Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder

The effect of GLP-1RAs on mental health and psychotropics-induced metabolic disorders: A systematic review

BACKGROUND

Mental illnesses and psychotropic drug use are associated with an increased risk of weight gain and metabolic disorders. Growing evidence suggests that agonists of the glucagon-like peptide-1 receptor (GLP-1RAs) might be safe and effective weight loss medications. However, the current evidence for the use of GLP-1RAs in individuals with obesity and mental illness is limited.

OBJECTIVE

Evaluation of the safety and the impact of GLP-1RAs on mental health and psychotropics-induced metabolic disorders such as obesity and type 2 diabetes (T2D).

METHODS

A literature search from January 1st, 2010 to August 31st, 2024 was conducted using PubMed and Cochrane Library online databases. Studies comprising adults with obesity or/and T2D and mental illness were included. Studies that examined individuals with obesity or/and T2D without mental illness and completed psychiatric questionnaires before and after GLP-1RAs treatment were also included.

RESULTS

From the 36 included studies 18 examined the weight-reducing effect of GLP-1RAs in patients with mental disorders and the other studies examined patients without mental illness. GLP-1RAs lead to a significant weight loss and improvement of glycemic control in patients with mental illness on psychotropics. They showed a beneficial effect on mental health in patients with and without mental disorders and were not associated with a worsening of mental state, suicidality, new-onset mental illness, or increased psychiatric admissions.

CONCLUSION

GLP-1RAs are safe and effective weight loss treatments for individuals with obesity and mental illness exerting a positive effect on mental state and quality of life. There is a need for RCTs with larger sample sizes, a longer treatment duration and longer follow-up periods to evaluate the long-term effect of GLP-1RAs. It would be of great interest to conduct studies investigating the use of GLP-1RAs with the purpose to treat mental illness in order to directly assess their use in improving mental health.

North Carolina Healthy Active Living: Describing a Wellness Coaching Program for First-Episode Psychosis Clinics

Cardiovascular disease presents a ten-fold higher risk of death than suicide in individuals with serious mental illness. Individuals experiencing first-episode psychosis already have high rates of modifiable risk factors contributing to cardiovascular disease. The initial 12 months are crucial for implementing behavioral interventions for effective risk factor modification and disease prevention. Coordinated Specialty Care (CSC) outpatient clinics provide multi-disciplinary team-based treatment for teens and young adults in the early stages of psychotic illness, significantly improving mental health outcomes and quality of life. However, these clinics lack support for addressing lifestyle behavior changes in their clients. The North Carolina Healthy Active Living (NC HeAL) program is an innovative clinical service offered to all CSC clients in this state. It offers personalized health and wellness coaching to help clients achieve meaningful health improvements. This paper provides a detailed description of the program's development, the target population and setting, the roles and skills of the NC HeAL team, program components and evidence-based program measures. Results of program measures, feasibility, acceptability, implementation, and fidelity will be published separately.

A double-blind, placebo-controlled trial of exenatide for the treatment of olanzapine-related weight gain in obese and overweight adults

OBJECTIVE

To assess the safety and efficacy of exenatide in overweight or obese patients treated with olanzapine.

METHODS

Adults with stable major mood or psychotic disorders were randomized to double-blind exenatide or placebo for 16 weeks. Weight and body mass index (BMI) were monitored throughout the study. A secondary objective was to evaluate the tolerability of exenatide and its effects on mood and psychotic symptoms.

RESULTS

A significant difference in weight change was detected between the treatment groups. Participants in the exenatide group experienced on average a minor weight loss, while participants in the placebo group on average experienced weight gain (-0.5 kg [-0.6 %] vs. +2.6 kg [+2.8 %], both p < .01). The most common side effects in the exenatide group were gastrointestinal symptoms and headaches. There were no clinically meaningful differences between the groups in changes to mood or psychotic symptoms.

CONCLUSIONS

Exenatide is effective and well-tolerated for attenuating olanzapine-associated weight gain.

CLINICAL TRIAL REGISTRATION INFORMATION

Exenatide for the Treatment of Weight Gain Associated with Olanzapine in Obese Adults. NCT00845507.

Polygenic risk for psychotic disorders in relation to cardiac autonomic dysfunction in unmedicated patients with schizophrenia

Cardiac autonomic dysfunction (CADF), mainly characterized by increased heart rate, decreased heart rate variability, and loss of vagal modulation, has been extensively described in patients with schizophrenia (SCZ) and their healthy first-degree relatives. As such, it represents an apparent physiological link that contributes to the increased cardiovascular mortality in these patients. Common genetic variation is a putative underlying mechanism, along with lifestyle factors and antipsychotic medications. However, the extent to which CADF is associated with genetic factors for SCZ is unknown. A sample of 83 drug-naive SCZ patients and 96 healthy controls, all of European origin, underwent a 30-minute autonomic assessment under resting conditions. We incorporated parameters from several domains into our model, including time and frequency domains (mean heart rate, low/high frequency ratio) and compression entropy, each of which provides different insights into the dynamics of cardiac autonomic function. These parameters were used as outcome variables in linear regression models with polygenic risk scores (PRS) for SCZ as predictors and age, sex, BMI, smoking status, principal components of ancestry and diagnosis as covariates. Of the three CADF parameters, SCZ PRS was significantly associated with mean heart rate in the combined case/control sample. However, this association was was no longer significant after including diagnosis as a covariate (p = 0.29). In contrast, diagnostic status is statistically significant for all three CADF parameters, accounting for a significantly greater proportion of the variance in mean heart rate compared to SCZ PRS (approximately 16% vs. 4%). Despite evidence for a common genetic basis of CADF and SCZ, we were unable to provide further support for an association between the polygenic burden of SCZ and cardiac autonomic function beyond the diagnostic state. This suggests that there are other important characteristics associated with SCZ that lead to CADF that are not captured by SCZ PRS.

Methods for the assessment of biological age - A systematic review

Biological age has long been proposed to complement chronological age because it has the potential to provide a more accurate assessment of someone's ageing process and functional status. At present, there are several methods to determine an individual's biological age through the measurement of biomarkers of ageing. This review compares methods for assessing biological age in adults, analyses biomarkers of ageing, and determines the goals for which biological age can be calculated, in order to help determine a gold standard for measuring biological age. Articles were eligible if studies included a test battery and statistical method to calculate biological age. Literature research included the databases Medline, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov. In total, 56 studies were included and the risk of bias in each of them was assessed. The most commonly used methods to assess biological age are Klemera and Doubal's method, principal component analysis, multiple linear regression, PhenoAge and Hochschild's method. Klemera and Doubal's method has proved the most reliable. Apart from using different statistical methods, the difference between the biological ageing scores lies in the choice of biomarkers of ageing, especially the inclusion of chronological age as a biomarker of ageing. Most of the included studies aimed to establish a new biological ageing score or compare biological age to different measurements of functionality of the human body. In conclusion, there is still no consensus on a gold standard and more research on this topic is necessary. Study protocol PROSPERO ID: CRD42021287548.

The long-term effects of a 24-week outdoor exercise program in persons with schizophrenia: Results of a 12-week follow-up period

This study aims to examine the long-term mental and physical health benefits of a 24-week outdoor exercise program after a 12-week follow-up. Forty-seven outpatients with schizophrenia completed a 24-week supervised exercise program twice a week, of whom forty-six were assessed after the follow-up period. Demographic and clinical measures were collected. Physical health was evaluated using anthropometric measures, six minutes walk test, Eurofit and accelerometer. Mental health was evaluated using Rosenberg Self-Esteem scale, Behavioural Exercise Regulations Questionnaire and World Health Organization Quality of Life Scale - Brief Version questionnaires. Participants were assessed at baseline, post-intervention and 12-week follow up. After follow-up, there were significant differences in time, between groups and in time*group in six minutes walk test. Previously observed improvements in functional exercise capacity were lost by 12-week. Flexibility scores were maintained during intervention but worsened significantly by 12-week. On the other hand, participants reported significant improvements in quality of life - physical domain by 12-week. Moderate-to-vigorous physical activity decreased and sedentary behaviour and number of flamingo errors increased but failed to achieve statistical significance. Persons with schizophrenia will lost physical health benefits previously achieved during an outdoor exercise program when supervised exercise cease.

Mixed discipline 'Simulation Integrating Mental and Physical health Learning' (SMIPL): A qualitative study of student experience and learning

BACKGROUND/PROBLEMS

Individuals with comorbid physical and mental health conditions face significant threats to their well-being while placing a substantial burden on healthcare systems through increased service costs. Nursing professionals encounter multiple challenges in delivering effective care to this population. These challenges include a lack of integrated care models, communication barriers among providers, the complexity of addressing dual health needs, insufficient training in comorbidity management, resource and time constraints, and pervasive stigma toward mental illness. These factors leave many nurses, in particular, report feeling ill-prepared to provide integrated care for individuals with such complex conditions. Comorbid physical and mental health problems pose significant risks to individuals and incur additional costs to healthcare services. Addressing these barriers calls for enhanced training programs, stronger collaboration among healthcare professionals, and the adoption of integrated care approaches. Simulation-based approaches have emerged as a potential solution to address some of these challenges, offering a way to enhance healthcare providers' knowledge and confidence in managing comorbidities.

AIM/OBJECTIVE

To 1) explore the experiences of students learning together in a mixed specialty high-fidelity simulation developed to increase knowledge and confidence in providing care for people with comorbidities and 2) understand what aspects of the simulation facilitated and hindered their engagement and learning.

METHODOLOGY

This study employed an illuminative evaluation, a qualitative research approach designed to provide a deeper understanding of how learning occurs in specific educational contexts.

METHODS

An exploratory qualitative study was conducted using focus groups to gather data. Eighteen undergraduate students from mental health and adult nursing programs participated in a novel, integrated simulation-based learning experience designed to simulate real-world healthcare challenges. Participants were purposively sampled to ensure diverse perspectives. The focus groups were semi-structured, with sessions lasting approximately 60 min, and discussions were analysed using thematic analysis.

RESULTS

Nursing students from both disciplines reported an increase in knowledge, confidence and assessment skills. Peer learning through observation and discussion, alongside the interdisciplinary working that was encouraged during the simulation session, was highly valued. Students spoke about the key features of the simulation, such as group size and authenticity, that had supported and hindered their engagement.

CONCLUSIONS

Collaborative learning between nursing specialisms about comorbid health conditions effectively aligns student experience and teaching methods with their learning outcomes. Educators might consider the potential of this approach for a range of complex, multi-factor health conditions.

Untangling the complex relationship between bipolar disorder and anxiety: a comprehensive review of prevalence, prognosis, and therapy

Bipolar disorder (BD) frequently coexists with anxiety disorders, creating complex challenges in clinical therapy and management. This study investigates the prevalence, prognostic implications, and treatment strategies for comorbid BD and anxiety disorders. High comorbidity rates, particularly with generalized anxiety disorder, underscore the necessity of thorough clinical assessments to guide effective management. Our findings suggest that anxiety disorders may serve as precursors to BD, especially in high-risk populations, making early detection of anxiety symptoms crucial for timely intervention and prevention. We also found that comorbid anxiety can negatively affect the course of BD, increasing clinical severity, reducing treatment responsiveness, and worsening prognosis. These complexities highlight the need for caution in using antidepressants, which may destabilize mood. Alternatively, cognitive-behavioral therapy presents a promising, targeted approach for managing BD with comorbid anxiety. In summary, this study provides essential insights for clinicians and researchers, enhancing understanding of BD and anxiety comorbidity and guiding more precise diagnostics and tailored interventions to improve overall patient care.

Shared medication coordination in a social psychiatric residence: adaptation to meet local requirements

BACKGROUND

Shared medication coordination (MedCo) is vital yet difficult to manage for residents living with severe mental disorders in residential care, where multidisciplinary teams provide support. A successful Shared MedCo model in one residence included three core components: "shared decision-making," "patient involvement" and "MedCo". This model was effective but transfer to other residential settings needed implementation adaptation. The aim of this study was to meet local MedCo requirements by achieving a good fit between a Shared MedCo intervention core components and a social psychiatric residential context.

METHODS

The methodology was guided by a complex intervention adaptation framework involving co-creation with stakeholders to gather iterative feedback. The intervention was adapted through a systematic four-phase process and tested through shared consultations. Ten residents took part in the test, and the intervention's feasibility and acceptability were assessed.

FINDINGS

The adaptation process ensured a good fit between the intervention's core components and the new context. Stakeholder input provided crucial content and contextual insights, while planned adaptations laid the foundation for modulating the individual residence Shared MedCo model. Iterative adaptations during the test phase refined the intervention, leading to near-routine performance by the tenth consultation. Residents gained a stronger voice in their healthcare, and all ten had their medication coordinated and optimised. The intervention was found feasible and acceptable.

CONCLUSION

For effective implementation, complex multidisciplinary Shared MedCo interventions require contextual adaptation and active stakeholder involvement. The shared MedCo intervention offers a guideline for achieving a good fit between the intervention core components and diverse residential contexts, ensuring successful medication coordination for residents living with severe mental disorders.

Who is at risk for weight gain after weight-gain associated treatment with antipsychotics, antidepressants, and mood stabilizers: A machine learning approach

BACKGROUND

Weight gain is a common side effect in psychopharmacology; however, targeted therapeutic interventions and prevention strategies are currently absent in day-to-day clinical practice. To promote the development of such strategies, the identification of factors indicative of patients at risk is essential.

METHODS

In this study, we developed a transdiagnostic model using and comparing decision tree classifiers, logistic regression, XGboost, and a support vector machine to predict weight gain of ≥5% of body weight during the first 4 weeks of treatment with psychotropic drugs associated with weight gain in 103 psychiatric inpatients. We included established variables from the literature as well as an extended set with additional clinical variables and questionnaires.

RESULTS

Baseline BMI, premorbid BMI, and age are known risk factors and were confirmed by our models. Additionally, waist circumference has emerged as a new and significant risk factor. Eating behavior next to blood glucose were found as additional potential predictor that may underlie therapeutic interventions and could be used for preventive strategies in a cohort at risk for psychotropics induced weight gain (PIWG).

CONCLUSION

Our models validate existing findings and further uncover previously unknown modifiable factors, such as eating behavior and blood glucose, which can be used as targets for preventive strategies. These findings underscore the imperative for continued research in this domain to establish effective preventive measures for individuals undergoing psychotropic drug treatments.

Challenges of Constipation in People Suffering from Schizophrenia: A Narrative Review

Background/Objectives: Individuals diagnosed with schizophrenia are susceptible to constipation induced by antipsychotic medications. However, research investigating the prevalence of this adverse effect and its underlying mechanisms is limited. Methods: To address this knowledge gap, a narrative review was conducted on the subject of constipation in patients with schizophrenia. A comprehensive electronic search was conducted in the PubMed and J-Stage databases. Results: The prevalence of constipation in individuals with schizophrenia is high, ranging from 30% to 60%. The risk of constipation increases with high doses of antipsychotics and with the concomitant use of anticholinergics and mood stabilizers. The prevalence of constipation varies by sex, with women demonstrating a higher risk compared to men. Conclusions: Constipation is a prevalent complaint among individuals with schizophrenia, with women exhibiting a higher risk. The underlying pathophysiology of sex differences in constipation is attributed to variations in monoamines within the descending pain inhibitory pathway, which governs the neural circuitry associated with defecation. Constipation can lead to significant complications, underscoring the need for a multifaceted approach to treatment that considers the intestinal environment beyond the mere use of laxatives.

Breaking Barriers Transforming Primary Care to Serve the Physical Health Needs of Individuals With SMI in the NHS

This critical review paper examines the health inequalities faced by individuals with Severe Mental Illness (SMI) in the United Kingdom; highlighting the disproportionate burden of physical health conditions such as respiratory disorders, cardiac illnesses, diabetes and stroke amongst this population. These conditions contribute to a significantly higher rate of premature mortality in individuals with SMI, with two-thirds of these deaths deemed preventable. Despite the National Health Service (NHS) acknowledging the need to address these health inequalities, the mortality gap between those with and without SMI continues to widen. Additionally, there is limited engagement from service users in annual physical health checks, a concern that this paper addresses by identifying several barriers and providing recommendations to improve access and engagement in physical health checks. This review emphasises the focus on primary care systems as a critical point for addressing health disparities in individuals with SMI. Also, it highlights the need for primary care services to be more adaptive and integrated, playing a key role in managing the physical health of patients with SMI through regular health checks, flexible service delivery, and enhanced coordination with secondary care. Effectively supporting individuals with SMI requires tailored, integrated primary care interventions that address both psychological and physical health challenges, considering diverse demographic needs across the UK.

Discontinuity of psychiatric care among patients with bipolar disorder in the Netherlands

BACKGROUND

Patients with bipolar disorder benefit from guidelines recommended continuous community-oriented psychiatric and somatic healthcare, but often discontinue psychiatric care.

AIMS

The first objective was to identify predictive factors of discontinuity of psychiatric care among patients who had received psychiatric care. The second objective was to examine if practice variation in discontinuity of psychiatric care existed between providers of psychiatric care.

METHOD

Registry healthcare data were used in a retrospective cohort study design using logistic regression models to examine potential predictive factors of discontinuity of care. Patient-related predictive factors were: age, sex, urbanization, and previous treatment (type and amount of psychiatric care, alcohol, and opioid treatment). Patients already diagnosed with bipolar disorder were selected if they received psychiatric care in December 2014 to January 2015. Discontinuity of psychiatric care was measured over 2016.

RESULTS

A total of 2,355 patients with bipolar disorder were included. In 12.1% discontinuity of care occurred in 2016. Discontinuity was associated with younger age and less outpatient care over 2013 to 2014. Discontinuity of patients who received all eight quarters outpatient care including BD medication was very low at 4%. The final model contained: age, type of psychiatric care, and amount of outpatient care in 2013 to 2014. Practice variation among providers appeared negligible.

CONCLUSIONS

The (mental) health service in the Netherlands has few financial or other barriers toward continuity of care for patients with severe mental disorders, such as bipolar disorder. An active network of providers, aim to standardize care. This seems successful. However, 12% discontinuity per year remains problematic and more detailed data on those most at risk to drop out of treatment are necessary.

Suicide and suicide attempt in users of GLP-1 receptor agonists: a nationwide case-time-control study

Background

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are extensively evaluated for the risk of suicidal behaviors or ideation; the influence of psychiatric history or obesity on this potential effect remains to be investigated. Therefore, we aimed to assess the association between GLP-1 RA and suicide or suicide attempt, considering these factors.

Methods

Patients ≥18 y who died by suicide or were hospitalized for suicide attempt (2013-2021) with at least one GLP-1 RA dispensing within the 180 preceding days were selected from the French National Health Data System (SNDS). A case-time-control design compared, for each patient, GLP-1 RA exposure in the 30 days preceding the outcome (composite of suicide or suicide attempt) to three earlier 30-day reference periods. Potential exposure trend bias was controlled using up to five time-controls matched on age, sex, psychiatric history, obesity, calendar time. Analyses were adjusted for time-varying confounders. Finally dipeptidyl peptidase-4 (DPP-4) inhibitors were studied as negative controls for potential biases.

Findings

This study included 1102 cases and 5494 controls. Mean case age was 57.4 years (SD 11.4); 44.6% were male, 67.6% had a recent psychiatric history and 51.3% had obesity. GLP-1 RA use was not associated with an increased risk of suicide or suicide attempt (OR, 0.62; 95% CI, 0.51-0.75), with consistent results for DPP-4 inhibitors (0.75; 0.67-0.84). Results obtained according to recent psychiatric history and obesity were comparable.

Interpretation

This large nationwide case-time-control study provides reassurance about the short-term psychiatric safety of GLP-1 RA, showing no specific risk for patients with psychiatric disorders or obesity.

Funding

French Medicines Agency.

Are Adults With Bipolar Disorder at Increased Cardiovascular Risk due to Their Physical, Biochemical, and Physiological Profiles? The FINEXT-BD Study

INTRODUCTION

Bipolar disorder (BD) is associated with considerable morbidity and premature mortality, mainly due to somatic causes. This study aims to determine some physical, exercise capacity-related physiological variables and biochemical markers of health status in adults (45.4 ± 13.1 years) with BD (n = 65) compared to a healthy control (HC) population (n = 29) sample and to estimate cardiovascular risk (CVR) through different methods in the BD group.

METHODS

Multiple assessments included body composition, cardiorespiratory fitness (CRF), and biochemical parameters. CVR was calculated using the Framingham Heart Study, SCORE2, and relative risk methods.

RESULTS

The BD population, compared to the HC, showed unfavorable body composition (waist-to-hip ratio, 0.9 ± 0.1 vs. 0.8 ± 0.1; fat body mass, 33.3 ± 10.2 vs. 24.3 ± 8.9%, p ≤ 0.001), CRF (peak oxygen uptake, 25.2 ± 8.2 vs. 33.4 ± 8.7 mL kg-1 min-1; and cardiorespiratory optimal point, 27.9 ± 4.2 vs. 23.6 ± 4.2 ventilation/oxygen uptake ratio, p ≤ 0.05), biochemical concentrations of atherogenic indexes (total cholesterol/high-density lipoprotein cholesterol ratio, 4.1 ± 1.5 vs. 3.3 ± 1.0; and triglycerides/high-density lipoprotein cholesterol ratio, 2.8 ± 2.3 vs. 1.5 ± 1.0, p ≤ 0.05), and inflammatory C-reactive protein (3.8 ± 10.2 vs. 0.9 ± 1.05 mg/dL, p ≤ 0.05). Consequently, CVR showed higher values (p ≤ 0.05) in BD (high risk, 3.1%) compared to HC (low-to-moderate risk, 2.2%) participants, according to SCORE2, higher (p ≤ 0.05) vascular age (49.8 years) than chronological age (45.8 years), with a significant difference (p = 0.005) compared to HC.

CONCLUSIONS

This study highlights the importance of specific physical, biochemical, and physiological screening and CVR and vascular age assessment for people with BD. The practical application of these findings would prevent cardiovascular disease in BD and promote a healthier lifestyle as an adjuvant strategy to pharmacological intervention.

Impact of cariprazine on body weight and blood pressure among adults with bipolar I disorder, schizophrenia, or major depressive disorder in a real-world setting

BACKGROUND

Atypical antipsychotics are a common treatment for serious mental illness, but many are associated with adverse effects, including weight gain and cardiovascular issues, and real-world experience may differ from clinical trial data. Cariprazine has previously demonstrated a favorable safety and tolerability profile in clinical trials. Here, we evaluated the effects of cariprazine on body weight and blood pressure for bipolar I disorder (BP-I), schizophrenia, or as adjunctive treatment for major depressive disorder (MDD) using real-world data.

METHODS

Symphony Health's Integrated Dataverse® with electronic medical record access (3/1/2015-10/31/2018) was used to identify adults (≥ 18 years) diagnosed with BP-I depression, BP-I mania/mixed, schizophrenia, or MDD, with ≥ 2 cariprazine dispensings (first dispensing = index) and continuous clinical activity for ≥ 12 months pre-index (baseline) and ≥ 3 months post-index. The on-treatment period spanned from index to cariprazine discontinuation, exposure to another atypical or long-acting injectable antipsychotic, or end of clinical activity/data availability. Outcomes included estimated annual linear trajectories for weight, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) during baseline and on treatment. Changes were estimated using linear mixed-effects models fitted over measurements pre-index and on treatment; 95% CIs were derived from nonparametric bootstrap procedures.

RESULTS

The body weight analysis included 612 patients (BP-I, n = 331 [BP-I depression, n = 172; BP-I mania/mixed, n = 159]; schizophrenia, n = 75; MDD, n = 206). The mean patient age was 43.4 years, 75.2% were female, and the mean (SD) on-treatment period was 219 (185) days. Among patients with measurements before and during cariprazine treatment, estimated annual weight trajectories were + 3.55 (95% CI 2.38, 4.59) kg/year before cariprazine initiation and + 0.91 (- 1.17, 2.82) kg/year during cariprazine treatment. Additionally, annual linear trajectories evaluated across the on-treatment period were + 0.31 (- 0.42, 1.01) kg/m2/year for BMI, - 2.38 (- 4.27, - 0.76) mmHg/year for SBP, and - 0.57 (- 1.75, 0.61) mmHg/year for DBP.

CONCLUSION

In this real-world analysis, cariprazine was associated with an estimated weight gain of + 0.91 kg/year and had minimal impact on BMI and blood pressure when evaluated up to 12 months.

Lurasidone versus typical antipsychotics for schizophrenia

BACKGROUND

Antipsychotic drugs are the mainstay of treatment for schizophrenia. Even though several novel second-generation antipsychotics (i.e. lurasidone, iloperidone and cariprazine) have been approved in recent years, typical antipsychotics (e.g. chlorpromazine, haloperidol, and fluphenazine) remain a crucial therapeutic option for the condition around the world. Little is known about the relative risk-to-benefit ratio of the 'latest' second-generation antipsychotics compared to the typical agents of 'established stature'.

OBJECTIVES

To systematically review the efficacy and safety of lurasidone versus typical antipsychotics for adults with schizophrenia or schizophrenia-related disorders.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials on 5 June 2019. We also ran an update search in CENTRAL, MEDLINE, Embase, and three additional databases as well as two trial registers and the US Food and Drug Administration database on 1 April 2024.

SELECTION CRITERIA

We searched for randomized controlled trials (RCTs) comparing lurasidonewith typical antipsychotic drugs (such as chlorpromazine, fluphenazine, haloperidol, loxapine, mesoridazine, molindone, perphenazine, thioridazine, thiothixene, zuclopenthixol) for adults with schizophrenia. No additional search restrictions were applied.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methodological procedures. We extracted information on participant characteristics, interventions, study outcomes, study design, trial methods, and funding sources. Two review authors independently extracted data and assessed the risk of bias. We assessed the certainty of evidence with GRADE for these key outcomes: change in mental state, death by suicide or natural cause, quality of life, total serious adverse events and severe adverse events (as defined by study authors).

MAIN RESULTS

We included two studies with a total of 308 individuals diagnosed with schizophrenia (220 men and 85 women). A total of 223 participants received lurasidone (20, 40, or 80 mg/day), and 82 received haloperidol (up to 10 mg/day) or perphenazine (up to 32 mg/day); three people did not receive any study medication. Both studies were performed in the US. The duration of the follow-up was four to six weeks. Death by suicide/natural causes and quality of life were not reported by the two included studies. The evidence is very uncertain about the effects of lurasidone on change in mental state: the Brief Psychiatric Rating Scale (BPRS) (MD 3.74, 95% CI 0.57 to 6.90; 1 RCT, 281 participants; very low-certainty evidence); and the Positive and Negative Syndrome Scale (PANSS) (MD 6.68, 95% CI 2.45 to 10.91; 1 RCT, 281 participants; very low-certainty evidence). The evidence is also very uncertain about the effects of lurasidone on total serious adverse events (RR 0.98, 95% CI 0.37 to 2.60; 2 RCTs, 303 participants; very low certainty of evidence) and on severe adverse events (RR 1.70, 95% CI 0.46 to 6.32; 1 RCT, 281 participants; very low certainty of evidence).

AUTHORS' CONCLUSIONS

We are very uncertain about whether lurasidone offers benefits to the mental state, total serious adverse events, or severe adverse events when compared to typical antipsychotics for people with schizophrenia. The evidence included in this review is of very low certainty, derived from two small trials. Study limitations (risk of bias) and imprecise results impacted our confidence in the evidence. Furthermore, data on mortality (due to suicide or natural causes) or quality of life are unavailable. Further large-scale randomized studies are needed to provide clearer insights into the benefits and harms of lurasidone compared to typical antipsychotics for treating schizophrenia.

Multigenerational family coaggregation study of obsessive-compulsive disorder and cardiometabolic disorders

BACKGROUND

Obsessive-compulsive disorder (OCD) is associated with an increased risk of morbidity and mortality due to cardiometabolic disorders. Whether this association is driven by familial factors is unknown. This population-based family study explored the familial co-aggregation of OCD and cardiometabolic disorders.

METHODS

We identified 6 049 717 individuals born in Sweden between 1950 and 2008, including 50 212 individuals with OCD, and followed them up to 2020. These individuals were linked to their mothers, fathers, full siblings, maternal and paternal half siblings, aunts, uncles and cousins. We estimated the risk of cardiovascular diseases (CVD) and metabolic disorders (including obesity, type 2 diabetes and hyperlipidaemia), comparing the relatives of probands with and without OCD. Cox proportional hazards regression models, incorporating time-varying exposures, estimated HRs.

RESULTS

OCD was associated with an increased risk of CVD (HR 1.47; 95% CI 1.43 to 1.51), obesity (HR 1.69; 95% CI 1.63 to 1.74), type 2 diabetes (HR 2.01; 95% CI 1.90 to 2.12) and hyperlipidaemia (HR 1.42; 95% CI 1.33 to 1.52). The relatives of probands with OCD exhibited small increased risks of CVD (HRs from 1.01 to 1.11) and obesity (HRs from 1.03 to 1.20). Slightly increased risks for type 2 diabetes were observed in mothers (HR 1.11; 95% CI 1.07 to 1.15) and full siblings (HR 1.12; 95% CI 1.05 to 1.20), while for hyperlipidaemia it was only observed in mothers (HR 1.06; 95% CI 1.02 to 1.10).

CONCLUSIONS

Our results do not support a major contribution of familial factors to the association between OCD and cardiometabolic disorders, suggesting a more prominent role of unique environmental factors.

Measuring the effects of ketogenic diet on neuropsychiatric disorder: A scoping review

OBJECTIVE

This scoping review aims to examine the available literature on the ketogenic diet's (KD) efficiency as a potential therapeutic intervention for various neuropsychiatric disorders.

INTRODUCTION

The KD is a high-fat, low-carbohydrate diet that has been studied for its potential benefits in managing neuropsychiatric disorders. However, the extent of its effectiveness across a spectrum of these conditions remains unclear.

INCLUSION CRITERIA

The study designs considered eligible encompassed randomized and non-randomized controlled trials, retrospective and prospective observational studies, and comparative effectiveness assessments. The criteria for including each study were specifically related to neuropsychiatric disorders, referring to the DSM-5 coding guidelines.

METHODS

A systemic search was performed by an experienced reference librarian across multiple databases to pinpoint studies relevant to the influence of the ketogenic diet on neuropsychiatric disorders. All relevant articles were included that ranged over the last thirteen years. All relevant records identified were compiled into the Covidence systematic review software.

RESULTS

A total of 30 studies were reviewed, which reported effects of the KD on neuropsychiatric disorders, including improvements in Global Developmental Delay, Childhood Autism, Attention Deficit/Hyperactivity Disorder (ADHD) symptoms, psychotic symptoms, Bipolar and Related Disorders, Depressive Disorder symptoms, anxiety symptoms, eating disorders, Substance-Related and Addictive Disorders, Major and Mild Neurocognitive Disorders, and Seizure Disorders.

CONCLUSION

The KD may serve as a promising therapeutic intervention for various neuropsychiatric disorders. However, the evidence is heterogeneous, and further rigorous research is needed to establish the KD as a standard treatment for these disorders and to understand the underlying mechanisms of its effects.

IMPLICATIONS FOR PRACTICE

This review underscores the need for healthcare professionals to consider the potential benefits and limitations of the KD when managing patients with neuropsychiatric disorders. It also highlights the importance of individualized treatment plans based on the specific needs and responses of each patient.

Association between the number of acute episodes and increased cardiac left ventricular mass index in patients diagnosed with schizophrenia

Patients with schizophrenia have a high risk of cardiovascular death. Increased cardiac left ventricular (LV) mass has been reported to be associated with heart failure and cardiac mortality. However, few studies have used echocardiographic imaging to evaluate the associations between cardiac LV mass and the clinical characteristics of schizophrenia. We recruited 121 adults to undergo standard and two-dimensional speckle-tracking echocardiography. Cardiac LV mass was determined using the Devereux formula and indexed with reference to the body surface area to obtain the cardiac LV mass index (LVMI). Clinical and demographic data were obtained through interviews and chart review. The results showed that relative to the mentally healthy controls (n = 55), individuals with schizophrenia (n = 66) had significantly higher mean values of cardiac LVMI as well as lower mitral valve E/A ratio, LV ejection fraction, and LV global longitudinal strain. Among the individuals with schizophrenia, cardiac LVMI was positively correlated with the number of acute episodes, and this association remained significant after adjustment for age, age at onset, and body mass index. On the contrary, there were no significant associations between cardiac LVMI and traditional cardiovascular risk factors. Taken together, this study suggests that the burden of psychotic symptoms may contribute to the increased risk of cardiac hypertrophy in individuals with schizophrenia independent of traditional cardiovascular risk factors. Because cardiac hypertrophy is among the major risk factors of heart failure and cardiac mortality, future research must investigate the mechanisms underlying the association between psychosis and increased cardiac LV mass.

Alterations in regional homogeneity in schizophrenia patients comorbid with metabolic syndrome treated with risperidone or clozapine

The neuroimaging mechanisms that arise in patients with schizophrenia and comorbid metabolic syndrome (MetS) remain poorly understood. This study was devised to examine potential alterations in regional homogeneity (ReHo) that arise in schizophrenia patients with comorbid MetS undergoing risperidone or clozapine treatment. In total, 43 schizophrenia patients undergoing risperidone or clozapine treatment were enrolled in this study, of whom 20 had comorbid MetS (SZ-MetS) while 23 did not (SZ-nMetS). In addition, 28 sex- and age-matched healthy controls (HCs) were analyzed. Analyses of covariance (ANCOVA) were used to compare ReHo in this study, utilizing age, sex, and years of education as covariates, with subsequent post hoc testing. Correlations between brain regions showing differences between groups of patients with schizophrenia and MetS-related indicators were also assessed. Relative to HCs, patients in both the SZ-MetS and SZ-nMetS groups exhibited reductions in ReHo in the right postcentral gyrus, left superior parietal gyrus, and left middle occipital gyrus. A decrease in ReHo was also evident in the left calcarine fissure and surrounding cortex and the right angular gyrus of patients in the SZ-MetS group, while the SZ-nMetS group exhibited reductions in ReHo in the left superior occipital gyrus and the right precuneus, together with an increase in ReHo in the right inferior orbitofrontal gyrus. Compared to the SZ-nMetS group, the SZ-MetS group exhibited a reduction in ReHo in the right inferior orbitofrontal gyrus. The ReHo of the right inferior orbitofrontal gyrus was significantly negatively correlated with BMI, waist circumference, and hip circumference in the SZ-MetS and SZ-nMetS groups. A reduction in ReHo in the right inferior orbitofrontal gyrus may thus be related to MetS in schizophrenia patients undergoing treatment. The findings may provide an imaging basis for brain alterations in patients with schizophrenia combined with MetS and provide a new insight into the neuroimaging mechanisms associated with MetS in patients with schizophrenia.

Preclinical evaluation of MK-8189: A novel phosphodiesterase 10A inhibitor for the treatment of schizophrenia

MK-8189 is a novel phosphodiesterase 10A (PDE10A) inhibitor being evaluated in clinical studies for the treatment of schizophrenia. PDE10A is a cyclic nucleotide phosphodiesterase enzyme highly expressed in medium spiny neurons of the striatum. MK-8189 exhibits subnanomolar potency on the PDE10A enzyme and has excellent pharmaceutical properties. Oral administration of MK-8189 significantly increased cyclic guanosine monophosphate and phospho glutamate receptor 1 in rat striatal tissues. Activation of the dopamine D1 direct and D2 indirect pathways was demonstrated by detecting significant elevation of mRNA encoding substance P and enkephalin after MK-8189 administration. The PDE10A tracer [3H]MK-8193 was used to determine the PDE10A enzyme occupancy (EO) required for efficacy in behavioral models. In the rat-conditioned avoidance responding assay, MK-8189 significantly decreased avoidance behavior at PDE10A EO greater than ∼48%. MK-8189 significantly reversed an MK-801-induced deficit in prepulse inhibition at PDE10A EO of ∼47% and higher. Target engagement of MK-8189 in rhesus monkeys was examined with [11C]MK-8193 in positron emission tomography studies, and plasma concentrations of 127 nM MK-8189 yielded ∼50% EO in the striatum. The impact of MK-8189 on cognitive symptoms was evaluated using the objective retrieval task in rhesus monkeys. MK-8189 significantly attenuated a ketamine-induced deficit in object retrieval performance at exposure that yielded ∼29% PDE10A EO. These findings demonstrate the robust impact of MK-8189 on striatal signaling and efficacy in preclinical models of symptoms associated with schizophrenia. Data from these studies were used to establish the relationship between preclinical efficacy, plasma exposures, and PDE10A EO to guide dose selection of MK-8189 in clinical studies. SIGNIFICANCE STATEMENT: We describe the primary pharmacology of MK-8189, a phosphodiesterase 10A (PDE10A) inhibitor under evaluation for the treatment of schizophrenia. We report efficacy in preclinical models that have been used to characterize other PDE10A inhibitors and atypical antipsychotics. The PDE10A occupancy achieved by MK-8189 in behavioral studies was used to support dose selection in clinical trials. This work provides evidence to support exploration of higher levels of PDE10A occupancy in clinical trials to determine if this translates to improved efficacy in patients.

Bibliometric Analysis of Antipsychotic-induced Metabolic Disorder from 2006 to 2021 Based on WoSCC Database

BACKGROUND

With the frequent use of antipsychotics, the metabolic disorder (MetD) caused by drugs has received increasing attention. However, the mechanism of drug-induced MetD is still unclear and is being explored. Keeping abreast of the progress and trending knowledge in this area is conducive to further work.

OBJECTIVE

The aim of this study is to analyze the latest status and trends of research on antipsychoticinduced metabolic disorder (AIMetD) by bibliometric and visual analysis.

METHODS

3478 publications of AIMetD from 2006 to 2021 were retrieved from the Web of Science Core Collection database. R-biblioshiny was used for descriptive analysis, CiteSpace for cooperative network, co-citation analysis and burst detection, and VOSviewer for co-occurrence keywords was used.

RESULTS

Since 2006, the publications have been growing fluctuantly. These studies have extensive cooperation among countries/regions. The most influential country/region, institution and author are the USA, King's College London and Christoph U Correll. Analysis of references shows the largest cluster of "antipsychotic-induced metabolic dysfunction", which is an important basis for MetD. The recent contents of the burst citation are related to "glucose homeostasis" and "cardiovascular metabolism". Several bursting keywords were discerned at the forefront, including "LC-MS/MS", "major depressive disorder", "expression", and "homeostasis".

CONCLUSION

The AIMetD study is in a state of sustained development. Close cooperation between countries/ regions has promoted progress. For grasping the foundation, development, and latest trends of AIMetD, it is recommended to focus on active institutions and authors. Based on AIMetD, subdivision areas such as "LC-MS/MS", "expression", and "homeostasis" are forefronts that deserve constant attention.

Evaluating the Significance of Obesity or Excessive Weight in Various Mental Health Disorders: A Systematic Review

Obesity is a major global public health challenge affecting all countries and communities. The link between obesity and various types of physical morbidities has been widely acknowledged in different studies. Despite the immense impact of obesity on mental health, its full effect on the areas has not been as explored as the impact on physical health has been. Following an extensive review of various recent studies, the objective of this study is to evaluate the correlations and effects of obesity on mental health disorders, in addition to reflecting on the significance of assessing the correlation. The other objective of this study is to evaluate obesity prevalence in mentally ill individuals. We believe that the realization of these objectives will address the existing literature gaps within the population of mentally ill persons in addition to aiding with the necessary preventive knowledge that will enable the provision of optimum mental and physical health. Therefore, this study entailed the performance of a systematic review of several online databases, including Scopus, Web of Sciences, PubMed, Google Scholar, and MEDLINE. This systematic review also utilized an increasingly robust methodology based on the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thus, the inclusion criteria stipulated that only studies published between 2010 and 2024 and published in the English language were to be included in this systematic review. The quality of the included studies was assessed using an appraisal tool for cross-sectional studies. As a result, 12 studies met the inclusion criteria for this systematic review and were reviewed. The findings indicate that the prevalence rate of obesity in individuals with mental health disorders surpasses the prevalence of the condition within the general population, suggesting that mentally ill persons are at a higher risk of developing obesity, even as one of the major side effects of psychiatric treatment is excessive weight gain. Individuals with personality disorders, including borderline personality disorder, avoidant personality disorder, dependent personality disorder, and antisocial personality disorder, among others, presented the highest prevalence rate of obesity compared to those with psychosis. Prospective studies should focus on evaluating the various mitigating factors that underlie the weight gain and obesity development that occur across mental health disorders.

Genetically Informed Study Highlights Income-Independent Effect of Schizophrenia Liability on Mental and Physical Health

BACKGROUND AND HYPOTHESIS

Individuals with schizophrenia (SCZ) suffer from comorbidities that substantially reduce their life expectancy. Socioeconomic inequalities could contribute to many of the negative health outcomes associated with SCZ.

STUDY DESIGN

We investigated genome-wide datasets related to SCZ (52 017 cases and 75 889 controls) from the Psychiatric Genomics Consortium, household income (HI; N = 361 687) from UK Biobank, and 2202 medical endpoints assessed in up to 342 499 FinnGen participants. A phenome-wide genetic correlation analysis of SCZ and HI was performed, also assessing whether SCZ genetic correlations were influenced by the HI effect on SCZ. Additionally, SCZ and HI direct effects on medical endpoints were estimated using multivariable Mendelian randomization (MR).

STUDY RESULTS

SCZ and HI showed overlapping genetic correlations with 70 traits (P < 2.89 × 10-5), including mental health, substance use, gastrointestinal illnesses, reproductive outcomes, liver diseases, respiratory problems, and musculoskeletal phenotypes. SCZ genetic correlations with these traits were not affected by the HI effect on SCZ. Considering Bonferroni multiple testing correction (P < 7.14 × 10-4), MR analysis indicated that SCZ and HI may affect medical abortion (SCZ OR = 1.07; HI OR = 0.78), panic disorder (SCZ OR = 1.20; HI OR = 0.60), personality disorders (SCZ OR = 1.31; HI OR = 0.67), substance use (SCZ OR = 1.2; HI OR = 0.68), and adjustment disorders (SCZ OR = 1.18; HI OR = 0.78). Multivariable MR analysis confirmed that SCZ effects on these outcomes were independent of HI.

CONCLUSIONS

The effect of SCZ genetic liability on mental and physical health may not be strongly affected by socioeconomic differences. This suggests that SCZ-specific strategies are needed to reduce negative health outcomes affecting patients and high-risk individuals.

Discordance Between Triglycerides, Remnant Cholesterol and Systemic Inflammation in Patients with Schizophrenia

BACKGROUND/OBJECTIVES

Hypertriglyceridaemia and systemic inflammation are prevalent in patients with schizophrenia and contribute to an increased risk of cardiovascular disease. Although elevated triglycerides (TGs) and remnant cholesterol are linked to inflammation in the general population and individuals with metabolic syndrome, whether they are associated in patients with schizophrenia remains unclear.

METHODS

Fasting levels of TG, cholesterol (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and remnant cholesterol)), and markers of systemic inflammation including high-sensitivity C-reactive protein (hsCRP), leukocyte counts and their differentials (neutrophils, monocytes and lymphocytes) were determined in 147 patients diagnosed with schizophrenia on long-term antipsychotic regimens and compared with 56 age- and sex-matched healthy controls. Apolipoprotein B and glycosylation of acute phase reactant (GlycA) signatures were assessed by NMR. Circulating cytokine levels were measured by a cytokine/chemokine multiplex assay.

RESULTS

Patients with schizophrenia had markedly elevated TG and remnant cholesterol relative to controls and had evidence of systemic inflammation with increased circulating hsCRP, GlycA, leukocyte, neutrophil counts and neutrophil-to-lymphocyte ratio (NLR). Unexpectedly TG and remnant cholesterol did not correlate with systemic inflammatory markers in patients with schizophrenia, and differences in inflammatory markers between controls and patients persisted after adjusting for the lipid profile. Interleukin (IL)-10 levels were increased in patients with schizophrenia, suggesting an anti-inflammatory signature.

CONCLUSIONS

The discordance between TG, remnant cholesterol and systemic inflammation in patients with schizophrenia suggests these are likely independent contributors to cardiovascular risk in this population.

EPA guidance on lifestyle interventions for adults with severe mental illness: A meta-review of the evidence

There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.

The Association Between Antipsychotics and Bone Fragility: An Updated Comprehensive Review

BACKGROUND

Antipsychotic drugs appear to be related to reduced bone mineral density (BMD). We conducted a narrative review to collect the available literature investigating the relationship between antipsychotic use and bone fragility.

METHODS

A review of the published literature was conducted and reported through PubMed/Scopus/Cochrane libraries. We included studies using any antipsychotic treatment where the bone metabolism, osteoporosis, and/or risk of fractures has been assessed.

RESULTS

After screening 1707 items, we finally included 15 papers. A total of 3245 initial patients were identified, of whom 1357 patients with a mean age of 43.8 years underwent antipsychotic treatment and were analyzed. The mean antipsychotic treatment duration of the treated group was 15.8 ± 13.9 years. Among the included studies, two reported a statistically significant difference in lumbar BMD reduction between the antipsychotic exposed group and the control group. Femoral neck BMD levels had been reported in four of the case-control studies; two reported a statistically significant difference in femoral neck BMD reduction between the antipsychotic exposed group and the control group.

CONCLUSIONS

Prolonged use of antipsychotic treatment seems to be associated with an increased risk of reduced BMD, and, consequentially, with an augmented risk of bone fragility and fractures. This effect is not limited to vulnerable groups, such as those with significant medical comorbidities, the elderly, and postmenopausal women, but may also apply to anyone using antipsychotics in the long-term. Clinicians' awareness of antipsychotic prescriptions should optimize their potential while reducing this risk.

Longitudinal relationships among number of chronic diseases, depression, and anxiety: A cross-lagged model analyses

BACKGROUND

Research is increasingly highlighting the intricate relationship between mental and physical health. However, longitudinal studies investigating the interplay between chronic diseases (CDs), depression and anxiety are still relatively scarce. This study aimed to delve into the longitudinal connections among these variables.

METHODS

This study conducted a 4-year prospective survey involving 486 participants from rural communities in Shandong Province, China. The relationships among these variables were analyzed using multiple linear regression, cross-lagged path analysis, and multiple-group analysis.

RESULTS

Our analysis revealed that the number of CDs reported at wave 1 significantly predicted anxiety levels (β = 0.126, p < .01) at wave 2, while depression symptoms also predicted anxiety (β = 0.220, p < .01) at wave 2. Furthermore, anxiety levels at wave 1 significantly predicted both the number of CDs (β = 0.219, p < .01) and depression symptoms (β = 0.160, p < .05) at wave 2. However, the study did not find support for a relationship between CDs and depression.

CONCLUSION

The study uncovered a bidirectional association between CDs and anxiety, depression and anxiety, but found no direct longitudinal relationship between CDs and depression. Research has indicated that CDs indirectly affect depression through anxiety.

Correlations Between Psychiatric Disorders and Perioperative Outcomes After Lumbar Fusions: An Analysis of the National Inpatient Sample (2009-2020)

BACKGROUND

Preoperative diagnoses of psychiatric disorders have a demonstrated association with higher rates of perioperative complications. However, recent studies examining the influence of psychiatric disorders on lumbar fusion outcomes are scarce. Our objective was to determine the relationship between the most common psychiatric disorders and perioperative outcomes after lumbar fusion.

METHODS

Demographic and perioperative data for patients who underwent lumbar spine fusion between 2009 and 2020 were collected from the National Inpatient Sample database. These patients were divided into 2 groups: those who were previously diagnosed with depression, bipolar disorder, or anxiety, and those who were not. Univariable and multivariable linear and logistic regression models were utilized to analyze the data.

RESULTS

Of 2,877,241 patients identified in the National Inpatient Sample database as having undergone lumbar fusion, 647,951 had diagnosed psychiatric disorders, and the remaining 2,229,290 were the unaffected cohort. On multivariable analysis, patients diagnosed with psychiatric disorders had significantly increased odds of respiratory (odds ratio [OR]:1.09) and urinary (OR: 1.08) complications and experienced higher odds of mechanical injury (OR: 1.27), fusion disorders (OR: 1.62), dural tears (OR: 1.08), postprocedure anemia (OR: 1.29), longer hospital stays, and higher total costs (P < 0.001). Conversely, patients with psychiatric disorders had lower odds of neurologic injury (OR: 0.8) and wound complications (OR: 0.91) (P < 0.05).

CONCLUSIONS

Patients with depression, bipolar disorder, or anxiety exhibited higher rates of certain types of complications. However, they appeared to have fewer neurological injuries and wound complications than patients without these psychiatric disorders. These findings highlight the necessity for additional studies to elucidate underlying reasons for these disparities.

Changes in Exercise Performance in Patients During a 6-Week Inpatient Psychiatric Rehabilitation Program and Associated Effects on Depressive Symptoms

Background/Objectives: The impact of exercise on affective disorders has been demonstrated in various studies. However, almost no data are available on performance effects. Therefore, this study investigated exercise performance related to the severity of depression symptoms in a pre-post within-subjects design in a 6-week standard inpatient psychiatric rehabilitation program. Methods: A total of 53 individuals (20 female; mean age, 40.98 ± 11.33) with a primary diagnosis of depression performed a cardiopulmonary exercise test (CPX) to obtain maximal oxygen uptake (VO2max), maximal power output (Pmax), and the first and second ventilatory threshold (VT1, VT2) at the start and the end of the rehabilitation. Degree of depression was assessed by Becks Depression Inventory (BDI) and the Brief Symptom Inventory test (BSI). Overall activity was measured by accelerometer step-counts. Results: Mean total step-count per day during rehabilitation was high (12,586 ± 2819 steps/day). Patients' BDI and BSI at entry were 21.6 ± 8.83 and 65.1 ± 6.8, respectively, and decreased significantly (p < 0.001) following rehabilitation, to 10.1 ± 9.5 and 54.5 ± 11.3, respectively. Pmax and VO2max increased significantly (p < 0.001) from entry values (182.6 ± 58.7 W, 29.74 ± 5.92 mL·kg-1·min-1) following rehabilitation: by 11.91 ± 12.09 W and 1.35 ± 2.78 mL·kg-1·min-1, respectively. VT1 and VT2 showed a similar behavior. An increase in physical performance could predict improvement in BDI (R2 = 0.104, F(1,48) = 5.582, p = 0.022) but not in BSI. Conclusions: The program was associated with improved mental health status in all patients and increased performance in the majority of patients, although increases were small. Since improvements in exercise performance may be positively related to depression symptoms and comorbidities, it is recommended to individualize and tailor exercise programs, which could yield larger effects.

The epigenetic mechanism of metabolic risk in bipolar disorder

Bipolar disorder (BD) is a complex and severe mental illness that causes significant suffering to patients. In addition to the burden of depressive and manic symptoms, patients with BD are at an increased risk for metabolic syndrome (MetS). MetS includes factors associated with an increased risk of atherosclerotic cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), which may increase the mortality rate of patients with BD. Several studies have suggested a link between BD and MetS, which may be explained at an epigenetic level. We have focused on epigenetic mechanisms to review the causes of metabolic risk in BD.

Efficacy and safety of lumateperone for bipolar depression and schizophrenia: a systematic review and meta-analysis

This study aimed to evaluate the efficacy and safety of lumateperone in treating bipolar disorder and schizophrenia. A comprehensive literature search was conducted across multiple databases and websites from inception to July 16, 2024, to identify both published and unpublished randomized controlled trials (RCTs). Meta-analyses were performed using random-effects or fixed-effects models depending on statistical heterogeneity. Relative risks (RRs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to summarize the effects. Out of 931 records screened, 7 RCTs (four focusing on bipolar depression and 3 on schizophrenia) were eligible for inclusion. Lumateperone was efficacious in reducing depressive symptoms in bipolar depression (SMDs = -0.36, 95% CI: -.59 to -.13). In treating schizophrenia, lumateperone exhibited a lower combined SMD of -0.14 (95% CI: -.27 to 0, P = .051, I² = 49.6%), showing no significant difference from the placebo group, although the P-value approached significance. The lumateperone group showed significantly higher response rates compared with placebo in both bipolar depression (RRs = 1.27, 95% CI = 1.07 to 1.51) and schizophrenia (RRs = 1.44, 95% CI = 1.12 to 1.86). Common treatment-emergent adverse events included somnolence, dry mouth, dizziness, nausea, and headache (RRs = 1.30 to 3.29). Importantly, lumateperone did not significantly increase extrapyramidal symptoms (EPS, RRs = 1.46, 95% CI = .84 to 2.53). Lumateperone is effective in treating bipolar depression but does not significantly reduce symptom severity in schizophrenia. It has a favorable safety and tolerability profile. However, caution is warranted in interpreting these findings due to the limited number of studies included.

Adaptive Hyperactivity and Biomarker Exploration: Insights from Elders in the Blue Zone of Sardinia

Background/Objectives: Adaptive hyperactivity characterized by increased activity levels and novelty-seeking traits without mood disorders is prevalent among older adults in Sardinia's "blue zone," an area with high longevity. This study aims to evaluate the adaptive nature of hyperactivity concerning quality of life, social rhythms, and mood symptoms in individuals from this region, particularly among elderly adults over 80. Methods: This observational cross-sectional study included adults and older adults over 80 from Sardinia's blue zone. This study included a sample of patients followed at the Center for Consultation Psychiatry and Psychosomatics for Bipolar Disorder of the University Hospital of Cagliari and a homogeneous comparison sample of patients without psychiatric pathologies, referred to the Dermatology Clinic of the same hospital, for a period of 6 months, from February to August 2024. The general sample, divided into two parts-cases, represented by patients with psychiatric pathology, and controls, patients without psychiatric pathology-was divided in turn into three sub-groups: "adults" (18-64 years), young elders (65-79), and old elders (over 80 years). The participants underwent psychiatric interviews and completed the Mood Disorder Questionnaire (MDQ), Patient Health Questionnaire (PHQ-9), SF-12, and Brief Social Rhythm Scale (BSRS). Data were compared with national and regional normative data. Results: Older adults in the blue zone demonstrated higher MDQ positivity (22.58%) compared to the national averages (0.87%), without corresponding increases in dysregulated rhythms, depressive symptoms, or reduced quality of life. Younger old persons (65-79 years) showed increased rhythm dysregulation (BSRS score: 20.64 ± 7.02) compared to adults (17.40 ± 6.09, p = 0.040), but this trend was not observed in the oldest group (80+ years). No significant differences were found in the CH3SH and (CH3)2S levels between groups. Conclusions: The hyperactivity observed in older adults from Sardinia's blue zone appears adaptive and not linked to social rhythm dysregulation, depressive symptoms, or a diminished quality of life, suggesting resilience factors which may contribute to longevity. These findings support the potential classification of such hyperactivity as beneficial rather than pathological, warranting further research into biomarkers and psychoeducational interventions to prevent the onset of bipolar disorders in predisposed individuals.

Assessing the Risk of QT Prolongation in a Psychiatric Inpatient Cohort: A Retrospective Cross-Sectional Study

BACKGROUND

QT prolongation is a potential serious adverse drug reaction, and assessing the risk of QT-prolonging drugs is routinely included in psychotropic medication reviews. However, the actual clinical benefits of such assessments are unknown. We investigate whether QT prolongation (QTc value > 480 ms) manifests in psychiatric inpatients at risk of QT prolongation as identified by assessing drug regimens. Secondly, we test the predictive value of well-known risk factors for QT prolongation.

RESULTS

The median patient age was 49 years (IQR 34-64) for patients treated with a median of nine drugs (IQR 6-12) and a median QT-prolonging drug sum of three daily defined dosages (IQR 1.88-4.76). We extracted 290 ECGs for patients where pharmacist-led-medication reviews (PMRs) identified an increased risk of QT prolongation and 190 ECGs for patients with no such risk, identifying 33 cases of verified QT prolongation equally distributed between groups. Unadjusted regression analysis revealed that advanced age (OR 3.27 CI 95% 1.60-6.84) and cardiovascular comorbidity (OR 3.53 CI 95% 1.71-7.29) were associated with manifest QT prolongation, while the QT-prolonging drug load was not.

METHODS

We reviewed electronic health records (EHRs) of 799 psychiatric inpatients exposed to PMRs made from 1 September 2016 to 31 December 2018 in Region Zealand Denmark.

CONCLUSIONS

Patients at risk of QT prolongation as identified by drug reviews rarely manifests with actual QT prolongation. Non-pharmacological risk factors seem to be better predictors for identifying patients with QT prolongation.

Physical health challenges faced by elders with severe mental illness: population-based retrospective cohort study

BACKGROUND

Severe mental illness (SMI), which includes schizophrenia, schizoaffective disorder and bipolar disorder, has profound health impacts, even in the elderly.

AIMS

To evaluate relative risk of hospital admission and length of hospital stay for physical illness in elders with SMI.

METHOD

To construct a population-based retrospective cohort observed from April 2007 to March 2016, data from a case registry with full but de-identified electronic health records were retrieved for patients of the South London and Maudsley NHS Foundation Trust, the single secondary mental healthcare service provider in south-east London. We compared participants with SMI aged >60 years old with the general population of the same age and residing in the same areas through data linkage by age-, sex- and fiscal-year-standardised admission ratios (SARs) for primary diagnoses at hospital discharge. Furthermore, we compared the duration of hospital stay with an age-, sex- and cause-of-admission-matched random group by linear regression for major causes of admission.

RESULTS

In total, records for 4175 older people with SMI were obtained, relating to 10 342 admission episodes, showing an overall SAR for all physical illnesses of 5.15 (95% CI: 5.05, 5.25). Among the top causes of admission, SARs ranged from 3.87 for circulatory system disorders (ICD-10 codes: I00-I99) to 6.99 for genitourinary system or urinary conditions (N00-N39). Specifically, the diagnostic group of 'symptoms, signs and findings, not elsewhere classified' (R00-R99) had an elevated SAR of 6.56 (95% CI: 6.22, 6.90). Elders with SMI also had significantly longer hospital stays than their counterparts in the general population, especially for digestive system illnesses (K00-K93), after adjusting for confounding.

CONCLUSIONS

Poorer overall physical health and specific patterns were identified in elders with SMI.

Risk of renal impairment in atypical antipsychotics: a systematic review and meta-analysis

PURPOSE

Atypical antipsychotics are associated with several adverse effects including metabolic syndrome, weight gain, QTc interval prolongation, and extrapyramidal effects. This study aims to investigate the risk of renal impairment in patients receiving atypical antipsychotics.

METHODS

A systematic literature search was conducted via PubMed and Ovid SP and Web of Science to retrieve studies reporting the risk of renal impairment in patients receiving atypical antipsychotic treatment. The pooled risk ratio (RR) of renal impairment and the subgroup analysis was calculated using the random-effects generic inverse variance method in Cochrane Review Manager.

RESULTS

A total of 4 studies involving 514,710 patients (221, 873 patients on atypical antipsychotics/CKD and 292, 837 controls) were included in this meta-analysis. Patients on atypical antipsychotics exhibited an increased risk of renal impairment, with a pooled risk ratio of 1.34 (95%CI 1.23-1.47). Subgroup analysis demonstrated that atypical antipsychotic use was associated with an increased risk of both acute kidney injury (AKI) (RR 1.51, 95%CI 1.34-1.71) and chronic kidney disease (CKD) (RR: 1.23, 95%CI 1.12-1.35).

CONCLUSION

Patients receiving atypical antipsychotics have an increased risk of renal impairment. Quetiapine carries the highest risk of renal impairment encompassing both AKI and CKD.

Poor muscle health and cardiometabolic risks associated with antidepressant treatment

OBJECTIVE

This study aims to investigate whether antidepressant users display differences in fat distribution and muscle composition relative to non-users and to explore risk factors for developing cardiovascular disease (CVD) and type 2 diabetes.

METHODS

The study used quantitative adipose and muscle tissue measures derived from magnetic resonance imaging data from UK Biobank (N = 40,174). Fat distribution and muscle composition of selective serotonin reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) users were compared with sex-, age-, and BMI-matched control individuals. Cox regression models were used to test for increased risk of developing CVD and type 2 diabetes.

RESULTS

SSRI users had more visceral fat, smaller muscle volume, and higher muscle fat infiltration compared with matched control individuals. Female users showed a larger increase in BMI over time compared with male users. However, male users displayed an unhealthier body composition profile. Male SSRI users also had an increased risk of developing CVD. Both male and female TCA users showed lower muscle volume and an increased risk of developing type 2 diabetes.

CONCLUSIONS

Adverse changes in body composition of antidepressant users are not captured by tracking the body weight or the BMI of the patients. These changes may lead to a worsened cardiometabolic risk profile.

Leveraging the Genetics of Psychiatric Disorders to Prioritize Potential Drug Targets and Compounds

Background

Genetics has the potential to inform biologically relevant drug treatment and repurposing which may ultimately improve patient care. In this study, we combine methods which leverage the genetics of psychiatric disorders to prioritize potential drug targets and compounds.

Methods

We used the largest available genome-wide association studies, in European ancestry, of four psychiatric disorders [i.e., attention deficit hyperactivity disorder (ADHD), bipolar disorder, depression, and schizophrenia] along with genes encoding drug targets. With this data, we conducted drug enrichment analyses incorporating the novel and biologically specific GSA-MiXeR tool. We then conducted a series of molecular trait analyses using large-scale transcriptomic and proteomic datasets sampled from brain and blood tissue. This included the novel use of the UK Biobank proteomic data for a proteome-wide association study of psychiatric disorders. With the accumulated evidence, we prioritize potential drug targets and compounds for each disorder.

Findings

We reveal candidate drug targets shared across multiple disorders as well as disorder-specific targets. Drug prioritization indicated genetic support for several currently used psychotropic medications including the antipsychotic paliperidone as the top ranked drug for schizophrenia. We also observed genetic support for other commonly used psychotropics (e.g., clozapine, risperidone, duloxetine, lithium, and valproic acid). Opportunities for drug repurposing were revealed such as cholinergic drugs for ADHD, estrogens for depression, and gabapentin enacarbil for schizophrenia. Our findings also indicate the genetic liability to schizophrenia is associated with reduced brain and blood expression of CYP2D6, a gene encoding a metabolizer of drugs and neurotransmitters, suggesting a genetic risk for poor drug response and altered neurotransmission.

Interpretation

Here we present a series of complimentary and comprehensive analyses that highlight the utility of genetics for informing drug development and repurposing for psychiatric disorders. Our findings present novel opportunities for refining psychiatric treatment.

Obesity-associated factors in psychiatric outpatients: A multicenter questionnaire survey

The prevalence of obesity is increasing worldwide, resulting in various health issues such as hypertension, dyslipidemia, diabetes mellitus, heart disease, and a lower life expectancy. Importantly, several psychiatric disorders and the use of psychotropic medications have been linked to obesity, and the possible risk factors need further investigation. This study examined the prevalence of obesity and its associated factors using a self-administered questionnaire. Participants were recruited from three outpatient clinics and individuals who met one or more of the ICD-10 F0-F9, G4 diagnoses were included. In total, 1384 participants completed the questionnaire about their lifestyle. Statistical analysis compared the demographic and clinical characteristics of the individuals who were obese (Body Mass Index: BMI ≥25) and those who were non-obese (BMI <25). The results revealed that the factors associated with obesity in psychiatric outpatients were being male, prolonged treatment duration, eating out frequently, and use of both second- and first-generation antipsychotics. The study emphasized the importance of closely monitoring BMI in individuals with multiple obesity-related factors.

Effects of web-based adapted physical activity on hippocampal plasticity, cardiorespiratory fitness, symptoms, and cardiometabolic markers in patients with schizophrenia: a randomized, controlled study

Among the lifestyle interventions, the physical activity (PA) has emerged as an adjuvant non-pharmacological treatment improving mental and physical health in patients with schizophrenia (SZPs) and increasing the hippocampus (HCP) volume. Previously investigated PA programs have been face-to-face, and not necessary adapted to patients' physiological fitness. We propose an innovative 16-week adapted PA program delivered by real-time videoconferencing (e-APA), allowing SZPs to interact with a coach and to manage their physical condition. The primary goal was to demonstrate a greater increase of total HCP volumes in SZPs receiving e-APA compared to that observed in a controlled group. The secondary objectives were to demonstrate the greater effects of e-APA compared to a controlled group on HCP subfields, cardiorespiratory fitness, clinical symptoms, cognitive functions, and lipidic profile. Thirty-five SZPs were randomized to either e-APA or a controlled group receiving a health education program under the same conditions (e-HE). Variables were assessed at pre- and post-intervention time-points. The dropout rate was 11.4%. Compared to the e-HE group, the e-APA group did not have any effect on the HCP total volumes but increased the left subiculum volume. Also, the e-APA group significantly increased cardiorespiratory fitness (VO2max), improved lipidic profile and negative symptoms but not cognitive functions. This study demonstrated the high feasibility and multiple benefits of a remote e-APA program for SZPs. e-APA may increase brain plasticity and improve health outcomes in SZPs, supporting that PA should be an add-on therapeutic intervention. ClinicalTrial.gov on 25 august 2017 (NCT03261817).

Does relapse cause illness progression in first-episode psychosis? A review

BACKGROUND

It is widely believed that relapse in first-episode psychosis (FEP) causes illness progression, with previous reviews suggesting that treatment non-response develops in one in six patients who relapse. This belief contributes to the primary treatment goal in FEP being relapse-prevention, often in favor of other recovery-oriented goals. However, previous reviews primarily reported on naturalistic studies in chronic schizophrenia and predated multiple major studies with higher-quality designs.

METHODS

We conducted a narrative review of studies of any design that examine the impact of relapse on medication response and other symptomatic and functional outcomes in FEP.

RESULTS

We identified eight relevant studies, five of these published since the last major review on this topic. Observational studies show a clear association between relapses and worse response to medication, but poorly control for confounding. Three higher-quality studies (two randomized) generally do not find worse symptomatic or functional outcomes among medication reduction/discontinuation arms compared to maintenance controls, despite significantly higher initial rates of relapse.

CONCLUSION

While the social and psychological consequences of a relapse should not be dismissed, clinicians should demand high-quality evidence about the risks of relapse on long-term outcomes. The conventional notion that relapse leads to treatment non-response or worse long-term outcomes is generally not supported by the highest quality studies. These findings can help clinicians and patients weigh the risks and benefits of competing treatment strategies in FEP.

Pathophysiological Mechanisms of Psychosis-Induced Atrial Fibrillation: The Links between Mental Disorder and Arrhythmia

Atrial fibrillation (AF) is a common phenomenon of sustained arrhythmia leading to heart failure or stroke. Patients with mental disorders (MD), particularly schizophrenia and bipolar disorder, are at a high risk of AF triggered by the dysregulation of the autonomic nervous system, atrial stretch, oxidative stress, inflammation, and electrical or structural remodeling. Moreover, pathophysiological mechanisms underlying MD may also contribute to the genesis of AF. An overactivated hypothalamic-pituitary-adrenal axis, aberrant renin-angiotensin-aldosterone system, abnormal serotonin signaling, disturbed sleep, and genetic/epigenetic factors can adversely alter atrial electrophysiology and structural substrates, leading to the development of AF. In this review, we provide an update of our collective knowledge of the pathophysiological and molecular mechanisms that link MD and AF. Targeting the pathogenic mechanisms of MD-specific AF may facilitate the development of therapeutics that mitigate AF and cardiovascular mortality in this patient population.

Predictors of adherence to exercise interventions in people with schizophrenia

Exercise interventions are nowadays considered as effective add-on treatments in people with schizophrenia but are usually associated with high dropout rates. Therefore, the present study investigated potential predictors of adherence from a large multicenter study, encompassing two types of exercise training, conducted over a 6-month period with individuals with schizophrenia. First, we examined the role of multiple participants' characteristics, including levels of functioning, symptom severity, cognitive performance, quality of life, and physical fitness. Second, we used K-means clustering to identify clinical subgroups of participants that potentially exhibited superior adherence. Last, we explored if adherence could be predicted on the individual level using Random Forest, Logistic Regression, and Ridge Regression. We found that individuals with higher levels of functioning at baseline were more likely to adhere to the exercise interventions, while other factors such as symptom severity, cognitive performance, quality of life or physical fitness seemed to be less influential. Accordingly, the high-functioning group with low symptoms exhibited a greater likelihood of adhering to the interventions compared to the severely ill group. Despite incorporating various algorithms, it was not possible to predict adherence at the individual level. These findings add to the understanding of the factors that influence adherence to exercise interventions. They underscore the predictive importance of daily life functioning while indicating a lack of association between symptom severity and adherence. Future research should focus on developing targeted strategies to improve adherence, particularly for people with schizophrenia who suffer from impairments in daily functioning.Clinical trials registration The study of this manuscript which the manuscript is based was registered in the International Clinical Trials Database, ClinicalTrials.gov (NCT number: NCT03466112, https://clinicaltrials.gov/ct2/show/NCT03466112?term=NCT03466112&draw=2&rank=1 ) and in the German Clinical Trials Register (DRKS-ID: DRKS00009804.

Therapeutic modulation of the kynurenine pathway in severe mental illness and comorbidities: A potential role for serotonergic psychedelics

Mounting evidence points towards a crucial role of the kynurenine pathway (KP) in the altered gut-brain axis (GBA) balance in severe mental illness (SMI, namely depression, bipolar disorder, and schizophrenia) and cardiometabolic comorbidities. Preliminary evidence shows that serotonergic psychedelics and their analogues may hold therapeutic potential in addressing the altered KP in the dysregulated GBA in SMI and comorbidities. In fact, aside from their effects on mood, psychedelics elicit therapeutic improvement in preclinical models of obesity, metabolic syndrome, and vascular inflammation, which are highly comorbid with SMI. Here, we review the literature on the therapeutic modulation of the KP in the dysregulated GBA in SMI and comorbidities, and the potential application of psychedelics to address the altered KP in the brain and systemic dysfunction underlying SMI and comorbidities. Psychedelics might therapeutically modulate the KP in the altered GBA in SMI and comorbidities either directly, via altering the metabolic pathway by influencing the rate-limiting enzymes of the KP and affecting the levels of available tryptophan, or indirectly, by affecting the gut microbiome, gut metabolome, metabolism, and the immune system. Despite promising preliminary evidence, the mechanisms and outcomes of the KP modulation with psychedelics in SMI and systemic comorbidities remain largely unknown and require further investigation. Several concerns are discussed surrounding the potential side effects of this approach in specific cohorts of individuals with SMI and systemic comorbidities.

Revisiting diabetes risk of olanzapine versus aripiprazole in serious mental illness care

BACKGROUND

Exposure to second-generation antipsychotics (SGAs) carries a risk of type 2 diabetes, but questions remain about the diabetogenic effects of SGAs.

AIMS

To assess the diabetes risk associated with two frequently used SGAs.

METHOD

This was a retrospective cohort study of adults with schizophrenia, bipolar I disorder or severe major depressive disorder (MDD) exposed during 2008-2013 to continuous monotherapy with aripiprazole or olanzapine for up to 24 months, with no pre-period exposure to other antipsychotics. Newly diagnosed type 2 diabetes was quantified with targeted minimum loss-based estimation; risk was summarised as the restricted mean survival time (RMST), the average number of diabetes-free months. Sensitivity analyses were used to evaluate potential confounding by indication.

RESULTS

Aripiprazole-treated patients had fewer diabetes-free months compared with olanzapine-treated patients. RMSTs were longer in olanzapine-treated patients, by 0.25 months [95% CI: 0.14, 0.36], 0.16 months [0.02, 0.31] and 0.22 months [0.01, 0.44] among patients with schizophrenia, bipolar I disorder and severe MDD, respectively. Although some sensitivity analyses suggest a risk of unobserved confounding, E-values indicate that this risk is not severe.

CONCLUSIONS

Using robust methods and accounting for exposure duration effects, we found a slightly higher risk of type 2 diabetes associated with aripiprazole compared with olanzapine monotherapy regardless of diagnosis. If this result was subject to unmeasured selection despite our methods, it would suggest clinician success in identifying olanzapine candidates with low diabetes risk. Confirmatory research is needed, but this insight suggests a potentially larger role for olanzapine in the treatment of well-selected patients, particularly for those with schizophrenia, given the drug's effectiveness advantage among them.

On- and Off-Label Atypical Antipsychotic Prescription Trends Across a Nine-Year Period Among Adolescents Pre- to Post-COVID-19

OBJECTIVE

This study examined atypical antipsychotic prescribing by Food and Drug Administration (FDA) approved-use (on-label) status for adolescents before and during the COVID-19 pandemic.

METHODS

Retrospective data were collected from electronic health records (EHRs) of adolescents aged 10-17 years in Kaiser Permanente Northern California. New outpatient atypical antipsychotic prescription orders during 2013-2021 were evaluated. Prescriptions were categorized as on-label if linked in EHRs to autism, psychosis, bipolar disorder, or Tourette's diagnoses; otherwise, they were potentially off-label (herein, off-label). Trend analysis of monthly prescribing rates assessed slope change at pandemic onset for the cohort and by sex and age groups.

RESULTS

Among 5828 patients, 74.5% of new antipsychotic orders were off-label in 2021. Overall prescribing decreased significantly until early 2020 (slope = -0.045, P < .01) but then significantly increased through 2021 (post-March 2020 slope change = 0.211, P = .01). Off-label prescriptions increased at a similar rate during the COVID-19 time period, but on-label prescriptions did not change significantly. Males and younger adolescents (ages 10-14 years) showed significant decreases until early 2020, while females and older adolescents (ages 15-17 years) did not. Females and younger adolescents exhibited significant increases in overall and off-label prescribing rates following pandemic onset; older adolescents exhibited increases in overall prescriptions while males had no detectable changes.

CONCLUSIONS

Antipsychotic prescribing declined slightly but then increased significantly following COVID-19 onset for overall and off-label prescriptions. Pandemic onset differentially impacted antipsychotic prescribing by sex and age, with overall and off-label prescribing driven by increases among female and younger adolescents.

Psychotomimetic compensation versus sensitization

It is a paradox that psychotomimetic drugs can relieve symptoms that increase risk of and cooccur with psychosis, such as attention and motivational deficits (e.g., amphetamines), pain (e.g., cannabis) and symptoms of depression (e.g., psychedelics, dissociatives). We introduce the ideas of psychotomimetic compensation and psychotomimetic sensitization to explain this paradox. Psychotomimetic compensation refers to a short-term stressor or drug-induced compensation against stress that is facilitated by engagement of neurotransmitter/modulator systems (endocannabinoid, serotonergic, glutamatergic and dopaminergic) that mediate the effects of common psychotomimetic drugs. Psychotomimetic sensitization occurs after repeated exposure to stress and/or drugs and is evidenced by the gradual intensification and increase of psychotic-like experiences over time. Theoretical and practical implications of this model are discussed.

Association of lipids and inflammatory markers with left ventricular wall thickness in patients with bipolar disorder

BACKGROUND

Individuals with bipolar disorder (BD) face a high risk of heart failure and left ventricular (LV) dysfunction. Despite strong evidence that high LV relative wall thickness (RWT) is a risk marker for heart failure, few studies have evaluated LV RWT and aggravating factors in individuals with BD.

METHODS

We recruited 104 participants (52 patients with BD and 52 age- and sex-matched mentally healthy controls) to undergo echocardiographic imaging and biochemistry, high-sensitivity C-reactive protein (hs-CRP), and blood cell count measurements. LV RWT was estimated using the following equation: (2 × LV posterior wall end-diastolic thickness)/LV end-diastolic diameter. Clinical data were obtained through interviews and chart reviews.

RESULTS

The BD group exhibited a significantly greater LV RWT (Cohen's d = 0.53, p = 0.003) and a less favorable mitral valve E/A ratio (Cohen's d = 0.54, p = 0.023) and LV global longitudinal strain (Cohen's d = 0.57, p = 0.047) than did the control group. Multiple linear regression revealed that in the BD group, serum triglyceride levels (β = 0.466, p = 0.001), platelet-to-lymphocyte ratios (β = 0.324, p = 0.022), and hs-CRP levels (β = 0.289, p = 0.043) were all significantly and positively associated with LV RWT.

LIMITATIONS

This study applied a cross-sectional design, meaning that the direction of causation could not be inferred.

CONCLUSIONS

Patients with BD are at a risk of heart failure, as indicated by their relatively high LV RWT. Lipid levels and systemic inflammation may explain this unfavorable association.