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Kwak PP, Ibarra C, Hernandez A, Carrasco J, Sears DD, Jeste D, Marquine MJ, Lee EE. Differences in metabolic biomarkers in people with schizophrenia who are of Mexican descent compared to non-Hispanic whites. Psychiatry Res 2024; 334:115788. [PMID: 38401486 PMCID: PMC11249025 DOI: 10.1016/j.psychres.2024.115788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
Metabolic dysfunction is highly prevalent and contributes to premature mortality among people with schizophrenia (PwS), especially in Hispanic/Latino/a/x/e PwS, compared to non-Hispanic White (NHW) PwS. This study evaluated the relative contributions of Mexican descent and schizophrenia diagnosis to metabolic biomarker levels. This cross-sectional study included 115 PwS and 102 non-psychiatric comparison (NC) participants - English-speakers aged 26-66 years, 27% Mexican descent, and 52% women across both groups. Assessments included evaluations of BMI, psychopathology, and fasting metabolic biomarkers. We used ANOVA analyses to compare metabolic outcomes between diagnostic and ethnic subgroups, linear regression models to examine associations between Mexican descent and metabolic outcomes, and Spearman's correlations to examine relationships between metabolic outcomes and illness-related variables in PwS. Mexican PwS had higher hemoglobin A1c levels, insulin resistance, and body mass index than NHW PwS. Mexican descent was associated with higher hemoglobin A1c levels, insulin resistance, body mass index, and leptin levels, controlling for age, sex, depression, education, and smoking. Among Mexican PwS, worse negative symptoms were associated with greater insulin resistance. These findings support the possibility of ethnicity-based differences in metabolic dysregulation, though further investigation is warranted to create targeted health interventions for Hispanic PwS.
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Affiliation(s)
- Paulyn P Kwak
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Cynthia Ibarra
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Alexa Hernandez
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Jessica Carrasco
- Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
| | - Dorothy D Sears
- Department of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Department of Family Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; College of Health Solutions, Arizona State University, 550N 3rd St, Phoenix, AZ 85004, USA
| | - Dilip Jeste
- Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - María J Marquine
- Department of Medicine Geriatrics Division, Duke Center for the Study of Aging and Human Development, Duke University, 201 Trent Dr, Durham, NC 27710, USA; Department of Psychiatry and Behavioral Sciences, Duke Center for the Study of Aging and Human Development, Duke University, 201 Trent Dr, Durham, NC 27710, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, 9500 Gilman Dr., La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
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Storosum BWC, Steinz C, Cohen SE, Mattila T, Brink WVD, Roes K, de Haan L, Denys DAJP, Zantvoord JB. Ethnic differences in response to atypical antipsychotics in patients with schizophrenia: individual patient data meta-analysis of randomised placebo-controlled registration trials submitted to the Dutch Medicines Evaluation Board. BJPsych Open 2023; 9:e45. [PMID: 36861144 PMCID: PMC10044330 DOI: 10.1192/bjo.2023.19] [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: 03/03/2023] Open
Abstract
BACKGROUND Little is known about the effect of ethnicity on the response to antipsychotic medication in patients with schizophrenia. AIMS To determine whether ethnicity moderates the response to antipsychotic medication in patients with schizophrenia, and whether this moderation is independent of confounders. METHOD We analysed 18 short-term, placebo-controlled registration trials of atypical antipsychotic medications in patients with schizophrenia (N = 3880). A two-step, random-effects, individual patient data meta-analysis was applied to establish the moderating effect of ethnicity (White versus Black) on symptom improvement according to the Brief Psychiatric Rating Scale (BPRS) and on response, defined as >30% BPRS reduction. These analyses were corrected for baseline severity, baseline negative symptoms, age and gender. A conventional meta-analysis was performed to determine the effect size of antipsychotic treatment for each ethnic group separately. RESULTS In the complete data-set, 61% of patients were White, 25.6% of patients were Black and 13.4% of patients were of other ethnicities. Ethnicity did not moderate the efficacy of antipsychotic treatment: pooled β-coefficient for the interaction between treatment and ethnic group was -0.582 (95% CI -2.567 to 1.412) for mean BPRS change, with an odds ratio of 0.875 (95% CI 0.510-1.499) for response. These results were not modified by confounders. CONCLUSIONS Atypical antipsychotic medication is equally effective in both Black and White patients with schizophrenia. In registration trials, White and Black patients were overrepresented relative to other ethnic groups, limiting the generalisability of our findings.
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Affiliation(s)
- Bram W C Storosum
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Cedrine Steinz
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Sem E Cohen
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Taina Mattila
- Department of CNS Products, Medicines Evaluation Board, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Kit Roes
- Biostatistics Research Group, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, The Netherlands; Amsterdam Neuroscience, University of Amsterdam, The Netherlands; and Department of Research, Arkin Institute for Mental Health, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, The Netherlands; Amsterdam Neuroscience, University of Amsterdam, The Netherlands; and Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, The Netherlands
| | - Jasper B Zantvoord
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
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Horvitz-Lennon M, Volya R, Zelevinsky K, Shen M, Donohue JM, Mulcahy A, Normand SLT. Significance and Factors Associated with Antipsychotic Polypharmacy Utilization Among Publicly Insured US Adults. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:59-70. [PMID: 34009492 DOI: 10.1007/s10488-021-01141-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/26/2022]
Abstract
Antipsychotic polypharmacy (APP) lacks evidence of effectiveness in the care of schizophrenia or other disorders for which antipsychotic drugs are indicated, also exposing patients to more risks. Authors assessed APP prevalence and APP association with beneficiary race/ethnicity and payer among publicly-insured adults regardless of diagnosis. Retrospective repeated panel study of fee-for-service (FFS) Medicare, Medicaid, and dually-eligible white, black, and Latino adults residing in California, Georgia, Iowa, Mississippi, Oklahoma, South Dakota, or West Virginia, filling antipsychotic prescriptions between July 2008 and June 2013. Primary outcome was any monthly APP utilization. Across states and payers, 11% to 21% of 397,533 antipsychotic users and 12% to 19% of 9,396,741 person-months had some APP utilization. Less than 50% of person-months had a schizophrenia diagnosis and up to 19% had no diagnosed mental illness. Payer modified race/ethnicity effects on APP utilization only in CA; however, the odds of APP utilization remained lower for minorities than for whites. Elsewhere, the odds varied by race/ethnicity only in OK, with Latinos having lower odds than whites (odds ratio 0.76; 95% confidence interval 0.60-0.96). The odds of APP utilization varied by payer in several study states, with odds generally higher for Dual eligibles, although the differences were generally small; the odds also varied by year (lower at study end). APP was frequently utilized but mostly declined over time. APP utilization patterns varied across states, with no consistent association with race/ethnicity and small payer effects. Greater use of APP-reducing strategies are needed, particularly among non-schizophrenia populations.
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Affiliation(s)
- Marcela Horvitz-Lennon
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA.
- Cambridge Health Alliance, Cambridge, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Rita Volya
- Institute for Health Care Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Katya Zelevinsky
- The Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Mimi Shen
- RAND Corporation, Santa Monica, CA, USA
| | - Julie M Donohue
- The Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sharon-Lise T Normand
- The Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- The Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
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Bernardo M, Rico-Villademoros F, García-Rizo C, Rojo R, Gómez-Huelgas R. Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies. Adv Ther 2021; 38:2491-2512. [PMID: 33826090 PMCID: PMC8107077 DOI: 10.1007/s12325-021-01689-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To assess the risk of occurrence and potential determinants of metabolic disorders in adult patients treated with second-generation antipsychotics (SGAs) under real-world practice conditions. METHODS MEDLINE, EMBASE, and PsycInfo were searched in July 2019 from database inception. We included population-based, longitudinal, comparative studies that report the results of the outcomes of interest for adult participants, including diabetes, ketoacidosis, hyperosmolar hyperglycemic state, weight gain/obesity, dyslipidemia, hypertension, and metabolic syndrome. Two reviewers independently extracted data on the study design, study quality, and study outcomes. RESULTS We included 40 studies. Most studies showed that clozapine and olanzapine were associated with an increased likelihood of developing diabetes, while the results for risperidone and quetiapine were mixed. Although less well studied, ziprasidone and aripiprazole appeared to not be associated with the occurrence of diabetes. Information on antipsychotic-induced weight gain/obesity is extremely scarce. Regarding dyslipidemia, aripiprazole was not associated with an increased likelihood of developing dyslipidemia, clozapine was associated with an increased likelihood of developing dyslipidemia, and risperidone, olanzapine, quetiapine, and ziprasidone showed mixed results. Two studies suggested an association between ziprasidone and the occurrence of hypertension. Several studies found that the occurrence of a metabolic disorder acted as a risk factor for the development of other metabolic disorders. We did not find information on brexpiprazole, cariprazine, or lurasidone, and data on any long-acting SGA were lacking. CONCLUSION Although there are relevant differences among SGAs concerning the risk of metabolic disorders, it appears that none of the SGAs included in our review are fully devoid of these disturbances.
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Affiliation(s)
- Miquel Bernardo
- Department of Psychiatry, Hospital Clínic, University of Barcelona, Idibaps, Cibersam, Barcelona, Spain.
| | | | - Clemente García-Rizo
- Department of Psychiatry, Hospital Clínic, University of Barcelona, Idibaps, Cibersam, Barcelona, Spain
| | - Rosa Rojo
- Faculty of Health Sciences, Alfonso X El Sabio University, Villanueva de la Cañada, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Instituto de Investigación Biomedica de Malaga-IBIMA, Regional University Hospital of Malaga, Malaga, Spain
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5
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Jerome RN, Pulley JM, Sathe NA, Krishnaswami S, Dickerson AB, Worley KJ, Wilkins CH. Exploring Biologic Predictors Response Disparities to Atypical Antipsychotics among Blacks: A Quasi-Systematic Review. Ethn Dis 2020; 30:229-240. [PMID: 32269465 DOI: 10.18865/ed.30.s1.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose Management of schizophrenia among Blacks in the United States is affected by persistent disparities. This review explored response to atypical antipsychotics among Blacks compared with other groups to assess systematic variation that may contribute to disparities. Methods We conducted a quasi-systematic review of studies reporting response to atypical antipsychotics among Blacks compared with other groups, including effects of genetic variation. Results Of 48 identified research articles, 29 assessed differences in outcomes without inclusion of genetic variation and 20 explored effects of genetic variation; of note: one article included both types of data. Analysis of the 29 papers with clinical outcomes only suggests that while data on efficacy and risk of movement disorders were heterogeneous, findings indicate increased risk of metabolic effects and neutropenia among Blacks. Of the 20 articles exploring effects of genetic variation, allelic or genotypic variations involving several genes were associated with altered efficacy or safety among Blacks but not Whites, including risk of decreased response involving variation in DRD4 and DRD1, and improved efficacy associated with variants in DRD2, COMT, and RGS4. Others showed significant improvement in treatment response only among Whites, including variation in DTNBP1, DRD4, and GNB3. Conclusions The current analysis can help tailor management among Blacks using an atypical antipsychotic. Heterogeneity in genetic variation effects and response allele frequency suggests that pharmacogenetics approaches for atypical antipsychotics will need to explicitly incorporate race and ethnicity.
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Affiliation(s)
- Rebecca N Jerome
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jill M Pulley
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Nila A Sathe
- Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN.,Vanderbilt Department of Health Policy, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Alyssa B Dickerson
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine J Worley
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN.,Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center and Department of Internal Medicine, Meharry Medical College, Nashville, TN
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6
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Misra BB, Misra A. The chemical exposome of type 2 diabetes mellitus: Opportunities and challenges in the omics era. Diabetes Metab Syndr 2020; 14:23-38. [PMID: 31838434 DOI: 10.1016/j.dsx.2019.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is a global silent killer, with > 450 million affected adults worldwide. A diverse array of non-modifiable risk factors such as family history, age (> 45 yrs), race/ethnicity, genetics, and history of gestational diabetes and modifiable risk factors such as physical inactivity, high body fat, body weight, high blood pressure, and high cholesterol for progression of prediabetes to T2DM. Given, that the modern world human population is constantly exposed to multiple stressors in the form of physical (i.e., sound, weather etc.) and chemical environment (i.e., diet, pollutants etc.), industrialization, and modernization has led to form a basis for exposomal correlation with T2DM incidence. Over the past decade, there have been emerging reports on association of levels of persistent organic pollutants (POPs), phthalates, antibiotics, drugs, air pollution, pesticides, and heavy metals with T2DM. In this review, we discuss the well known chemical exposome that has been associated with T2DM; the tools and approaches to capture this chemical exposome, and future opportunities and challenges in this exciting area of research. We further provide a window of thoughts, whether omics technologies can help fill in the gaps to help provide high throughput exposomics datasets in an unbiased manner to help understand T2DM pathophysiology in the context of industrialization, drastic lifestyle changes, urbanization, and pollution. We also discuss and provide guidelines/call to action for future exposomics studies investigating the association of T2DM with exposomes in the context of both epidemiological and experimental approaches.
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Affiliation(s)
- Biswapriya B Misra
- Center for Precision Medicine, Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, 27157, NC, USA
| | - Anoop Misra
- Diabetes Foundation (India), Safdarjung Development Area, New Delhi, India; Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, Nehru Place, New Delhi, India.
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7
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Abosi O, Lopes S, Schmitz S, Fiedorowicz JG. Cardiometabolic effects of psychotropic medications. Horm Mol Biol Clin Investig 2018; 36:hmbci-2017-0065. [PMID: 29320364 DOI: 10.1515/hmbci-2017-0065] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/18/2017] [Indexed: 12/27/2022]
Abstract
Background Many psychiatric disorders including schizophrenia, bipolar disorder and major depression convey an excess burden of cardiovascular morbidity and mortality. The medications used to treat these conditions may further adversely affect cardiovascular risk and exacerbate health disparities for vulnerable populations. There is a clinical need to appreciate the cardiometabolic adverse effects of psychotropic medications. Methods This paper reviews the most relevant cardiometabolic effects of psychotropic medications, organized around the components of metabolic syndrome. When known, the molecular and physiological mechanisms underlying any adverse cardiometabolic effects are detailed. Results Many commonly used psychotropic medications, particularly antipsychotics, mood stabilizers and some antidepressants, have been independently associated with cardiometabolic risk factors such as insulin resistance, obesity and dyslipidemia. Stimulants, antidepressants that inhibit reuptake of norepinephrine, some antipsychotics and valproic acid derivatives may also increase blood pressure. Conclusion Understanding, assessing and subsequently managing cardiometabolic complications of psychotropic medications are important to mitigate the excess cardiovascular morbidity and mortality in the clinical populations prescribed psychotropic medications. There is considerable variability in risk between medications and individuals. Timely management of iatrogenic cardiometabolic effects is critical.
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Affiliation(s)
- Oluchi Abosi
- Department of Psychiatry, The University of Iowa, Iowa City, IA, USA
| | - Sneha Lopes
- Department of Psychiatry, The University of Iowa, Iowa City, IA, USA
| | - Samantha Schmitz
- Department of Psychiatry, The University of Iowa, Iowa City, IA, USA.,Department of Epidemiology College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Jess G Fiedorowicz
- Department of Epidemiology College of Public Health, The University of Iowa, Iowa City, IA, USA.,Department of Psychiatry, The University of Iowa, 200 Hawkins Drive, W278 GH, Iowa City, IA 52242, USA, Phone: +319-384-9267.,Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.,François M. Abboud Cardiovascular Research Center, The University of Iowa, Iowa City, IA, USA.,Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA.,Obesity Research and Education Initiative, The University of Iowa, Iowa City, IA, USA
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8
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Citrome LL, Holt RIG, Zachry WM, Clewell JD, Orth PA, Karagianis JL, Hoffmann VP. Risk of Treatment-Emergent Diabetes Mellitus in Patients Receiving Antipsychotics. Ann Pharmacother 2016; 41:1593-603. [PMID: 17785613 DOI: 10.1345/aph.1k141] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Type 2 diabetes mellitus has been reported during antipsychotic treatment. Objective: To quantify the potential risk of treatment-emergent diabetes mellitus among patients receiving antipsychotic medications. Methods: The MEDLINE and Psychinfo databases were searched using the key words antipsychotic (including individual drug names), diabetes, risk, and incidence for all English-language articles published between 1966 and 2005. Risk calculations were performed using data obtained from pharmacoepidemiologic studies that met the following criteria: (1) cohort design, (2) determination of preexisting diabetes, (3) inclusion of antipsychotic monotherapy as an exposure variable, and (4) comparison with exposure to first-generation antipsychotics. Studies meeting these criteria were used to calculate incidence, attributable risk between agents, and number needed to harm. Results: A total of 25 observational pharmacoepidemiologic studies were found comparing antipsychotics on the outcome of diabetes mellitus. Sufficient information was provided in 15 of the reports to be able to estimate attributable risk, Attributable risk for individual second-generation antipsychotics relative to first-generation antipsychotics ranged from 53 more to 46 fewer new cases of diabetes per 1000 patients. Little observable difference was noted between the individual second-generation antipsychotics versus first-generation antipsychotics on this outcome. However, few of the studies controlled for body weight, race or ethnicity, or the presence of diabetogenic medications. None adjusted for familial history of diabetes, levels of physical activity, or diet, as this information is not usually available in the databases used in pharmacoepidemiologic studies. Conclusions: Based on the published pharmacoepidemiologic reports reviewed, the avoidance of diabetes as an outcome cannot be predictably achieved with precision by choice of a second- versus a first-generation antipsychotic. Risk management for new-onset diabetes requires the assessment of established risk factors such as family history, advancing age, non-white ethnicity, diet, central obesity, and level of physical activity.
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Affiliation(s)
- Leslie L Citrome
- Department of Psychiatry, School of Medicine, New York University, New York, NY, USA.
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Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review. J Gen Intern Med 2016; 31:1083-91. [PMID: 27149967 PMCID: PMC4978675 DOI: 10.1007/s11606-016-3712-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications.In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system.Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.
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Abstract
Carbohydrate, lipid, and protein metabolism are largely controlled by the interplay of various hormones, which includes those secreted by the pancreatic islets of Langerhans. While typically representing only 1% to 2% of the total pancreatic mass, the islets have a remarkable ability to adapt to disparate situations demanding a change in hormone release, such as peripheral insulin resistance. There are many different routes to the onset of insulin resistance, including obesity, lipodystrophy, glucocorticoid excess, and the chronic usage of atypical antipsychotic drugs. All of these situations are coupled to an increase in pancreatic islet size, often with a corresponding increase in insulin production. These adaptive responses within the islets are ultimately intended to maintain glycemic control and to promote macronutrient homeostasis during times of stress. Herein, we review the consequences of specific metabolic trauma that lead to insulin resistance and the corresponding adaptive alterations within the pancreatic islets.
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Affiliation(s)
- Susan J. Burke
- Laboratory of Islet Biology and Inflammation, Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Michael D. Karlstad
- Department of Surgery, Graduate School of Medicine, University of Tennessee Health Science Center, Knoxville, TN 37920
| | - J. Jason Collier
- Laboratory of Islet Biology and Inflammation, Pennington Biomedical Research Center, Baton Rouge, LA 70808
- Department of Surgery, Graduate School of Medicine, University of Tennessee Health Science Center, Knoxville, TN 37920
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11
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Heintjes EM, Overbeek JA, Penning-van Beest FJA, Brobert G, Herings RMC. Post authorization safety study comparing quetiapine to risperidone and olanzapine. Hum Psychopharmacol 2016; 31:304-12. [PMID: 27297785 DOI: 10.1002/hup.2539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/26/2016] [Accepted: 04/15/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare rates of specific adverse outcomes between patients starting quetiapine, olanzapine, or risperidone use in the Netherlands. METHODS Observational study using the PHARMO Database Network, including patients starting quetiapine (4658), olanzapine (5856), or risperidone (7229) in 2000-2009, comparing rates of all-cause mortality, failed suicide attempts, extrapyrimidal symptoms (EPS), diabetes mellitus (DM), hypothyroidism, and acute myocardial infarction (AMI). KEY FINDINGS Median follow-up until discontinuation/end of follow-up was 0.6 years. Prescribed doses were generally lower than the approved defined daily doses, especially for quetiapine. Quetiapine was significantly associated with lower EPS rates (HR 0.18; 95% CI 0.13-0.24), but higher failed suicide attempt rates (HR 2.07; 95% CI 1.35-3.16) compared to risperidone. Quetiapine was significantly associated with lower EPS rates (HR 0.59; 95% CI 0.42-0.84) and DM rates (HR 0.66; 95% CI 0.44-0.97) compared to olanzapine. Rates for all-cause mortality, hypothyroidism, and stroke were similar between groups. AMI events were too infrequent to draw conclusions. CONCLUSIONS Quetiapine was associated with lower EPS, but higher failed suicide attempt rates compared to risperidone. Quetiapine was associated with lower EPS and DM rates compared to olanzapine. The results should be interpreted with caution because of possible channelling and residual confounding. Copyright © 2016 John Wiley & Sons, Ltd.
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12
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Ward M, Druss B. The epidemiology of diabetes in psychotic disorders. Lancet Psychiatry 2015; 2:431-451. [PMID: 26360287 DOI: 10.1016/s2215-0366(15)00007-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/09/2015] [Indexed: 01/14/2023]
Abstract
Diabetes is highly prevalent in people with psychotic disorders, including schizophrenia and schizoaffective disorders. Exact prevalence is difficult to estimate, since diabetes is often underdiagnosed in people with psychosis. Results of several studies show that the prevalence of diabetes exceeds that in the general population, with documented prevalence in those with psychosis ranging from 1·26% to 50% across studies (median 13%). The association between diabetes and psychosis is complex and multifactorial. Many of the traditional risk factors for disease have increased prevalence in patients with psychotic disorders. In addition to these traditional risk factors, people with psychosis have unique risks that might have additive or even synergistic effects. These risks include the use of antipsychotic medication, the effects of adverse social determinants of health, and genetic loading. Despite evidence that rates of diabetes are increased in individuals with psychosis, many of these patients are not diagnosed or treated, resulting in increased diabetes-associated morbidity and mortality. Specific patient factors, provider issues, and systems-level factors contribute to the treatment gap. Interventions at both the clinical and public health levels are needed to successfully address this problem.
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Affiliation(s)
- Martha Ward
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Emory University, Atlanta, GA, USA.
| | - Benjamin Druss
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Emory University, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Pomytkin IA, Cline BH, Anthony DC, Steinbusch HW, Lesch KP, Strekalova T. Endotoxaemia resulting from decreased serotonin tranporter (5-HTT) function: A reciprocal risk factor for depression and insulin resistance? Behav Brain Res 2015; 276:111-7. [DOI: 10.1016/j.bbr.2014.04.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/25/2014] [Accepted: 04/28/2014] [Indexed: 12/31/2022]
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Cabassa LJ, Gomes AP, Meyreles Q, Capitelli L, Younge R, Dragatsi D, Alvarez J, Nicasio A, Druss B, Lewis-Fernández R. Primary health care experiences of hispanics with serious mental illness: a mixed-methods study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:724-36. [PMID: 24162079 PMCID: PMC4000574 DOI: 10.1007/s10488-013-0524-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This mixed-methods study examines the primary health care experiences of Hispanic patients with serious mental illness. Forty patients were recruited from an outpatient mental health clinic. Participants reported a combination of perceived discrimination and stigmatization when receiving medical care. They rated the quality of chronic illness care as poor and reported low levels of self-efficacy and patient activation. These indicators were positively associated with how patients viewed their relationships with primary care providers. A grounded model was developed to describe the structural, social, and interpersonal processes that shaped participants' primary care experiences.
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Affiliation(s)
- Leopoldo J. Cabassa
- School of Social Work, Columbia University and the New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, NY, USA
| | | | | | | | - Richard Younge
- Columbia Center for Family and Community Medicine, Columbia University, New York, NY, USA
| | - Dianna Dragatsi
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - Juana Alvarez
- New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
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Carliner H, Collins PY, Cabassa LJ, McNallen A, Joestl SS, Lewis-Fernández R. Prevalence of cardiovascular risk factors among racial and ethnic minorities with schizophrenia spectrum and bipolar disorders: a critical literature review. Compr Psychiatry 2014; 55:233-47. [PMID: 24269193 PMCID: PMC4164219 DOI: 10.1016/j.comppsych.2013.09.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 09/10/2013] [Accepted: 09/18/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE People with serious mental illness (SMI) die at least 11 years earlier than the general U.S. population, on average, due largely to cardiovascular disease (CVD). Disparities in CVD morbidity and mortality also occur among some U.S. racial and ethnic minorities. The combined effect of race/ethnicity and SMI on CVD-related risk factors, however, remains unclear. To address this gap, we conducted a critical literature review of studies assessing the prevalence of CVD risk factors (overweight/obesity, diabetes mellitus, metabolic syndrome, hypercholesterolemia, hypertension, cigarette smoking, and physical inactivity) among U.S. racial/ethnic groups with schizophrenia-spectrum and bipolar disorders. METHODS AND RESULTS We searched MEDLINE and PsycINFO for articles published between 1986 and 2013. The search ultimately yielded 40 articles. There was great variation in sampling, methodology, and study populations. Results were mixed, though there was some evidence for increased risk for obesity and diabetes mellitus among African Americans, and to a lesser degree for Hispanics, compared to non-Hispanic Whites. Sex emerged as an important possible effect modifier of risk, as women had higher CVD risk among all racial/ethnic subgroups where stratified analyses were reported. CONCLUSIONS Compared to general population estimates, there was some evidence for an additive risk for CVD risk factors among racial/ethnic minorities with SMI. Future studies should include longitudinal assessment, stratification by sex, subgroup analyses to clarify the mechanisms leading to potentially elevated risk, and the evaluation of culturally appropriate interventions to eliminate the extra burden of disease in this population.
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Affiliation(s)
- Hannah Carliner
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
| | - Pamela Y Collins
- Office for Research on Disparities and Global Mental Health, National Institute of Mental Health/NIH, Bethesda, MD, USA
| | - Leopoldo J Cabassa
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, NY, USA; Columbia University School of Social Work, New York, NY, USA
| | - Ann McNallen
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah S Joestl
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, NY, USA; Hispanic Treatment Program, New York State Psychiatric Institute, New York, NY, USA
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Pratt N, Andersen M, Bergman U, Choi NK, Gerhard T, Huang C, Kimura M, Kimura T, Kubota K, Lai ECC, Ooba N, Ösby U, Park BJ, Sato T, Shin JY, Sundström A, Yang YHK, Roughead EE. Multi-country rapid adverse drug event assessment: the Asian Pharmacoepidemiology Network (AsPEN) antipsychotic and acute hyperglycaemia study. Pharmacoepidemiol Drug Saf 2013; 22:915-24. [DOI: 10.1002/pds.3440] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 02/26/2013] [Accepted: 03/03/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research; University of South Australia; Adelaide Australia
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Karolinska Institutet, and Division of Clinical Pharmacology, Department of Laboratory Medicine; Karolinska Institutet, Karolinska University Hospital; Stockholm Sweden
| | - Ulf Bergman
- Centre for Pharmacoepidemiology, Karolinska Institutet, and Division of Clinical Pharmacology, Department of Laboratory Medicine; Karolinska Institutet, Karolinska University Hospital; Stockholm Sweden
| | - Nam-Kyong Choi
- Medical Research Collaborating Centre; Seoul National University College of Medicine/Seoul National University Hospital; Seoul Korea
| | - Tobias Gerhard
- Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick NJ USA
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy; Rutgers University; Piscataway NJ USA
| | - Cecilia Huang
- Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick NJ USA
| | - Michio Kimura
- Department of Medical Informatics; Hamamatsu University, School of Medicine; Shizuoka Japan
| | - Tomomi Kimura
- Department of Medical Informatics; Hamamatsu University, School of Medicine; Shizuoka Japan
| | - Kiyoshi Kubota
- Department of Pharmacoepidemiology; University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Edward Chia-Cheng Lai
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, Health Outcome Research Centre; National Cheng Kung University; Tainan Taiwan
| | - Nobuhiro Ooba
- Department of Pharmacoepidemiology; University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Urban Ösby
- Neurogenetics Unit, Department of Molecular Medicine and Surgery; Karolinska Institutet, and Centre for Molecular Medicine; Stockholm Sweden
| | - Byung-Joo Park
- Department of Preventative Medicine; Seoul National University College of Medicine
- Medical Research Collaborating Centre; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Korea
| | - Tsugumichi Sato
- Department of Pharmacoepidemiology; University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Ju-Young Shin
- Department of Preventative Medicine; Seoul National University College of Medicine
| | - Anders Sundström
- Centre for Pharmacoepidemiology, Karolinska Institutet, and Division of Clinical Pharmacology, Department of Laboratory Medicine; Karolinska Institutet, Karolinska University Hospital; Stockholm Sweden
| | - Yea-Huei Kao Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, Health Outcome Research Centre; National Cheng Kung University; Tainan Taiwan
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research; University of South Australia; Adelaide Australia
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Cabassa LJ, Parcesepe A, Nicasio A, Baxter E, Tsemberis S, Lewis-Fernández R. Health and wellness photovoice project: engaging consumers with serious mental illness in health care interventions. QUALITATIVE HEALTH RESEARCH 2013; 23:618-30. [PMID: 23258117 PMCID: PMC3818106 DOI: 10.1177/1049732312470872] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
People with serious mental illnesses (SMI) are at increased risk for cardiovascular disease and premature mortality. We used photovoice in two supportive housing agencies to engage consumers with SMI to inform the implementation of health care interventions. Sixteen consumers participated in six weekly sessions in which they took photographs about their health and discussed the meanings of these photographs in individual interviews and group sessions. We identified several implementation themes related to consumers' preferences. Peer-based approaches were preferred more than clinician-driven models. Participants expressed a desire to learn practical skills through hands-on activities to modify health behaviors. Consumers expressed a desire to increase their physical activity. Participants revealed in their photographs and narratives the important role that communities' food environments play in shaping eating habits. In this article, we show how photovoice can generate valuable community knowledge to inform the translation of health care interventions in supportive housing agencies.
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Affiliation(s)
- Leopoldo J Cabassa
- Columbia University School of Social Work, New York, New York 10027, USA.
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Moisan J, Turgeon M, Desjardins O, Grégoire JP. Comparative safety of antipsychotics: another look at the risk of diabetes. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:218-24. [PMID: 23547645 DOI: 10.1177/070674371305800407] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The association between the use of antipsychotics and diabetes mellitus (DM) is still unclear, as depicted by several conflicting reports. Our study aims to assess the risk of DM in new users of antipsychotics. METHODS Our nested case-control study used the Quebec Health Insurance Board databases. People in the source cohort were DM-free and had initiated an antipsychotic treatment. Subjects were cohort members who initiated an antidiabetic or had a diagnosis of DM during their follow-up period. Three variables were used to assess antipsychotic exposure: the antipsychotic used (any typical, clozapine, olanzapine, quetiapine, risperidone, or more than 1 drug); the number of 30-day periods of use; and antipsychotic use at index date (current or past). A paired multivariate logistic regression model was used to calculate adjusted odds ratios. RESULTS Among the 88 467 people included in the cohort, 6109 subjects with DM were identified and were matched to 61 090 control subjects. New users of quetiapine were less likely to develop DM than new users of typical antipsychotics (OR, 0.89; 95% CI 0.81 to 0.99). The risk of DM was not statistically different across the atypical antipsychotics. A longer exposure to any antipsychotic (for each 30-day period, OR 1.009; 95% CI 1.006 to 1.011) and current use of antipsychotics (OR 1.26; 95% CI 1.17 to 1.36) were associated with DM. CONCLUSION These results suggest that metabolic parameters of people exposed to antipsychotics should be monitored, irrespective of the drug taken, among the drugs available at the time of analysis.
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Ely SF, Neitzel AR, Gill JR. Fatal diabetic ketoacidosis and antipsychotic medication. J Forensic Sci 2012; 58:398-403. [PMID: 23278567 DOI: 10.1111/1556-4029.12044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/14/2012] [Accepted: 02/19/2012] [Indexed: 11/30/2022]
Abstract
Hyperglycemia and new onset diabetes have been described with certain antipsychotic medications and some of the initial presentations are fatal diabetic ketoacidosis (DKA). We report 17 deaths due to DKA in psychiatric patients treated with second generation antipsychotic medications. Death certificates and toxicology data were searched for DKA and hyperglycemia. We reviewed the medical examiner records which included the autopsy, toxicology, police, and medical examiner investigators' reports. The decedents ranged in age from 32 to 57 years (average 48 years). There were 15 men and two women. The immediate cause of death was DKA in all. The psychiatric disorders included: 10 schizophrenia, three bipolar/schizophrenia, two bipolar, and two major depression. The most frequent atypical antipsychotic medications found were quetiapine and olanzapine followed by risperidone. In 16 deaths, we considered the medication as primary or contributory to the cause of death.
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Affiliation(s)
- Susan F Ely
- New York City Office of Chief Medical Examiner and Department of Forensic Medicine, New York University School of Medicine, 520 First Avenue, New York, NY, 10016
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Fiedorowicz JG, Miller DD, Bishop JR, Calarge CA, Ellingrod VL, Haynes WG. Systematic Review and Meta-analysis of Pharmacological Interventions for Weight Gain from Antipsychotics and Mood Stabilizers. ACTA ACUST UNITED AC 2012; 8:25-36. [PMID: 22712004 DOI: 10.2174/157340012798994867] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pharmacological treatments for serious mental illness (SMI) can cause weight gain and adverse metabolic effects. Many second generation antipsychotics and mood stabilizers appear to be particularly problematic in this regard. Several studies have investigated interventions for antipsychotic-induced, or less commonly mood stabilizer -induced, weight gain. Both lifestyle and pharmacological interventions have demonstrated effectiveness. We systematically review randomized controlled trials of pharmacological interventions for weight gain related to these medications. We conducted a meta-analysis of clinical trials for the most studied agents to estimate mean weight loss: metformin (2.93 kg, 95% C.I. 0.97-4.89, p=0.003), H(2) antagonists (1.78 kg (95% C.I. -0.50-4.06, p=0.13), topiramate (3.95 kg 95% C.I. 1.77-6.12, p=0.0004), and norepinephrine reuptake inhibitors (1.30 kg (95% C.I. -0.06-2.66, p=0.06). Among the studied options for antipsychotic-related weight gain, metformin has the strongest evidence base and may improve vascular risk factors beyond obesity. The use of topiramate is also supported by the literature and may improve psychotic symptoms in those refractory to treatment. A marginal benefit is seen with norepinephrine reuptake inhibitors, and any vascular benefits from such weight loss may be counteracted by increases in blood pressure or heart rate. Pharmacological therapies may offer benefits as a means of supplementing the effects of lifestyle changes for weight loss. However, the existing evidence provides little evidence of specificity for pharmacological therapies to antipsychotic-induced weight gain and has not studied any connection between benefits and reduced incidence of diabetes mellitus or any vascular outcomes.
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, Iowa, 52242
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Cabassa LJ, Druss B, Wang Y, Lewis-Fernández R. Collaborative planning approach to inform the implementation of a healthcare manager intervention for Hispanics with serious mental illness: a study protocol. Implement Sci 2011; 6:80. [PMID: 21791070 PMCID: PMC3169485 DOI: 10.1186/1748-5908-6-80] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 07/26/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified intervention to improve the physical health of Hispanics with serious mental illness (SMI) and at risk for cardiovascular disease (CVD). METHODS The proposed study uses a multiphase approach that applies CBPR principles and intervention-mapping steps--an intervention-planning approach--to move from intervention planning to pilot testing. In phase I, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. Phase II uses a combination of qualitative methods--patient focus groups and stakeholder interviews--to ensure that the modifications are acceptable to all stakeholders. Phase III uses results from phase II to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase IV consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its initial effects. Lastly, phase V consists of analysis of pilot study data and preparation for future funding to develop a more rigorous evaluation of the modified intervention. DISCUSSION The proposed study is one of the few projects to date to focus on improving the physical health of Hispanics with SMI and at risk for CVD by using a collaborative planning approach to enhance the transportability and use of a promising healthcare manager intervention. This study illustrates how blending health-disparities research and implementation science can help reduce the disproportionate burden of medical illness in a vulnerable population.
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Affiliation(s)
- Leopoldo J Cabassa
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, USA
| | - Benjamin Druss
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Yuanjia Wang
- Mailman School of Public Health, Columbia University, New York, USA
| | - Roberto Lewis-Fernández
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, USA
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Hsu JH, Chien IC, Lin CH, Chou YJ, Chou P. Incidence of diabetes in patients with schizophrenia: a population-based study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:19-26. [PMID: 21324239 DOI: 10.1177/070674371105600105] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To detect the incidence of diabetes in patients with schizophrenia in Taiwan. METHODS The National Health Research Institute provided a database of 1 million random subjects for study, from which we drew a random sample of 617 068 subjects aged 18 years and older in the year 2000. Subjects who had at least one service claim during this year, with a primary diagnosis of schizophrenia, diabetes, or with a prescription for treatment of diabetes, were identified. We compared initial diagnosis of diabetes between patients with schizophrenia and the general population in 2000. We also followed a cohort of subjects with schizophrenia from 2000 to 2005. RESULTS The incidence of diabetes was higher in patients with schizophrenia than in the general population (1.46% and 1.12%, respectively; OR 1.47; 95% CI 1.09 to 1.97) in 2000. Compared with the general population, patients with schizophrenia showed a higher incidence of diabetes in the group aged 18 to 29 years; among females; among those with insurance of more than US$1281; among those living in the northern region; and among those residing in urban areas. The average annual incidence of diabetes in patients with schizophrenia was 1.84% from 2000 to 2005. Higher incidence of diabetes in patients with schizophrenia was associated with increased age, females, hypertension, and hyperlipidemia. CONCLUSIONS Patients with schizophrenia had a higher incidence of diabetes for the youngest adult age group and for females than for the general population. Increased age, females, hypertension, and hyperlipidemia were risk factors of diabetes in patients with schizophrenia.
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Affiliation(s)
- Jer-Hwa Hsu
- Department of Health, Chia-Yi Hospital, Chiayi, Taiwan
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Cabassa LJ, Blanco C, Lopez-Castroman J, Lin KH, Lui SM, Lewis-Fernández R. Racial and ethnic differences in diabetes mellitus among people with and without psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Gen Hosp Psychiatry 2011; 33:107-15. [PMID: 21596203 PMCID: PMC3099036 DOI: 10.1016/j.genhosppsych.2010.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 11/24/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study examined racial/ethnic differences in the prevalence of diabetes mellitus in a nationally representative sample of adults with and without common psychiatric disorders. METHOD Data were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34,653). Logistic regression models adjusting for sociodemographic variables and diabetes risk factors were used to examine racial/ethnic differences in 12-month prevalence rates of diabetes by psychiatric status. RESULTS Among people without psychiatric disorders, African Americans, Hispanics and American Indians/Alaska Natives, but not Asians/Pacific Islanders, had significantly higher rates of diabetes than non-Hispanic whites even after adjusting for sociodemographic variables and diabetes risk factors. In the presence of psychiatric disorders, these health disparities persisted for African Americans and Hispanics, but not for American Indians/Alaska Natives. No significant interactions between race/ethnicity and psychiatric disorders in the odds of diabetes were found across any group. CONCLUSION Policies and services that support culturally appropriate prevention and treatment strategies are needed to reduce racial/ethnic disparities in diabetes among people with and without psychiatric disabilities.
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Affiliation(s)
- Leopoldo J. Cabassa
- New York State Psychiatric Institute, New York, NY, 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
,Corresponding author: New York State Psychiatric Institute, 1051 Riverside Dr. Rm 1715, Unit 11, New York, NY 10032, USA, Tel: +1 212 543 5311; Fax: +1 212 543 5416.
| | - Carlos Blanco
- New York State Psychiatric Institute, New York, NY, 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | | | - Keng-Han Lin
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | | | - Roberto Lewis-Fernández
- New York State Psychiatric Institute, New York, NY, 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
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Chebane L, Tavassoli N, Bagheri H, Montastruc JL. [Drug-induced hyperglycemia: a study in the French pharmacovigilance database]. Therapie 2010; 65:447-58. [PMID: 21144480 DOI: 10.2515/therapie/2010051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 03/01/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To analyse drugs inducing hyperglycemia by using data reported to the French spontaneous reporting system and recorded in the French PharmacoVigilance Database (FPVD). METHODS All cases with a report of hyperglycemia and/or diabetes in the French database between 1985 and 2008 were included in the study. We estimated the risk of hyperglycemia linked to drugs by the case/non-case method. Cases were reports including hyperglycemia and non cases all other reports. This risk was estimated through calculation of reporting odds ratios (ROR). RESULTS During this period, 1219 reports including the words "hyperglycemia and/or diabetes" were registered (0.34% of the database). This adverse drug reaction occurred 1 fold over 4 in diabetics or as a part of HIV infection. Effect was "serious" in approximatively 50% of cases. We found an increase of risk during exposition with methylprednisolone [ROR=43.5; 95% CI (37.3-50.8)], tacrolimus [ROR=25; 95% CI (17.9-34.8)], olanzapine [ROR=19.9; 95% CI (14.9-26.5)], prednisone [ROR=18.9; 95% CI (15.7-22.8)] or pentamidine [ROR=15.4; 95% CI (8.2-28.3)]. CONCLUSION Drug classes most frequently found in FPVD linked to hyperglycemia are antiretroviral, steroidal anti-inflammatory, second generation neuroleptic, immunosuppressive and diuretic drugs.
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Affiliation(s)
- Leila Chebane
- Laboratoire de Pharmacologie Médicale et Clinique, Unité de Pharmacoépidémiologie EA 3696, Université de Toulouse, Faculté de Médecine, Toulouse, France
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How reimbursement databases can be used to support drug utilisation studies: example using the main French national health insurance system database. Eur J Clin Pharmacol 2010; 66:743-8. [DOI: 10.1007/s00228-010-0819-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 03/24/2010] [Indexed: 10/19/2022]
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Yood MU, DeLorenze G, Quesenberry CP, Oliveria SA, Tsai AL, Willey VJ, McQuade R, Newcomer J, L'Italien G. The incidence of diabetes in atypical antipsychotic users differs according to agent--results from a multisite epidemiologic study. Pharmacoepidemiol Drug Saf 2009; 18:791-9. [PMID: 19526626 DOI: 10.1002/pds.1781] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study was to examine the association between atypical antipsychotics, including the newer agents, aripiprazole and ziprasidone, and newly treated diabetes, using the largest post-marketing cohort of patients exposed to these newer treatments that has been studied to date. METHODS Identified two overlapping cohorts-a simple cohort (all antipsychotic users) and an inception cohort (new users of antipsychotics)-using automated data from three United States sites (60.4 million covered lives). Patients exposed to antipsychotics > or = 45 days were identified and followed for incident diagnoses of treated diabetes. Data analysis accounted for drug switching and non-consistent drug use. RESULTS In the 55 287-member inception cohort, 357 cases of newly treated diabetes were identified. Compared with current use of typical antipsychotics, current users of aripiprazole (adjusted hazard ratio (aHR) 0.93, 95% confidence interval (CI) 0.50-1.76), quetiapine (aHR 1.04, 95%CI, 0.67-1.62), risperidone (aHR 0.85, 95%CI, 0.54-1.36) and ziprasidone (aHR 1.05, 95%CI, 0.54-2.08) had similar low risk of diabetes. Patients exposed to olanzapine had an increased risk of diabetes (aHR 1.71, 95%CI, 1.12-2.61), and although the effect estimate is imprecise, clozapine-exposed patients had a trend towards an elevated hazard ratio (aHR 2.58, 95%CI, 0.76-8.80). Results for the simple cohort were similar. CONCLUSIONS Relative to typical antipsychotics, aripiprazole, ziprasidone, risperidone and quetiapine were not associated with an increased risk of diabetes; olanzapine and clozapine were associated with an increased risk. This analysis constitutes the largest post-marketing pharmacoepidemiologic study to date that includes the newer agents.
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Abstract
OBJECTIVES To compare the risk for cardiovascular mortality between bipolar I and bipolar II subtypes and determine correlates of cardiovascular mortality. Bipolar disorder conveys an increased risk of cardiovascular mortality. METHODS Participants with major affective disorders were recruited for the National Institute of Mental Health Collaborative Depression Study and followed prospectively for up to 25 years. A total of 435 participants met the diagnostic criteria for bipolar I (n = 288) or bipolar II (n = 147) disorder based on Research Diagnostic Criteria at intake and measures of psychiatric symptoms during follow-up. Diagnostic subtypes were contrasted by cardiovascular mortality risk using Cox proportional hazards regression. Affective symptom burden (the proportion of time with clinically significant manic/hypomanic or depressive symptoms) and treatment exposure were additionally included in the models. RESULTS Thirty-three participants died from cardiovascular causes. Participants with bipolar I disorder had more than double the cardiovascular mortality risk of those with bipolar II disorder, after controlling for age and gender (hazard ratio = 2.35, 95% Confidence Interval = 1.04-5.33; p = .04). The observed difference in cardiovascular mortality between these subtypes was at least partially confounded by the burden of clinically significant manic/hypomanic symptoms which predicted cardiovascular mortality independent of diagnosis, treatment exposure, age, gender, and cardiovascular risk factors at intake. Selective serotonin uptake inhibitors seemed protective although they were introduced late in follow-up. Depressive symptom burden was not related to cardiovascular mortality. CONCLUSIONS Participants with bipolar I disorder may face a greater risk of cardiovascular mortality than those with bipolar II disorder. This difference in cardiovascular mortality risk may reflect manic/hypomanic symptom burden.
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Ried LD, Brumback B, Bengtson MA, Garman PM, Hsu C, McConkey JR. Glucose dysregulation among veterans living with schizophrenia-related disorders after switching second-generation antipsychotics. J Am Pharm Assoc (2003) 2009; 49:223-31. [PMID: 19289350 DOI: 10.1331/japha.2009.08151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare (1) blood glucose and glycosylated hemoglobin (A1C) laboratory results and (2) longitudinal trends in blood glucose levels among veterans switched from one second-generation antipsychotic (SGA) to another. DESIGN Retrospective, naturalistic, nonequivalent control group. SETTING United States between April 1, 2003, and September 30, 2003. PATIENTS 1,776 U.S. Veterans Health System beneficiaries living with schizophrenia-related disorders switching (1) from olanzapine to another SGA, (2) to olanzapine from another SGA, and (3) among nonolanzapine SGAs. INTERVENTION Data were retrieved from the laboratory results (LAR) database for a maximum of 180 days before and 365 days after the index date. MAIN OUTCOME MEASURES Mean blood glucose, A1C, and change in blood glucose. RESULTS Blood glucose (36.0 mg/dL, paired t test109 = -4.87, P < 0.001) and A1C (1.0%, paired t143 = -4.84, P < 0.001) declined among veterans switched from olanzapine who were taking a blood glucose-lowering agent before the switch but was unchanged for those who were not. Adjusting for age, gender, and race, addition of the switch-type variables improved prediction of blood glucose change (F-ratio = 3.76, P = 0.03). Linear mixed-effects models confirmed that blood glucose levels declined for veterans switched from olanzapine with glucose dysregulation before the switch (Est(beta2 - beta1) = -34.5 mg/dL, t424 = -5.05, P < 0.001). CONCLUSION Blood glucose and A1C were significantly improved among veterans switched from olanzapine with evidence of glucose dysregulation before the switch. They were stable among those without evidence of preexisting glucose dysregulation. Therapeutic switches from one SGA to another should be monitored as a risk factor for changes in glucose regulation.
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Affiliation(s)
- L Douglas Ried
- Rehabilitation Outcomes Research Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA.
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Perez-Iglesias R, Mata I, Pelayo-Teran JM, Amado JA, Garcia-Unzueta MT, Berja A, Martinez-Garcia O, Vazquez-Barquero JL, Crespo-Facorro B. Glucose and lipid disturbances after 1 year of antipsychotic treatment in a drug-naïve population. Schizophr Res 2009; 107:115-21. [PMID: 18993033 DOI: 10.1016/j.schres.2008.09.028] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 09/23/2008] [Accepted: 09/30/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examined the main metabolic side effects induced by antipsychotic treatment in a cohort of first episode drug-naïve subjects after the first year of treatment. METHODS A randomized, open-label, prospective clinical trial was conducted. Participants were 164 consecutive subjects included in a first episode program and never treated with antipsychotic medication. Patients were assigned to haloperidol, olanzapine or risperidone. The main outcome measures were changes at 1 year in fasting glucose parameters (glucose, insulin levels and insulin resistance index) and changes in fasting lipid parameters (total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol). RESULTS 144 of the total sample were evaluated at 1 year. There was a statistically significant increase in the mean values of insulin levels, insulin resistance index, total cholesterol, LDL-cholesterol and triglycerides. No pathological values in fasting glucose plasma levels were found at baseline and there were no changes after 1 year. Weight gain was positively correlated with changes in insulin levels, insulin resistance index and triglyceride levels. We did not detect statistically significant differences between treatments in any of the parameters evaluated. CONCLUSIONS Fasting glycaemia and insulin concentrations at baseline do not support the hypothesis that schizophrenia is associated with an underlying abnormality in glucose metabolism. The changes in insulin and lipid parameters at 1 year seem to be related to the magnitude of weight gain. There were no significant differences between haloperidol, olanzapine and risperidone concerning metabolic adverse effects after the first year of treatment.
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Affiliation(s)
- Rocio Perez-Iglesias
- Department of Psychiatry, Marques de Valdecilla University Hospital, Avda. Valdecilla s/n, 39008, University of Cantabria, Spain
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Regenold WT, Hisley KC, Phatak P, Marano CM, Obuchowski A, Lefkowitz DM, Sassan A, Ohri S, Phillips TL, Dosanjh N, Conley RR, Gullapalli R. Relationship of cerebrospinal fluid glucose metabolites to MRI deep white matter hyperintensities and treatment resistance in bipolar disorder patients. Bipolar Disord 2008; 10:753-64. [PMID: 19032707 PMCID: PMC3753008 DOI: 10.1111/j.1399-5618.2008.00626.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Both diabetes mellitus and magnetic resonance image (MRI) deep white matter hyperintensities (WMHs) are more common in bipolar disorder (BD) patients than in matched controls. Deep-as opposed to periventricular--WMHs and diabetes are associated with treatment resistance and poorer outcome. This study investigated whether brain glucose metabolism by the polyol pathway--a pathway linked to nervous tissue disease in diabetes--is related to deep WMH volume and treatment resistance in BD patients. METHODS Volumes of fluid-attenuated inversion recovery WMHs were quantified and correlated with cerebrospinal fluid (CSF) concentrations of glucose metabolites in 20 nondiabetic patients with BD and nondiabetic comparison subjects with schizophrenia (n = 15) or transient neurologic symptoms (neurologic controls, n = 15). RESULTS BD patients, but not schizophrenic patients, had significantly greater volumes of deep but not periventricular WMHs compared to neurologic controls. BD subjects also had significantly greater CSF concentrations of sorbitol and fructose (the polyol pathway metabolites of glucose) compared to controls. Significant positive correlations between CSF metabolites and WMH volumes were found only in the BD group and were between deep WMH volumes and CSF sorbitol (rho = 0.487, p = 0.029) and fructose (rho = 0.474, p = 0.035). An index of treatment resistance correlated significantly with deep WMH volume (rho = 0.578, p = 0.008), sorbitol (rho = 0.542, p = 0.013), and fructose (rho = 0.692, p = 0.001) in BD subjects but not in other subjects. CONCLUSIONS This is the first reported evidence of relationships between abnormal brain glucose metabolism and both deep WMHs and treatment resistance in a group of BD patients. Further studies are necessary to determine the significance of these findings to BD pathophysiology.
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Affiliation(s)
- William T Regenold
- Department of Psychiatry, Division of Geriatric Psychiatry, University of Maryland School of Medicine, Baltimore, MD,
| | - K Calvin Hisley
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pornima Phatak
- Division of Geriatric Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher M Marano
- Division of Geriatric Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Abraham Obuchowski
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David M Lefkowitz
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amritpal Sassan
- Division of Geriatric Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sameer Ohri
- Division of Geriatric Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tony L Phillips
- Division of Geriatric Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Narveen Dosanjh
- Division of Geriatric Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert R Conley
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rao Gullapalli
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
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Colombo GL, Caruggi M, Di Matteo S, Rossi A. An economic evaluation of aripiprazole vs olanzapine adapted to the Italian setting using outcomes of metabolic syndrome and risk for diabetes in patients with schizophrenia. Neuropsychiatr Dis Treat 2008; 4:967-76. [PMID: 19183788 PMCID: PMC2626916 DOI: 10.2147/ndt.s3701] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of aripiprazole and olanzapine in patients with schizophrenia. METHODS Data from a double-blind, randomized study demonstrating the efficacy of aripiprazole and olanzapine were used to observe new incidence of metabolic syndrome (26-week therapy) and to model the risk of developing diabetes over 5 years of therapy. Cumulative incidence of metabolic syndrome was compared using Kaplan-Meier estimates; diabetes risk was estimated using a validated, general population risk-prediction model. Economic assessment was conducted from the third-party payer perspective by evaluating pharmacotherapy costs of treating schizophrenia and medical costs associated with treating adverse metabolic effects in a hypothetical cohort of 1000 patients. Resource utilization and costs were derived from the underlying study and published data, using a 3% rate to discount costs and benefits. RESULTS For the patients switched from olanzapine to aripiprazole, treatment with aripiprazole was a dominant cost-saving strategy. Use of aripiprazole avoided 184 events of metabolic syndrome over 26 weeks of treatment, contributing to a real-world (RW) cost savings of euro2.53 per patient and a total savings of approximately euro465.52 over a 5-year period. For the same cohort, the risk-prediction model indicated that 34 occurrences of diabetes could be avoided over 5 years, corresponding to a RW cost savings of euro56.86 per patient and a total saving of approximately euro1,933.24. These savings reflect avoided costs in treating adverse metabolic events and comparable costs in the acquisition of aripiprazole. CONCLUSIONS Maintenance aripiprazole therapy offers medical and economic benefits over olanzapine, reflected by reduced incidence of metabolic syndrome and diabetes and associated lower costs.
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Fiedorowicz JG, Palagummi NM, Forman-Hoffman VL, Miller DD, Haynes WG. Elevated prevalence of obesity, metabolic syndrome, and cardiovascular risk factors in bipolar disorder. Ann Clin Psychiatry 2008; 20:131-7. [PMID: 18633739 PMCID: PMC2776768 DOI: 10.1080/10401230802177722] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bipolar disorder is associated with excess cardiovascular mortality. We hypothesized outpatients with bipolar disorder would exhibit excess cardiovascular risk factors, particularly among prevalent users of the second-generation antipsychotics associated with weight gain and valproic acid derivatives. METHODS This chart review of 217 patients with bipolar disorder examined cardiovascular risk factors of the metabolic syndrome. We also evaluated if certain medications were cross-sectionally associated with metabolic syndrome. RESULTS Fifty-six patients were not weighed and many did not have available lipid profiles. Over three-quarters of those with available data (n = 161) were overweight or obese (body mass index >or= 25) and nearly half were obese (body mass index >or= 30). A prevalence exceeding general population estimates was also observed for hypertriglyceridemia, elevated blood pressure/hypertension, and elevated fasting glucose/diabetes. Among those with all requisite data (n = 60), over 50% met criteria for National Cholesterol Education Program-defined metabolic syndrome, nearly double the expected prevalence. A trend toward greater prevalence of metabolic syndrome among prevalent users of the second-generation antipsychotics associated with weight gain was observed. CONCLUSIONS Obesity and the metabolic syndrome were common in patients with bipolar disorder. These patients may be under-evaluated for cardiovascular risk and warrant screening and early intervention.
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Psychiatry, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA.
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Smith M, Hopkins D, Peveler RC, Holt RIG, Woodward M, Ismail K. First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 2008; 192:406-11. [PMID: 18515889 DOI: 10.1192/bjp.bp.107.037184] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The increased prevalence of diabetes in schizophrenia is partly attributed to antipsychotic treatment, in particular second-generation antipsychotics, but the evidence has not been systematically reviewed. AIMS Systematic review and meta-analysis comparing diabetes risk for different antipsychotics in people with schizophrenia. METHOD We searched MEDLINE, PsycINFO, EMBASE, International Pharmaceutical Abstracts, CINAHL and Web of Knowledge until September 2006. Studies were eligible for inclusion if the design was cross-sectional, case-control, cohort or a controlled trial in individuals with schizophrenia or related psychotic disorders, where second-generation antipsychotics (defined as clozapine, olanzapine, risperidone and quetiapine) were compared with first-generation antipsychotics and diabetes was an outcome. Data were pooled using random effects inverse variance weighted meta-analysis. RESULTS Of the studies that met the inclusion criteria (n=14), 11 had sufficient data to include in the meta-analysis. Four of these were retrospective cohort studies. The relative risk of diabetes in patients with schizophrenia prescribed one of the second-generation v. first-generation antipsychotics was 1.32 (95% CI 1.15-1.51). There were insufficient data to include aripiprazole, ziprasidone and amisulpride in this analysis. CONCLUSIONS There is tentative evidence that the second-generation antipsychotics included in this study are associated with a small increased risk for diabetes compared with first-generation antipsychotics in people with schizophrenia. Methodological limitations were found in most studies, leading to heterogeneity and difficulty interpreting data. Regardless of type of antipsychotic, screening for diabetes in all people with schizophrenia should be routine.
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Affiliation(s)
- M Smith
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 9RJ, UK.
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Metabolic syndrome and insulin resistance in schizophrenia patients receiving antipsychotics genotyped for the methylenetetrahydrofolate reductase (MTHFR) 677C/T and 1298A/C variants. Schizophr Res 2008; 98:47-54. [PMID: 17976958 PMCID: PMC2271139 DOI: 10.1016/j.schres.2007.09.030] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 09/18/2007] [Accepted: 09/24/2007] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The metabolic syndrome and insulin resistance represent growing concerns related to atypical antipsychotic (AAP) use as their incidence in the schizophrenia population is two-to-four-fold higher than the general population. Reduced methylenetetrahydrofolate reductase (MTHFR) activity, resulting in aberrant folate metabolism and hyperhomocysteinemia, has been linked to cardiovascular disease and is unstudied in relation to AAP associated metabolic complications. PURPOSE To examine the relationship between MTHFR, metabolic syndrome, and insulin resistance in schizophrenia subjects receiving AAPs for >or=12 months. METHODS Fifty-eight subjects were included in this cross-sectional analysis and screened for the metabolic syndrome, insulin resistance and MTHFR 677C/T and 1298A/C genotype. RESULTS Overall, 23 subjects (40%) met metabolic syndrome criteria. There were no differences in age, gender, race, or AAP exposure between genotype groups. For the 677 T allele carriers, 53% met metabolic syndrome criteria, compared to 23% in the CC genotype group, giving an OR=3.7, (95% CI=1.24-12.66, p=0.02). Thus, for T allele subjects, the risk was almost four times greater, despite similar antipsychotic exposure. Both waist circumference and MTHFR genotype significantly predicted insulin resistance (F=8.35, df=5, 51, p<0.0001), with these two terms interacting (F=8.6, df=2, p=0.0006) suggesting that TT subjects are at greater risk for insulin resistance with increasing central adiposity, which is independent of age, gender, BMI, or metabolic syndrome diagnosis. CONCLUSION Results should be taken cautiously due to the small sample size, but suggest the MTHFR 677C/T variant may predispose patients to AAP metabolic complications.
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Abstract
Coronary heart disease (CHD) is a major cause of mortality in people who have schizophrenia, and it is caused by many factors relating to lifestyle choices, antipsychotic treatment, and other medical comorbidities. This article focuses on modifiable risk factors such as cigarette smoking, diabetes, hyperlipidemia, hypertension, and the metabolic syndrome, all of which occur more frequently in patients who have schizophrenia than in the general population. Although treatment of risk factors for CHD is still far from ideal, all attempts should be made to strive for wellness to improve patients' long-term outcomes.
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Guo JJ, Keck PE, Corey-Lisle PK, Li H, Jiang D, Jang R, L'Italien GJ. Risk of diabetes mellitus associated with atypical antipsychotic use among Medicaid patients with bipolar disorder: a nested case-control study. Pharmacotherapy 2007; 27:27-35. [PMID: 17192159 DOI: 10.1592/phco.27.1.27] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To quantify the risk of diabetes mellitus associated with atypical antipsychotics compared with conventional antipsychotics in managed care Medicaid patients with bipolar disorder. DESIGN Retrospective nested case-control study. DATA SOURCE Integrated seven-state Medicaid managed care claims database from January 1, 1998-December 31, 2002. PATIENTS Two hundred eighty-three patients with diabetes (cases) and 1134 controls matched by age, sex, and the index date on which bipolar disorder was diagnosed. MEASUREMENTS AND MAIN RESULTS Cases were defined as those having an International Classification of Diseases, Ninth Revision diagnosis of diabetes or those receiving treatment with antidiabetic drugs. Both case and control patients had at least a 3-month exposure to either conventional or atypical antipsychotic agents or three filled prescriptions related to treatment for bipolar disorder. Of the 283 cases, 139 (49%) received atypical antipsychotics (olanzapine, risperidone, quetiapine, ziprasidone, and clozapine) and 133 (47%) were prescribed conventional antipsychotics. To compare the risk for new-onset diabetes associated with atypical versus conventional antipsychotics, we conducted a Cox proportional hazard regression, in which we controlled for age; sex; duration of bipolar disorder follow-up; use of lithium, anticonvulsants, antidepressants, and other drugs; and psychiatric and medical comorbidities. Compared with patients receiving conventional antipsychotics, the risk of diabetes was greatest among patients taking risperidone (hazard ratio [HR] 3.8, 95% confidence interval [CI] 2.7-5.3), olanzapine (3.7, 95% CI 2.5-5.3), and quetiapine (2.5, 95% CI 1.4-4.3). The risk for developing diabetes was also associated with weight gain (HR 2.5, 95% CI 1.9-3.4), hypertension (HR 1.6, 95% CI 1.2-2.2), and substance abuse (HR 1.5, 95% CI 1.0-2.2). CONCLUSION Olanzapine, risperidone, and quetiapine are all associated with development or exacerbation of diabetes mellitus in patients with bipolar disorder. When prescribing therapy for this patient population, metabolic complications such as diabetes, weight gain, and hypertension need to be considered.
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Affiliation(s)
- Jeff J Guo
- College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0004, USA.
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Kolanowski A, Fick D, Waller JL, Ahern F. Outcomes of antipsychotic drug use in community-dwelling elders with dementia. Arch Psychiatr Nurs 2006; 20:217-25. [PMID: 17010825 DOI: 10.1016/j.apnu.2006.04.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 03/23/2006] [Accepted: 04/15/2006] [Indexed: 11/15/2022]
Abstract
This study used administrative data from a large health care insurer in the southeast United States to describe the utilization pattern and health care outcomes of antipsychotic drug use in community-dwelling elders with dementia. Claims data from 959 unique cases were analyzed to address research aims. Overall, 27% of the sample was dispensed antipsychotic drugs, with the most prevalent type being atypical antipsychotic drugs. Individuals on any type of antipsychotic drug experienced more delirium, depression, hip fracture, falls, and syncope than those not on these drugs, even after controlling for age, sex, comorbidity, and number of other drugs prescribed. Implications for practice are discussed.
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Affiliation(s)
- Ann Kolanowski
- School of Nursing, The Pennsylvania State University, 201 Health and Human Development Bldg., University Park, PA 16802, USA.
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Ried LD, Renner BT, McConkey JR, Bengtson MA, Lopez LM. Increased Cardiovascular Risk with Second-Generation Antipsychotic Agent Switches. J Am Pharm Assoc (2003) 2006; 46:491-8; quiz 499-501. [PMID: 16913393 DOI: 10.1331/154434506778073574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To model the risk of long-term, adverse cardiovascular events after switching from one second-generation antipsychotic medication (SGA) to another in patients with schizophrenia or schizoaffective disorder. DATA SOURCES PubMed from 1985 to 2004 using the search terms atypical antipsychotics, obesity, weight, diabetes mellitus, dyslipidemia, hypercholesterolemia, lipids, second generation antipsychotics, antipsychotic agents, schizophrenia, metabolic syndrome, cardiovascular disease, and cardiovascular risk factors. STUDY SELECTION By the authors. DATA EXTRACTION By the authors. DATA SYNTHESIS The selection of an SGA for an individual patient should be primarily based upon its therapeutic effectiveness. However, when two medications are clinically equivalent with respect to treatment outcomes, other important consequences of the medication choice should be considered. Depending upon the type of SGA switch, the risk of an adverse cardiovascular event may be lower, as when olanzapine is switched to risperidone, or may increase by as much as 33%, as when risperidone is switched to olanzapine or clozapine. CONCLUSION Cardiovascular risk likely differs depending upon SGA choice, but limited data make it difficult to predict the metabolic changes associated with switching. Prospective controlled studies are needed to describe the cardiovascular consequences of switching among the antipsychotic agents so that evidence-based strategies can be developed for selection of the optimal SGA.
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Affiliation(s)
- L Douglas Ried
- Pharmacy Health Care Administration, College of Pharmacy, P.O. Box 100496, University of Florida, Gainesville, FL 32610-0496, USA.
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Holt RIG, Peveler RC. Antipsychotic drugs and diabetes--an application of the Austin Bradford Hill criteria. Diabetologia 2006; 49:1467-76. [PMID: 16752165 DOI: 10.1007/s00125-006-0279-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 03/02/2006] [Indexed: 12/26/2022]
Abstract
There is concern that antipsychotic drugs cause diabetes. Although there has been an explosion in the quantity of literature about this subject, it remains confusing and inconsistent. To assess whether the association between antipsychotic drugs and diabetes is causative, we applied the Austin Bradford Hill criteria to the available evidence. In support of a causative relationship, there is temporality for some cases of diabetes, and there is a biologically plausible explanation. The causative link between antipsychotic drugs and diabetes is coherent with our understanding of diabetes and there are other analogies. However the strength of association is weak, there is lack of consistency or specificity, and there is little evidence to support a biological gradient. We should therefore conclude that the evidence surrounding a causative link between antipsychotic drugs and diabetes is inconclusive. Moreover, the risk is probably low and the attributable risk of developing diabetes is greater for traditional risk factors such as family history, ethnicity, obesity and ageing than it is for receiving an antipsychotic drug. Consequently, the majority of patients receiving second-generation antipsychotics will not develop diabetes as a result of their medication.
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Affiliation(s)
- R I G Holt
- Endocrinology & Metabolism Subdivision, Developmental Origins of Health and Disease Division, School of Medicine, University of Southampton, Southampton, UK.
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Barbui C, Percudani M. Epidemiological impact of antidepressant and antipsychotic drugs on the general population. Curr Opin Psychiatry 2006; 19:405-10. [PMID: 16721172 DOI: 10.1097/01.yco.0000228762.40979.8f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To analyse the prevalence of and sex and age distribution associated with antidepressant and antipsychotic drug exposure in the general population and to highlight recent epidemiological findings concerning specific adverse outcomes associated with drug exposure. RECENT FINDINGS Epidemiological studies indicate high rates of second-generation antidepressant and antipsychotic drug use in the general population. The use is more prevalent among women than among men, and in older rather than in younger age groups. A new pattern of adverse outcomes has been described in individuals exposed to newer agents, including a possible risk of suicidal acts in adults receiving second-generation antidepressants, the risk of cerebrovascular events in older individuals receiving second-generation antipsychotics and the risk of metabolic disturbances in individuals exposed to specific second-generation antipsychotics. SUMMARY The assessment of, and attention to, the development of specific adverse reactions in individuals exposed to second-generation psychotropic drugs may improve treatment outcomes.
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Affiliation(s)
- Corrado Barbui
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
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Newcomer JW, Haupt DW. The metabolic effects of antipsychotic medications. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:480-91. [PMID: 16933585 DOI: 10.1177/070674370605100803] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To review current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and type 2 diabetes mellitus (T2DM) and to examine the relation of adiposity to medical risk. METHODS We identified relevant publications through a search of MEDLINE from the years 1975 to 2006, using the following primary search parameters: "diabetes or hyperglycemia or glucose or insulin or lipids" and "antipsychotic." Meeting abstracts and earlier nonindexed articles were also reviewed. We summarized key studies in this emerging literature, including case reports, observational studies, retrospective database analyses, and controlled experimental studies. RESULTS Treatment with different antipsychotic medications is associated with variable effects on body weight, ranging from modest increases (for example, less than 2 kg) experienced with amisulpride, ziprasidone, and aripiprazole to larger increases during treatment with agents such as olanzapine and clozapine (for example, 4 to 10 kg). Substantial evidence indicates that increases in adiposity are associated with decreases in insulin sensitivity in individuals both with and without psychiatric disease. The effects of increasing adiposity, as well as other effects, may contribute to increases in plasma glucose and lipids observed during treatment with certain antipsychotics. CONCLUSION Treatment with certain antipsychotic medications is associated with metabolic adverse events that can increase the risk for metabolic syndrome and related conditions such as prediabetes, T2DM, and cardiovascular disease.
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Affiliation(s)
- John W Newcomer
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri 63110, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gardner DM, Baldessarini RJ, Waraich P. Modern antipsychotic drugs: a critical overview. CMAJ 2005; 172:1703-11. [PMID: 15967975 PMCID: PMC1150265 DOI: 10.1503/cmaj.1041064] [Citation(s) in RCA: 235] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Conventional antipsychotic drugs, used for a half century to treat a range of major psychiatric disorders, are being replaced in clinical practice by modern "atypical" antipsychotics, including aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone among others. As a class, the newer drugs have been promoted as being broadly clinically superior, but the evidence for this is problematic. In this brief critical overview, we consider the pharmacology, therapeutic effectiveness, tolerability, adverse effects and costs of individual modern agents versus older antipsychotic drugs. Because of typically minor differences between agents in clinical effectiveness and tolerability, and because of growing concerns about potential adverse long-term health consequences of some modern agents, it is reasonable to consider both older and newer drugs for clinical use, and it is important to inform patients of relative benefits, risks and costs of specific choices.
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Affiliation(s)
- David M Gardner
- Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, NS.
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