: PMC9170991 DOI: 10.3389/fpsyt.2022.914165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Obesity and its complications are associated with several adverse effects that may cause a serious impact on health. Antipsychotics-induced weight gain (AIWG) is one of the major, yet often neglected side effects of first and second generations antipsychotics. Importantly, several researches have shown metformin to be effective in managing weight gain especially, with AIWG. This study investigated the effect of antipsychotics use on weight gain and the theory of metformin concomitant use on the prevention of AIWG. METHODS A retrospective cohort review of the medical records of patients from the psychiatry outpatient clinics in the King Abdulaziz Medical city, a tertiary hospital in Jeddah from May 2016 to August 2021. The population of patients in Psychiatry section was 4,141. The sampling technique was a non-random consecutive sampling technique. Moreover, the included patients' records were divided to group 1 (patients on antipsychotics) and group 2 (patients using antipsychotics with Metformin). RESULTS According to the study criteria, 395 patients' records were included. A total of 309 (78%) patients were using antipsychotics without metformin, which in this study were depicted as group 1. In addition, a total of 86 (22%) were using antipsychotics with metformin, which in this study were assigned as group 2. Out of Group 1 patients (n = 309), only 67 patients experienced weight loss (21.68%), 43 remained with no weight change (13.92%), and 199 experienced weight gain (64.4%). Out of Group 2 patients (n = 86), 35 patients experienced weight loss (40.7%), 18 patients remained with no weight change (20.93%), and 33 experienced weight gain (38.37%). In addition, group 1 had a mean weight change of 2.5 kg, whereas group 2 had a mean weight change of -0.04 kg. CONCLUSION Statistical analysis revealed that patients on antipsychotics alone experienced weight gain, whereas the concomitant use of metformin showed reduction in the weight gain tendency. Thus, study outcomes indicate that concomitant use of metformin with antipsychotics might significantly reduce the AIWG.
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Affiliation(s)
- Alqassem Y Hakami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Razaz Felemban
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Rami Ghazi Ahmad
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Psychiatry Section, Department of Medicine, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | | | - Hassan K Salamatullah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Jamil M Baljoon
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Loay J Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mostafa H Ramadani Sindi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohamed Eldigire Ahmed
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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97
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Combining Therapeutic Drug Monitoring and Pharmacokinetic Modelling Deconvolutes Physiological and Environmental Sources of Variability in Clozapine Exposure. Pharmaceutics 2021; 14:pharmaceutics14010047. [PMID: 35056943 PMCID: PMC8779032 DOI: 10.3390/pharmaceutics14010047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Clozapine is a key antipsychotic drug for treatment-resistant schizophrenia but exhibits highly variable pharmacokinetics and a propensity for serious adverse effects. Currently, these challenges are addressed using therapeutic drug monitoring (TDM). This study primarily sought to (i) verify the importance of covariates identified in a prior clozapine population pharmacokinetic (popPK) model in the absence of environmental covariates using physiologically based pharmacokinetic (PBPK) modelling, and then to (ii) evaluate the performance of the popPK model as an adjunct or alternative to TDM-guided dosing in an active TDM population. Methods: A popPK model incorporating age, metabolic activity, sex, smoking status and weight was applied to predict clozapine trough concentrations (Cmin) in a PBPK-simulated population and an active TDM population comprising 142 patients dosed to steady state at Flinders Medical Centre in Adelaide, South Australia. Post hoc analyses were performed to deconvolute the impact of physiological and environmental covariates in the TDM population. Results: Analysis of PBPK simulations confirmed age, cytochrome P450 1A2 activity, sex and weight as physiological covariates associated with variability in clozapine Cmin (R2 = 0.7698; p = 0.0002). Prediction of clozapine Cmin using a popPK model based on these covariates accounted for <5% of inter-individual variability in the TDM population. Post hoc analyses confirmed that environmental covariates accounted for a greater proportion of the variability in clozapine Cmin in the TDM population. Conclusions: Variability in clozapine exposure was primarily driven by environmental covariates in an active TDM population. Pharmacokinetic modelling can be used as an adjunct to TDM to deconvolute sources of variability in clozapine exposure.
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98
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Tang C, Chua YC, Abdin E, Subramaniam M, Verma S. Twenty-Four Week, Randomized, Double-Blind, Placebo-Controlled Trial of Metformin for Antipsychotic-Induced Weight Gain in Patients with First-Episode Psychosis: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:137. [PMID: 35010394 PMCID: PMC8750805 DOI: 10.3390/ijerph19010137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Excessive weight gain and cardiometabolic dysfunction are common and clinically relevant side effects of antipsychotic medications. In this pilot study, we aimed to establish the feasibility of using metformin and its effectiveness in managing antipsychotic-induced weight gain in patients with first-episode psychosis (FEP) on follow-up with the Singapore Early Psychosis Intervention Programme in a 24-week, randomized, double-blind, placebo-controlled trial, to ascertain the effects of metformin discontinuation on body weight and evaluate the safety and tolerability of metformin. Participants between the ages of 16 and 40 with FEP assessed as clinically stable and who had gained ≥5% of their pre-drug weight after initiation of the antipsychotic treatment were recruited from outpatient clinics between April 2015 and April 2018. Seventeen participants met all the inclusion criteria and were randomized to receive metformin (n = 8) or the placebo (n = 9) at Week 0, with follow up assessments at Weeks 3, 6, 12, 24, and 36. Metformin was generally well-tolerated. Participants in the metformin arm were able to control their weight better than participants receiving the placebo, an effect that did not persist after discontinuation. Our results support the use of metformin as a safe and tolerable weight control measure in a typical outpatient sample of young people with FEP.
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Affiliation(s)
- Charmaine Tang
- Department of Psychosis, Institute of Mental Health, Singapore 539747, Singapore;
| | - Yi Chian Chua
- Department of Psychosis, Institute of Mental Health, Singapore 539747, Singapore;
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (E.A.); (M.S.)
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (E.A.); (M.S.)
| | - Swapna Verma
- Medical Board, Institute of Mental Health, Singapore 539747, Singapore;
- MD Programme Department, Duke-NUS Medical School, Singapore 169857, Singapore
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99
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Clements JN, Albanese NP, D'Souza JJ, Misher A, Reece S(M, Trujillo J, Whitley HP. Clinical review and role of clinical pharmacists in obesity management: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Jennifer N. Clements
- Diabetes Transition Spartanburg Regional Healthcare System Spartanburg South Carolina USA
| | - Nicole P. Albanese
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences Buffalo New York USA
| | - Jennifer J. D'Souza
- Midwestern University Chicago College of Pharmacy Downers Grove Illinois USA
| | - Anne Misher
- Patient Health Support Pharmacist Caromont Health Gastonia North Carolina USA
| | | | - Jennifer Trujillo
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado USA
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100
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A Double-Blind, Placebo-Controlled Trial of Bupropion Add-on to Olanzapine or Risperidone in Overweight Individuals With Schizophrenia. J Clin Psychopharmacol 2021; 41:629-631. [PMID: 34735098 DOI: 10.1097/jcp.0000000000001481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Weight gain due to antipsychotics is a challenging clinical problem because, to date, no effective pharmacological strategies have been found. Bupropion is often used in people with schizophrenia for smoking cessation and is well tolerated. However, studies on its use as weight loss treatment are scarce. The aim of the study was to examine the effectiveness of bupropion as a single weight loss treatment in overweight individuals maintained on long-term olanzapine or risperidone. METHODS This randomized, double-blind, placebo-controlled, 8-week study included 26 overweight (body mass index ≥27 kg/m2) individuals with schizophrenia maintained on olanzapine (10-20 mg/d) or risperidone (2-4 mg/d). Participants were randomly allocated to a study group that received bupropion (150-300 mg/d) or to a placebo group. The positive and Negative Syndrome Scale and the Clinical Global Impression-Severity Scale were used to assess severity of psychosis at baseline and end of study (8 weeks). RESULTS Bupropion addition, but not placebo, was associated with a significant reduction in body weight. Severity of psychotic symptoms was not altered in either group. CONCLUSIONS The results demonstrate the efficacy of bupropion, compared with placebo, in patients maintained on chronic treatment with olanzapine or risperidone, both known to be major contributors to significant weight gain.
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