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Al Jumaili W, Muzwagi A, Shah K, Trivedi C, Durga P, Mansuri Z, Jain S, Al Jumaili Y. Pharmacological Interventions of Atypical Antipsychotics Induced Weight Gain in the Pediatric Population: A Systemic Review of Current Evidence. Child Psychiatry Hum Dev 2024; 55:479-487. [PMID: 36066654 DOI: 10.1007/s10578-022-01424-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 12/18/2022]
Abstract
To systematically review studies evaluating pharmacological treatment intervention of the atypical antipsychotic induced weight gain in the pediatric population and summarize the current evidence of the pharmacological treatment. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we searched the various databases Medline, PubMed, PubMed central (PMC), CINAHL, and clinicaltrial.gov. until Jan 30th, 2022 for relevant clinical studies. Medical subject heading (MeSH) terms or keywords were used, "Body Weight," "Weight Gain," "Weight Loss," "Body Weight Maintenance," "Pediatric Obesity" in "Pediatrics," "Adolescent," "Child" in context of "Antipsychotic Agents" and "Drug Therapy," "Therapeutics," "Treatment Outcome," "Early Medical Intervention." We used the PICO algorithm for our search (Population, Intervention, Comparison, Outcomes, and Study Design) framework. The initial search included 746 articles, nine studies were ultimately selected in the final qualitative review. We included relevant clinical reviews, case series, and randomized clinical trials that evaluated pharmacological intervention for antipsychotic-induced weight gain in the pediatric population. Non-peer-reviewed, non-human, non-English languages article was excluded. Metformin is the most studied medication for antipsychotic-induced weight gain in children. Three studies have shown that adding Metformin to the antipsychotics can significantly reduce the body weight and body mass index with mild transient side effects. Other adjunct medications like topiramate, amantadine, betahistine, or melatonin vary greatly in mitigating weight with various side effects. Lifestyle modification is the first step in dealing with AIWG, but the result is inconsistent. Avoiding the use of antipsychotic in children is preferred. Adding an adjuvant medication to the antipsychotic could prevent or mitigate their negative metabolic effect on the body weight and body mass index. Metformin has the most evidence, topiramate, betahistine, amantadine, and melatonin is possible alternatives in the pediatric patient without changing their antipsychotic medication. Other viable options show some benefits but need further clinical studies to establish efficacy and safety.
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Affiliation(s)
- Wisam Al Jumaili
- Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA.
| | - Ashraf Muzwagi
- Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA
| | - Kaushal Shah
- Griffin Memorial Hospital-Oklahoma State University, Tulsa, OK, USA
| | - Chintan Trivedi
- Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA
| | - Priya Durga
- Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA
| | - Zeeshan Mansuri
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Shailesh Jain
- Regional Chair of Psychiatry Department, Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA
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Carnovale C, Battini V, Santoro C, Riccio MP, Carucci S, Nobile M, Formisano P, Bravaccio C, Zuddas A, Clementi E, Pozzi M, Pisano S. Umbrella Review: Association Between Antipsychotic Drugs and Metabolic Syndrome Hallmarks in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2024; 63:313-335. [PMID: 37391174 DOI: 10.1016/j.jaac.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/04/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To summarize the available evidence on metabolic parameters indicating metabolic adverse effects and risk of metabolic syndrome in children and adolescents treated with antipsychotics, following a pre-specified protocol (PROSPERO ID 252336). METHOD We searched PubMed, Embase and PsycINFO until May 14, 2021, to identify systematic reviews (SR), meta-analyses (MA) and network meta-analyses (NMA) examining symptoms associated to metabolic syndrome in patients <18 years of age who required treatment with oral antipsychotic drugs. Evidence from quantitative analyses for all outcomes related to anthropometric, glyco-metabolic, and blood pressure parameters (measured from baseline to intervention-end and/or follow-up, in subjects exposed to antipsychotics and placebo) was reported on the basis of their metrics (median difference [medianD], mean difference [MD], standardized mean difference [SMD], odds ratio [OR], risk ratio ([RR]). A qualitative synthesis was also made. A formal quality assessment of the included studies was carried out by using the AMSTAR 2. We also provided a hierarchical stratification of the evidence from meta-analyses based on the class of evidence. RESULTS A total of 23 articles (13 MA, 4 NMA and 6 SR) were included for review. As compared with placebo, an increase in triglyceride levels was associated with olanzapine (medianD [95% CI]: 37 [12.27, 61.74] mg/dL; MD [95% CI]: 38.57 [21.44, 55.77] mg/dL) and quetiapine (medianD [95% CI]: 21.58 [95% CI]: 4.27, 38.31 mg/dL; MD [95% CI]: 34.87 [20.08, 49.67] mg/dL; SMD [95% CI]: 0.37 [0.06, 0.068]), whereas decreased triglyceride levels were found for lurasidone. Increased total cholesterol level was associated with asenapine (medianD [95% CI]: 9.1 [1.73, 16.44] mg/dL), quetiapine (medianD [95% CI]: 15.60 [7.30, 24.05] mg/dL; olanzapine (MD [95% CI] from 3.67 [1.43, 5.92] mg/dL to 20.47 [13.97, 26.94] mg/dL]; and lurasidone (medianD [95% CI]: 8.94 [1.27, 16.90] mg/dL). Change in glucose levels did not differ among antipsychotics or placebo. Lurasidone, molindone, and ziprasidone were the best tolerated in terms of weight gain. According to the AMSTAR 2 scoring system, 13 (56.5%) reviews were rated as very low quality. According to classes of evidence, most MA were level 4, especially because of their limited total sample size. CONCLUSION By collating meta-analyses assessing biochemical markers of metabolic syndrome in antipsychotic-treated children, we conclude that olanzapine should not be the antipsychotic of choice in patients at risk for hypertriglyceridemia or hypercholesterolemia. Aripiprazole and lurasidone appear to be better tolerated in terms of metabolic adverse events. Insufficient meta-analytic data are available to provide a precise risk estimate of metabolic syndrome, and, overall, the quality of evidence is low. STUDY REGISTRATION INFORMATION Association between the use of antipsychotic drugs and alterations of the parameters defining the Metabolic Syndrome (MetS) in children and adolescents: an umbrella review; https://www.crd.york.ac.uk/prospero/; CRD42021252336.
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Affiliation(s)
- Carla Carnovale
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Vera Battini
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Claudia Santoro
- Università degli Studi della Campania "Luigi Vanvitelli", Italy
| | | | - Sara Carucci
- University of Cagliari, Cagliari, Italy, and "A.Cao" Pediatric Hospital, Cagliari, Italy
| | - Maria Nobile
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | | | | | - Alessandro Zuddas
- University of Cagliari, Cagliari, Italy, and "A.Cao" Pediatric Hospital, Cagliari, Italy
| | - Emilio Clementi
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy; Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy.
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Lundberg M, Andersson P, Lundberg J, Desai Boström AE. Challenges and opportunities in the diagnosis and treatment of early-onset psychosis: a case series from the youth affective disorders clinic in Stockholm, Sweden. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:5. [PMID: 38172588 PMCID: PMC10851694 DOI: 10.1038/s41537-023-00427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Early-onset psychosis is linked to adverse long-term outcomes, recurrent disease course, and prolonged periods of untreated illness; thus highlighting the urgency of improving early identification and intervention. This paper discusses three cases where initial emphasis on psychosocial treatments led to diagnostic and therapeutic delays: (1) a 15-year-old misdiagnosed with emotionally unstable personality disorder and autism, who improved on bipolar medication and antipsychotics; (2) another 15-year-old misdiagnosed with autism, who stabilized on lithium and antipsychotics, subsequently allowing for gender dysphoria evaluation; (3) a 9-year-old autistic boy incorrectly treated for ADHD, who recovered with appropriate antipsychotic treatment. These cases illuminate the vital importance of adhering to a diagnostic hierarchy, prioritizing diagnostic utility, and conducting longitudinal evaluations to facilitate early targeted treatment of psychotic symptoms in early-onset psychosis. Adherence to such strategies can minimize delays in managing early-onset psychosis and improve long-term prognoses.
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Affiliation(s)
- Mathias Lundberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- The Affective Disorders Clinic, Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Andersson
- Department of Clinical Neuroscience/Psychology, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Johan Lundberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Adrian E Desai Boström
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
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Isop LM, Neculau AE, Necula RD, Kakucs C, Moga MA, Dima L. Metformin: The Winding Path from Understanding Its Molecular Mechanisms to Proving Therapeutic Benefits in Neurodegenerative Disorders. Pharmaceuticals (Basel) 2023; 16:1714. [PMID: 38139841 PMCID: PMC10748332 DOI: 10.3390/ph16121714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Metformin, a widely prescribed medication for type 2 diabetes, has garnered increasing attention for its potential neuroprotective properties due to the growing demand for treatments for Alzheimer's, Parkinson's, and motor neuron diseases. This review synthesizes experimental and clinical studies on metformin's mechanisms of action and potential therapeutic benefits for neurodegenerative disorders. A comprehensive search of electronic databases, including PubMed, MEDLINE, Embase, and Cochrane library, focused on key phrases such as "metformin", "neuroprotection", and "neurodegenerative diseases", with data up to September 2023. Recent research on metformin's glucoregulatory mechanisms reveals new molecular targets, including the activation of the LKB1-AMPK signaling pathway, which is crucial for chronic administration of metformin. The pleiotropic impact may involve other stress kinases that are acutely activated. The precise role of respiratory chain complexes (I and IV), of the mitochondrial targets, or of the lysosomes in metformin effects remains to be established by further research. Research on extrahepatic targets like the gut and microbiota, as well as its antioxidant and immunomodulatory properties, is crucial for understanding neurodegenerative disorders. Experimental data on animal models shows promising results, but clinical studies are inconclusive. Understanding the molecular targets and mechanisms of its effects could help design clinical trials to explore and, hopefully, prove its therapeutic effects in neurodegenerative conditions.
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Affiliation(s)
- Laura Mihaela Isop
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania; (L.M.I.)
| | - Andrea Elena Neculau
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania; (L.M.I.)
| | - Radu Dan Necula
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania
| | - Cristian Kakucs
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania
| | - Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania
| | - Lorena Dima
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania; (L.M.I.)
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Stogios N, Humber B, Agarwal SM, Hahn M. Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Curr Psychiatry Rep 2023; 25:707-721. [PMID: 37755655 DOI: 10.1007/s11920-023-01458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Weight gain is a disconcerting issue experienced by patients treated with antipsychotics (APs). This review summarizes current knowledge on the prevalence, etiology, and risk factors for antipsychotic-induced weight gain (AIWG), and evidence for interventions, including special considerations. RECENT FINDINGS Predisposing risk factors for AIWG include lack of prior AP exposure, sex, and age. AP dose and duration of exposure are additional treatment-related factors that may contribute to this issue. Among current approaches to target AIWG, metformin has the most evidence to support its use, and this is increasingly reflected in clinical guidelines. While lifestyle approaches are recommended, cost-effectiveness and scalability represent limitations. More research is needed to identify newer treatment options and inform clinical recommendations for AIWG. Concerns around scope of practice in psychiatry to address AIWG and related comorbidities will require enhanced training opportunities and interdisciplinary collaborations, as well as updated position statements/practice guidelines emphasizing prevention.
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Affiliation(s)
- Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Bailey Humber
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada.
- Department of Pharmacology, University of Toronto, Toronto, Canada.
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Vandana P, Veenstra-VanderWeele J. Editorial: Failing in our Responsibility to Address Obesity Caused by Psychotropic Medications. J Am Acad Child Adolesc Psychiatry 2023; 62:1194-1196. [PMID: 37245708 DOI: 10.1016/j.jaac.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
Obesity is the most common pediatric chronic disease, affecting close to 14.4 million children and adolescents in the US, according to a recent estimate.1 Despite a significant increase in systematic research and clinical focus in this area, the problem is estimated to worsen in the next 20 years, with estimates predicting that about 57% of children and adolescents between 2 and 19 years of age will be obese by 2050.2 Obesity is defined as a body mass index (BMI) at or greater than the 95th percentile for children and teens of the same age and sex. Because of changes in weight and height with age, and their relation to body fat percentage, BMI levels among children and teens are expressed relative to those of other children of the same sex and age. These percentiles are calculated from the Centers for Disease Control and Prevention (CDC) growth charts, which were based on national survey data collected from 1963-1965 to 1988-1994 (CDC.gov healthy weight webpage). Mental health providers, especially child and adolescent psychiatrists, have an important role in assessing, treating, and even preventing obesity, but current data indicate that we are failing in this responsibility. This is particularly relevant in the context of metabolic side effects of psychotropic agents.
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Affiliation(s)
- Pankhuree Vandana
- Drs. Vandana and Veenstra-VanderWeele are with Columbia University, New York; New York State Psychiatric Institute, New York; Center for Autism and the Developing Brain, New York Presbyterian Hospital, White Plains, New York
| | - Jeremy Veenstra-VanderWeele
- Drs. Vandana and Veenstra-VanderWeele are with Columbia University, New York; New York State Psychiatric Institute, New York; Center for Autism and the Developing Brain, New York Presbyterian Hospital, White Plains, New York.
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Chen H, Lyu N, Chan W, De La Cruz A, Calarge C. Utilization and Predictors of Adjuvant Metformin for Children and Adolescents on Mixed Receptor Antagonists (Second-Generation Antipsychotics). J Am Acad Child Adolesc Psychiatry 2023; 62:1245-1255. [PMID: 37245706 PMCID: PMC10750998 DOI: 10.1016/j.jaac.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/30/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To examine utilization and predictors of adjuvant metformin among pediatric recipients of second-generation antipsychotics (SGAs) (mixed receptor antagonist). METHOD This study used 2016-2021 data of a national electronic medical record database. Eligible participants were children aged 6 to 17 with a new SGA prescription for at least 90 days. Predictors of prescribing adjuvant metformin in general and to nonobese pediatric SGA recipients in particular were assessed using conditional logistic regression and logistic regression analyses, respectively. RESULTS Of 30,009 pediatric SGA recipients identified, 2.3% (n = 785) received adjuvant metformin. Among 597 participants with a body mass index z score documented during the 6-month period before metformin initiation, 83% were obese, and 34% had either hyperglycemia or diabetes. Significant predictors for metformin prescribing were high baseline body mass index z score (odds ratio [OR] 3.5, 95% CI 2.8-4.5, p < .0001), having hyperglycemia or diabetes (OR 5.3, 95% CI 3.4-8.3, p < .0001), and undergoing a switch from a higher metabolic risk SGA to a lower risk one (OR 9.9, 95% CI 3.5-27.5, p = .0025) or a switch in the opposite direction (OR 4.1, 95% CI 2.1-7.9, p = .0051) compared with no switch. Nonobese metformin users were more likely to have a positive body mass index z score velocity before metformin initiation than their obese counterparts. Receiving the index SGA prescribed by a mental health specialist was associated with higher likelihood of receiving adjuvant metformin and receiving metformin before the development of obesity. CONCLUSION Utilization of adjuvant metformin among pediatric SGA recipients is uncommon, and early introduction of the medication among nonobese children is rare.
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Affiliation(s)
- Hua Chen
- University of Houston, College of Pharmacy, Houston, Texas.
| | - Ning Lyu
- University of Houston, College of Pharmacy, Houston, Texas
| | - Wenyaw Chan
- University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
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Gurusamy J, Amudhan S, Menen M, Veerabhadraiah KB, Damodharan D. Barriers and Needs of Mental Health Nursing Practitioners toward the Provision of Physical Health Care for Individuals with Severe Mental Illness: Findings from a Cross-Sectional Survey in India. Issues Ment Health Nurs 2023; 44:1009-1019. [PMID: 37819752 DOI: 10.1080/01612840.2023.2262581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse's attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse's workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.
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Affiliation(s)
- Jothimani Gurusamy
- College of Nursing, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Senthil Amudhan
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Melwine Menen
- Clinical Nursing Services, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | - Dinakaran Damodharan
- Center for Psychosocial Support and Disaster Management, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Sanyal S, Lyu N, Calarge C, Rowan PJ, Aparasu RR, Abughosh S, Chen H. Association Between Abnormal Metabolic Parameters and Receiving Subsequent Interventions in Children and Adolescents Initiating Second-Generation Antipsychotics. J Child Adolesc Psychopharmacol 2023; 33:269-278. [PMID: 37676976 DOI: 10.1089/cap.2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Objectives: This study aimed to examine the association between abnormal readings of metabolic parameters detected during second-generation antipsychotic (SGA) treatment and the likelihood of receiving subsequent adverse drug event interventions. Methods: This was a nested case-control study conducted on patients 1-17 years of age with at least two prescriptions of SGAs between January 2010 and January 2019 using TriNetX EMR data. Following an incident density sampling procedure, patients who received the SGA metabolic adverse event intervention (mAEI) (case) were matched with three nonrecipients (controls). The abnormal readings of metabolic parameters within 30 days before the initiation of mAIEs were further identified. These metabolic parameters include body mass index (BMI) and laboratory parameters such as cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, blood glucose, HbA1c, thyroid hormones, liver enzymes, and prolactin. The association of abnormal metabolic parameters with subsequent mAEIs was assessed using a conditional logistic regression model, after adjusting for demographic and other clinical risk factors. Results: One thousand eight hundred eighty-four children and adolescents met the inclusion criteria and were prescribed SGA mAEIs. The most common types of mAEIs prescribed were weight management pharmacotherapy (40.6%), switching from a high or medium metabolic risk profile SGA to a low-risk one (30.9%), nonpharmacological treatment (25.4%), and switching from SGA polytherapy to monotherapy (11.7%). The conditional logistic regression analysis on matched mAEI recipients and nonrecipients showed that patients with an abnormal BMI had 43% higher odds of receiving mAEI (odds ratio [95% confidence interval]: 1.43 [1.13-1.79]). However, the presence of an abnormal laboratory reading was not associated with the initiation of mAEIs. Conclusions: The prescribing of mAEIs were associated with the presence of obesity, but not with abnormal readings of other metabolic parameters, suggesting that additional data are needed to clarify the long-term implication of SGA metabolic adverse events other than weight gain and to inform the appropriate timing for interventions.
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Affiliation(s)
- Swarnava Sanyal
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Ning Lyu
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Chadi Calarge
- Child and Adolescent Psychiatry, Baylor College of Medicine & Texas Children's Hospital, Houston, Texas, USA
| | - Paul J Rowan
- Division of Management, Policy, and Community Health, The University of Texas-Houston School of Public Health, Houston, Texas, USA
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Susan Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA
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Liu XF, Zhao SW, Cui JJ, Gu YW, Fan JW, Fu YF, Zhang YH, Yin H, Chen K, Cui LB. Differential expression of diacylglycerol kinase ζ is involved in inferior parietal lobule-related dysfunction in schizophrenia with cognitive impairments. BMC Psychiatry 2023; 23:526. [PMID: 37479996 PMCID: PMC10362743 DOI: 10.1186/s12888-023-04955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Cognitive impairment is the main factor in the poor prognosis of schizophrenia, but its mechanism remains unclear. The inferior parietal lobule (IPL) is related to various clinical symptoms and cognitive impairment in schizophrenia. We aimed to explore the relationship between IPL-related functions and cognitive impairment in schizophrenia. METHODS 136 schizophrenia patients and 146 demographically matched healthy controls were enrolled for a cross-sectional study. High-spatial-resolution structural and resting-state functional images were acquired to demonstrate the alternations of brain structure and function. At the same time, the digit span and digit symbol coding tasks of the Chinese Wechsler Adult Intelligence Test Revised (WAIS-RC) were utilized in assessing the subjects' cognitive function. Patients were divided into cognitive impairment and normal cognitive groups according to their cognitive score and then compared whether there were differences between the three groups in fractional amplitude of low-frequency fluctuation (fALFF). In addition, we did a correlation analysis between cognitive function and the fALFF for the left IPL of patients and healthy controls. Based on the Allen Human Brain Atlas, we obtained genes expressed in the left IPL, which were then intersected with the transcriptome-wide association study results and differentially expressed genes in schizophrenia. RESULTS Grouping of patients by the backward digit span task and the digit symbol coding task showed differences in fALFF values between healthy controls and cognitive impairment patients (P < 0.05). We found a negative correlation between the backward digit span task score and fALFF of the left IPL in healthy controls (r = - 0.388, P = 0.003), which was not seen in patients (r = 0.203, P = 0.020). In addition, none of the other analyses were statistically significant (P > 0.017). In addition, we found that diacylglycerol kinase ζ (DGKζ) is differentially expressed in the left IPL and associated with schizophrenia. CONCLUSION Our study demonstrates that the left IPL plays a vital role in cognitive impairment in schizophrenia. DGKζ may act as an essential regulator in the left IPL of schizophrenia patients with cognitive impairment.
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Affiliation(s)
- Xiao-Fan Liu
- Department of Radiology, Xi'an People's Hospital, Xi'an, China
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an, China
| | - Shu-Wan Zhao
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an, China
| | - Jin-Jin Cui
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yue-Wen Gu
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an, China
| | - Jing-Wen Fan
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an, China
| | - Yu-Fei Fu
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an, China
| | - Ya-Hong Zhang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hong Yin
- Department of Radiology, Xi'an People's Hospital, Xi'an, China.
| | - Kun Chen
- Department of Human Anatomy and K. K. Leung Brain Research Centre, Fourth Military Medical University, Xi'an, China.
- Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, Xi'an, China.
| | - Long-Biao Cui
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an, China.
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
- Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, Xi'an, China.
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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11
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Sunshine A, McClellan J. Practitioner Review: Psychosis in children and adolescents. J Child Psychol Psychiatry 2023; 64:980-988. [PMID: 36878476 PMCID: PMC10501332 DOI: 10.1111/jcpp.13777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/08/2023]
Abstract
Psychotic symptoms, including hallucinations, delusions, and disorganized thinking and behaviors, are the hallmarks of schizophrenia; but may also present in the context of other psychiatric and medical conditions. Many children and adolescents describe psychotic-like experiences, which can be associated with other types of psychopathology and past experiences (e.g., trauma, substance use, and suicidality). However, most youth reporting such experiences do not have, nor will ever develop, schizophrenia or another psychotic disorder. Accurate assessment is critical because these different presentations have different diagnostic and treatment implications. For this review, we focus primarily on the diagnosis and treatment of early onset schizophrenia. In addition, we review the development of community-based first-episode psychosis programming, and the importance of early intervention and coordinated care.
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Affiliation(s)
- Anna Sunshine
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Jon McClellan
- Department of Psychiatry, University of Washington, Seattle, WA, USA
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12
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Meyer JM, Correll CU. Increased Metabolic Potential, Efficacy, and Safety of Emerging Treatments in Schizophrenia. CNS Drugs 2023; 37:545-570. [PMID: 37470979 PMCID: PMC10374807 DOI: 10.1007/s40263-023-01022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Abstract
Patients with schizophrenia experience a broad range of detrimental health outcomes resulting from illness severity, heterogeneity of disease, lifestyle behaviors, and adverse effects of antipsychotics. Because of these various factors, patients with schizophrenia have a much higher risk of cardiometabolic abnormalities than people without psychiatric illness. Although exposure to many antipsychotics increases cardiometabolic risk factors, mortality is higher in patients who are not treated versus those who are treated with antipsychotics. This indicates both direct and indirect benefits of adequately treated illness, as well as the need for beneficial medications that result in fewer cardiometabolic risk factors and comorbidities. The aim of the current narrative review was to outline the association between cardiometabolic dysfunction and schizophrenia, as well as discuss the confluence of factors that increase cardiometabolic risk in this patient population. An increased understanding of the pathophysiology of schizophrenia has guided discovery of novel treatments that do not directly target dopamine and that not only do not add, but may potentially minimize relevant cardiometabolic burden for these patients. Key discoveries that have advanced the understanding of the neural circuitry and pathophysiology of schizophrenia now provide possible pathways toward the development of new and effective treatments that may mitigate the risk of metabolic dysfunction in these patients. Novel targets and preclinical and clinical data on emerging treatments, such as glycine transport inhibitors, nicotinic and muscarinic receptor agonists, and trace amine-associated receptor-1 agonists, offer promise toward relevant therapeutic advancements. Numerous areas of investigation currently exist with the potential to considerably progress our knowledge and treatment of schizophrenia.
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Affiliation(s)
- Jonathan M Meyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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13
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O'Hara V, Cuda S, Kharofa R, Censani M, Conroy R, Browne NT. Clinical review: Guide to pharmacological management in pediatric obesity medicine. OBESITY PILLARS (ONLINE) 2023; 6:100066. [PMID: 37990657 PMCID: PMC10661861 DOI: 10.1016/j.obpill.2023.100066] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 11/23/2023]
Abstract
Introduction Newer pharmacotherapy agents (anti-obesity medication [AOM]) are revolutionizing the management of children and adolescents with obesity. Previously, treatment based on intensive behavioral therapy involved many patient and family contact hours and yielded improvements in obesity status of 1-3 percent of the 95th percentile of the body mass index (BMI). Newer AOMs are yielding more clinically significant improvement of 5-18 percent. This review provides guidance for practitioners in the care of children and adolescents with obesity who frequently have complex medical and behavioral health care needs. Specifically, we discuss the use of newer AOMs in these complex patients. Methods This review details an approach to the care of the child and adolescent with obesity using AOMs. A shared decision-making process is presented in which the provider and the patient and family collaborate on care. Management of medical and behavioral components of the disease of obesity in the child are discussed. Results Early aggressive treatment is recommended, starting with an assessment of associated medical and behavioral complications, weight promoting medications, use of AOMs and ongoing care. Intensive behavioral therapy is foundational to treatment, but not a specific treatment. Patients and families deserve education on expected outcomes with each therapeutic option. Conclusions The use of new AOMs in children and adolescents has changed expected clinical outcomes in the field of pediatric obesity management. Clinically significant improvement in obesity status occurs when AOMs are used early and aggressively. Ongoing, chronic care is the model for optimizing outcomes using a shared decision-making between provider and patient/family. Depending on the experience and comfort level of the primary care practitioner, referral to an obesity medicine specialist may be appropriate, particularly when obesity related co-morbidities are present and pharmacotherapy and metabolic and bariatric surgery are considerations.
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Affiliation(s)
- Valerie O'Hara
- Weight & Wellness Clinic, Maine Medical Center, S. Portland, ME, 04106, USA
| | - Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Roohi Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine, Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Marisa Censani
- Clinical Pediatrics, Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason Avenue, Springfield, MA, 01107, USA
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14
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Cai J, Li L, Shao T, Sun M, Wang W, Xie P, Wang X, Yang Y, Long Y, Kang D, Xiao J, Su Y, Peng X, Huang Y, Gao M, Wu Q, Song C, Liu F, Shao P, Ou J, Shen Y, Huang J, Wu R. Relapse in patients with schizophrenia and amisulpride-induced hyperprolactinemia or olanzapine-induced metabolic disturbance after switching to other antipsychotics. Psychiatry Res 2023; 322:115138. [PMID: 36871411 DOI: 10.1016/j.psychres.2023.115138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
Hyperprolactinemia and metabolic disturbance are common side effects of antipsychotics that cause intolerance. Despite its potential influence on relapse, there are no established guidelines for antipsychotic switching. This naturalistic study explored the association between antipsychotic switching, baseline clinical status, metabolic changes, and relapse in patients with schizophrenia. In total, 177 patients with amisulpride-induced hyperprolactinemia and 274 with olanzapine-induced metabolic disturbance were enrolled. Relapse was determined by assessing changes in Positive and Negative Syndrome Scale (PANSS) total scores from baseline to 6 months (increased over 20% or 10% reaching 70). Metabolic indices were measured at baseline and 3 months. Patients with baseline PANSS >60 were more likely to relapse. Further, patients switching to aripiprazole had a higher risk of relapse regardless of their original medication. Participants who originally used amisulpride had reduced prolactin levels following medication change, while switching to olanzapine caused increased weight and blood glucose levels. In patients originally using olanzapine, only switching to aripiprazole reduced insulin resistance. Adverse effects on weight and lipid metabolism were observed in patients who switched to risperidone, while amisulpride improved lipid profiles. Changing schizophrenia treatment requires careful consideration of multiple variables, particularly the choice of substituted drug and the patient's baseline symptoms.
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Affiliation(s)
- Jingda Cai
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Li Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Tiannan Shao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Mengxi Sun
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Weiyan Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Peng Xie
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xiaoyi Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ye Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yujun Long
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Dongyu Kang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jingmei Xiao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuhan Su
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xingjie Peng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuyan Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Menghui Gao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qiongqiong Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Chuhan Song
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Furu Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ping Shao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jianjun Ou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yidong Shen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jing Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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15
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Ye W, Xing J, Yu Z, Hu X, Zhao Y. Mechanism and treatments of antipsychotic-induced weight gain. Int J Obes (Lond) 2023; 47:423-433. [PMID: 36959286 DOI: 10.1038/s41366-023-01291-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
The long-term use of antipsychotics (APs) may cause a variety of diseases, such as metabolic syndrome, antipsychotic-induced weight gain (AIWG), and even obesity. This paper reviews the various mechanisms of AIWG and obesity in detail, involving genetics, the central nervous system, the neuroendocrine system, and the gut microbiome. The common drug and non-drug therapies used in clinical practice are also introduced, providing the basis for research on the molecular mechanisms and the future selection of treatments.
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Affiliation(s)
- Wujie Ye
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jingyu Xing
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Zekai Yu
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xingang Hu
- Internal encephalopathy of traditional Chinese medicine, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, 100078, China.
| | - Yan Zhao
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
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16
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Wilson C, Carpenter JS, Nichles A, Zmicerevska N, Song YJC, McHugh C, Hamilton B, Hockey S, Crouse J, Koethe D, Scott EM, Hickie IB. Double-blind, randomised placebo-controlled clinical trial of metformin as an adjunct to a sleep-wake, activity and metabolically focused behavioural intervention to improve cardiometabolic outcomes and mood symptoms in youth with major mood syndromes: study protocol. BMJ Open 2023; 13:e064682. [PMID: 36810174 PMCID: PMC9945047 DOI: 10.1136/bmjopen-2022-064682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Metformin is a medication likely to improve measures of cardiometabolic disturbance in young people with mental illness. Evidence also suggests metformin may improve depressive symptoms. This 52-week double-blind randomised control trial (RCT) aims to investigate the efficacy of metformin pharmacotherapy as an adjunct to a healthy lifestyle behavioural intervention in improving cardiometabolic outcomes, and depressive, anxiety and psychotic symptoms in youth with clinically diagnosed major mood syndromes. METHODS AND ANALYSIS At least 266 young people aged 16-25 presenting for mental healthcare for major mood syndromes who are also at risk for poor cardiometabolic outcomes will be invited to participate in this study. All participants will engage in a 12-week sleep-wake, activity and metabolically focused behavioural intervention programme. As an adjunctive intervention, participants will receive either metformin (500-1000 mg) or placebo pharmacotherapy for 52 weeks.Participants will undergo a series of assessments including: (1) self-report and clinician-administered assessments; (2) blood tests; (3) anthropometric assessments (height, weight, waist circumference and blood pressure); and (4) actigraphy. Univariate and multivariate tests (generalised mixed-effects models) will be used to examine changes in primary and secondary outcomes (and associations with predetermined predictor variables). ETHICS AND DISSEMINATION This study has been approved by the Sydney Local Health District Research Ethics and Governance Office (X22-0017). The results of this double-blind RCT will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001559101p, 12 November 2019.
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Affiliation(s)
- Chloe Wilson
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Blake Hamilton
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Samuel Hockey
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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17
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Cortese S, Besag FM, Clark B, Hollis C, Kilgariff J, Moreno C, Nicholls D, Wilkinson P, Woodbury-Smith M, Sharma A. Common practical questions - and answers - at the British Association for Psychopharmacology child and adolescent psychopharmacology course. J Psychopharmacol 2023; 37:119-134. [PMID: 36476096 PMCID: PMC9912307 DOI: 10.1177/02698811221140005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The British Association for Psychopharmacology course on child and adolescent psychopharmacology has been run for more than 20 years and is currently a very popular course, attracting around 140 delegates/year from across the United Kingdom and abroad. As Faculty of recent sessions of the course, we have selected the most common questions we have been asked in recent years and provided evidence-based and/or expert-informed answers. We have included 27 questions and answers related to attention-deficit/hyperactivity disorder, anxiety and depressive disorders, autism spectrum disorder, bipolar disorder, eating disorders, epilepsy (in differential diagnosis or comorbid with mental health conditions), obsessive-compulsive disorder, personality disorders, psychotic spectrum disorders, and tics/Tourette syndrome in children and young people. We hope that this article will be helpful for prescribers in their daily clinical practice and we look forward to further, high-level evidence informing the answers to these and other questions in child and adolescent psychopharmacology.
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Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Solent NHS Trust, Southampton, UK.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA.,Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Frank Mc Besag
- UCL School of Pharmacy, London, UK.,East London Foundation NHS Trust, Bedfordshire, UK.,Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Bruce Clark
- National Specialist Clinic for Young People with OCD, BDD and Related Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chris Hollis
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen's Medical Centre, Nottingham, UK.,National Institute of Mental Health (NIHR) MindTech Medtech Co-operative, Institute of Mental Health, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Mental Health & Technology Theme, Institute of Mental Health, Nottingham, UK
| | - Joseph Kilgariff
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen's Medical Centre, Nottingham, UK
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK.,NIHR ARC Northwest, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, UK
| | | | - Aditya Sharma
- Academic Psychiatry, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Specialist Adolescent Mood Disorders Service (SAMS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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18
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Misera A, Łoniewski I, Palma J, Kulaszyńska M, Czarnecka W, Kaczmarczyk M, Liśkiewicz P, Samochowiec J, Skonieczna-Żydecka K. Clinical significance of microbiota changes under the influence of psychotropic drugs. An updated narrative review. Front Microbiol 2023; 14:1125022. [PMID: 36937257 PMCID: PMC10014913 DOI: 10.3389/fmicb.2023.1125022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Relationship between drugs and microbiota is bilateral. Proper composition thus function of microbiota is a key to some medications used in modern medicine. However, there is also the other side of the coin. Pharmacotherapeutic agents can modify the microbiota significantly, which consequently affects its function. A recently published study showed that nearly 25% of drugs administered to humans have antimicrobial effects. Multiple antidepressants are antimicrobials,. and antibiotics with proven antidepressant effects do exist. On the other hand, antibiotics (e.g., isoniaside, minocycline) confer mental phenotype changes, and adverse effects caused by some antibiotics include neurological and psychological symptoms which further supports the hypothesis that intestinal microbiota may affect the function of the central nervous system. Here we gathered comprehensively data on drugs used in psychiatry regarding their antimicrobial properties. We believe our data has strong implications for the treatment of psychiatric entities. Nevertheless the study of ours highlights the need for more well-designed trials aimed at analysis of gut microbiota function.
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Affiliation(s)
- Agata Misera
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Igor Łoniewski
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
- Sanprobi sp. z o.o. sp.k., Szczecin, Poland
| | - Joanna Palma
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Monika Kulaszyńska
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Wiktoria Czarnecka
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Paweł Liśkiewicz
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karolina Skonieczna-Żydecka
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, Szczecin, Poland
- *Correspondence: Karolina Skonieczna-Żydecka,
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19
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Cuda S, Censani M, Kharofa R, O'Hara V, Conroy R, Williams DR, Paisley J, Browne AF, Karjoo S, Browne NT. Medication-induced weight gain and advanced therapies for the child with overweight and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 4:100048. [PMID: 37990664 PMCID: PMC10662101 DOI: 10.1016/j.obpill.2022.100048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details medication-induced weight gain and advanced therapies for the child with overweight or obesity. Methods The scientific information and clinical guidance in this CPS are based on scientific evidence, supported by the medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement addresses medication-induced weight gain and advanced therapies for the child with overweight or obesity. Conclusions This OMA Clinical Practice Statement on medication induced-weight gain and advanced therapies for the child with overweight or obesity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications. This CPS also addresses treatment recommendations. This section is designed to help the provider with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Roohi Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | | | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason AvenueSpringfield, MA, 01107, USA
| | - Dominique R Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street Lawrenceburg, IN, 47025-2048, USA
| | | | - Sara Karjoo
- Johns Hopkins All Children's Hospital Pediatric Gastroenterology 501 6th Ave S St. Petersburg, FL, 33701, USA
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20
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Fiorillo A, Cuomo A, Sampogna G, Albert U, Calò P, Cerveri G, De Filippis S, Masi G, Pompili M, Serafini G, Vita A, Zuddas A, Fagiolini A. Lurasidone in adolescents and adults with schizophrenia: from clinical trials to real-world clinical practice. Expert Opin Pharmacother 2022; 23:1801-1818. [DOI: 10.1080/14656566.2022.2141568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | | | - Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Integrata Giuliano-Isontina - ASUGI, UCO Clinica Psichiatrica, Trieste, Italy
| | - Paola Calò
- Department of Mental Health, Azienda Sanitaria Integrata Giuliano-IsontinaLecce, Italy
| | | | | | - Gabriele Masi
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Stella Maris, Calambrone, Pisa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandro Zuddas
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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21
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Improving physical activity and diet in patients with severe mental disorders: Results from the LIFESTYLE multicentric, real-world randomized controlled trial. Psychiatry Res 2022; 317:114818. [PMID: 36088834 DOI: 10.1016/j.psychres.2022.114818] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
Aims of the present study are to test the efficacy of a lifestyle group intervention, compared to a brief psychoeducational intervention, on levels of physical activity and dietary habits in a real-world sample of patients with severe mental disorders. The study, funded by the Italian Ministry of Education, has been carried out in six Italian University psychiatric outpatient units. All patients were randomly assigned to the experimental or control group and were assessed through standardized assessment instruments at baseline and six months after randomization. Of the 401 recruited patients, 43.3% had a diagnosis of bipolar disorder, 29.9% of psychosis and 26.9% of major depression. Patients were mainly female (57%), with a mean age of 45.6±11.8 years. Treated patients have almost 8 times the likelihood to show an increase of the total MET (OR: 8.02; p < .001) and of the walking MET (OR: 7.68; p < .001) and are more likely to increase the weekly consumption of vegetables (OR= 1.98, p < .05) and to reduce that of junk food (OR:0.23; p < .05). The present study support the notion that patients with severe mental disorders can improve their lifestyle behaviours and that, with appropriate support, they can achieve a healthy living.
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22
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Sampogna G, Borgi M, Collacchi B, Cirulli F, Cerino S, Rullo S, Di Vincenzo M, Luciano M, Di Tommaso V, Moliterni S, Bichi A, Garside J, Kivistö S, Iarion A, Fiorillo A. Using sport-based interventions for people with severe mental disorders: results from the European EASMH study. Int Rev Psychiatry 2022; 34:837-847. [PMID: 36786110 DOI: 10.1080/09540261.2022.2106122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People with severe mental disorders report significantly poorer physical health and a higher mortality rate compared with the general population. Several interventions have been proposed in order to challenge this mortality gap, the promotion of physical activities represents one of the most important strategies. In fact, in people with severe mental disorders, physical activity can improve body composition, quality of life, personal functioning, self-esteem, cognition, and cardiorespiratory fitness, as well as reducing affective, psychotic and anxiety symptoms, cardiometabolic burden and increase the global recovery. While sport-based programs are consistently being proposed as an integral part of effective personalized treatment approaches for people with severe mental disorders, their routine implementation is hampered by poor working task integration among different professionals and the lack of training programmes for sport professionals focused on people with severe mental disorders. In this paper, we will: (a) review the efficacy of exercise/sport-based interventions for people with severe mental disorders; (b) describe the main difficulties in engaging patients with severe mental disorders in these interventions; and (c) report the results of the first study on the best practices available in Europe in the field of sport and mental health carried out in the context of the European Alliance for Sport and Mental Health (EASMH) project. According to the EASMH survey, sport-based psychosocial interventions are not frequently available in mental health services, with significant differences at the European level. In the near future, it would be advisable to promote the integration and collaboration between mental health professionals and sport professionals, in order to improve the dissemination and availability of sport-based interventions in routine clinical practice. The EASMH project aims to fill this gap by creating a network of collaborators, researchers and stakeholders with different backgrounds in order to improve the dissemination of sport-based rehabilitation interventions and by developing an innovative training programme for sport coaches in order to improve their skills in interacting and building an effective relationship with people with severe mental disorders.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marta Borgi
- National Institute of Health, Rome, Italy.,European Culture and Sport Organization, ECOS, Rome; Italy
| | | | - Francesca Cirulli
- National Institute of Health, Rome, Italy.,European Culture and Sport Organization, ECOS, Rome; Italy
| | | | - Santo Rullo
- European Culture and Sport Organization, ECOS, Rome; Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | | | - Alberto Bichi
- The European Platform for Sport Innovation, EPSI, Brussels; Belgium
| | | | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
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23
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Switching Antipsychotic Medications in People with Schizophrenia: A 4-Year Naturalistic Study. J Clin Med 2022; 11:jcm11195965. [PMID: 36233835 PMCID: PMC9573332 DOI: 10.3390/jcm11195965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Although generally effective in ameliorating the core manifestations of schizophrenia, antipsychotics (APs) may lead to only suboptimal responses or may be associated with a variety of treatment-related adverse events which require additional treatment strategies. Under such clinical circumstances, switching APs represents a rational treatment option. The present study aimed to identify the variables that predict AP switch and to quantify the frequency of this phenomenon in people with schizophrenia in real-life. A secondary analysis was conducted on the data collected at baseline and at a 4-year follow-up from a large sample of community-dwelling Italian people with schizophrenia. Demographic and clinical variables as well as information about AP treatment were recorded at two time points. Over the 4-year period, 34.9% of the 571 participants switched the AP; in particular, 8.4% of participants switched from first-generation APs (FGAs) to second-generation APs or vice versa, while 8.2% of them switched to clozapine. Logistic regression models showed that combination of APs at baseline was negatively associated with AP switch, while treatment with FGAs and the presence of extrapyramidal symptoms at baseline were associated with AP class switch. Although the aim of the present study was not to assess predictors of clinical relapse in people with schizophrenia, we might speculate that switching APs represents a surrogate indicator of treatment failure in some patients and could lead into relapse, which is a costly aspect of schizophrenia management in both economic and human terms. The sooner such a negative outcome can be predicted and managed, the sooner the treatment can be optimized to avoid it.
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Agarwal SM, Stogios N, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H, Cohn T, Taylor VH, Remington G, Faulkner GEJ, Hahn M. Pharmacological interventions for prevention of weight gain in people with schizophrenia. Cochrane Database Syst Rev 2022; 10:CD013337. [PMID: 36190739 PMCID: PMC9528976 DOI: 10.1002/14651858.cd013337.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Antipsychotic-induced weight gain is an extremely common problem in people with schizophrenia and is associated with increased morbidity and mortality. Adjunctive pharmacological interventions may be necessary to help manage antipsychotic-induced weight gain. This review splits and updates a previous Cochrane Review that focused on both pharmacological and behavioural approaches to this problem. OBJECTIVES To determine the effectiveness of pharmacological interventions for preventing antipsychotic-induced weight gain in people with schizophrenia. SEARCH METHODS The Cochrane Schizophrenia Information Specialist searched Cochrane Schizophrenia's Register of Trials on 10 February 2021. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that examined any adjunctive pharmacological intervention for preventing weight gain in people with schizophrenia or schizophrenia-like illnesses who use antipsychotic medications. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data and assessed the quality of included studies. For continuous outcomes, we combined mean differences (MD) in endpoint and change data in the analysis. For dichotomous outcomes, we calculated risk ratios (RR). We assessed risk of bias for included studies and used GRADE to judge certainty of evidence and create summary of findings tables. The primary outcomes for this review were clinically important change in weight, clinically important change in body mass index (BMI), leaving the study early, compliance with treatment, and frequency of nausea. The included studies rarely reported these outcomes, so, post hoc, we added two new outcomes, average endpoint/change in weight and average endpoint/change in BMI. MAIN RESULTS Seventeen RCTs, with a total of 1388 participants, met the inclusion criteria for the review. Five studies investigated metformin, three topiramate, three H2 antagonists, three monoamine modulators, and one each investigated monoamine modulators plus betahistine, melatonin and samidorphan. The comparator in all studies was placebo or no treatment (i.e. standard care alone). We synthesised all studies in a quantitative meta-analysis. Most studies inadequately reported their methods of allocation concealment and blinding of participants and personnel. The resulting risk of bias and often small sample sizes limited the overall certainty of the evidence. Only one reboxetine study reported the primary outcome, number of participants with clinically important change in weight. Fewer people in the treatment condition experienced weight gains of more than 5% and more than 7% of their bodyweight than those in the placebo group (> 5% weight gain RR 0.27, 95% confidence interval (CI) 0.11 to 0.65; 1 study, 43 participants; > 7% weight gain RR 0.24, 95% CI 0.07 to 0.83; 1 study, 43 participants; very low-certainty evidence). No studies reported the primary outcomes, 'clinically important change in BMI', or 'compliance with treatment'. However, several studies reported 'average endpoint/change in body weight' or 'average endpoint/change in BMI'. Metformin may be effective in preventing weight gain (MD -4.03 kg, 95% CI -5.78 to -2.28; 4 studies, 131 participants; low-certainty evidence); and BMI increase (MD -1.63 kg/m2, 95% CI -2.96 to -0.29; 5 studies, 227 participants; low-certainty evidence). Other agents that may be slightly effective in preventing weight gain include H2 antagonists such as nizatidine, famotidine and ranitidine (MD -1.32 kg, 95% CI -2.09 to -0.56; 3 studies, 248 participants; low-certainty evidence) and monoamine modulators such as reboxetine and fluoxetine (weight: MD -1.89 kg, 95% CI -3.31 to -0.47; 3 studies, 103 participants; low-certainty evidence; BMI: MD -0.66 kg/m2, 95% CI -1.05 to -0.26; 3 studies, 103 participants; low-certainty evidence). Topiramate did not appear effective in preventing weight gain (MD -4.82 kg, 95% CI -9.99 to 0.35; 3 studies, 168 participants; very low-certainty evidence). For all agents, there was no difference between groups in terms of individuals leaving the study or reports of nausea. However, the results of these outcomes are uncertain given the very low-certainty evidence. AUTHORS' CONCLUSIONS There is low-certainty evidence to suggest that metformin may be effective in preventing weight gain. Interpretation of this result and those for other agents, is limited by the small number of studies, small sample size, and short study duration. In future, we need studies that are adequately powered and with longer treatment durations to further evaluate the efficacy and safety of interventions for managing weight gain.
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Affiliation(s)
- Sri Mahavir Agarwal
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Zohra A Ahsan
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Jonathan T Lockwood
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Markus J Duncan
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Hiroyoshi Takeuchi
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Tony Cohn
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Gary Remington
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Guy E J Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Margaret Hahn
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
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25
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Zhao G, Zhang Q, Wu F, Yin S, Xie Y, Liu H. Comparison of weight loss and adverse events of obesity drugs in children and adolescents: a systematic review and meta-analysis. Expert Rev Clin Pharmacol 2022; 15:1119-1125. [PMID: 36039827 DOI: 10.1080/17512433.2022.2117152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The global incidence of childhood obesity is increasing. Currently, there are only few established drugs for treating adolescent obesity. Randomized clinical trials (RCTs) comparing pharmacological interventions in children with obesity are scarce; therefore, we aimed to analyze the relative efficacy and adverse reactions of these drugs and compare the effects of each drug on body mass index (BMI). RESEARCH DESIGN AND METHODS This meta-analysis focused on the slimming effect, safety, and correlation of metformin, orlistat, exenatide, liraglutide, and topiramate in children with obesity. Several international databases were searched and clinical trials on the treatment of obesity in children in which the drug was administered for ≥ 6 months were included. Changes in BMI before and after treatment were analyzed using a Bayes framework, and the surface under the cumulative ranking was calculated. RESULTS Of 2102 relevant articles retrieved, 21 RCTs were included in the study. Compared to other drugs, liraglutide reduced BMI the most in children with obesity. However, it was most associated with drug withdrawal due to adverse events while topiramate was least. CONCLUSIONS Liraglutide had a higher probability of achieving clinically significant weight loss compared with other drugs while topiramate was superior in safety.
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Affiliation(s)
- Guangming Zhao
- Changchun University of Chinese Medicine, Changchun 130117, China
| | - Qi Zhang
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Fan Wu
- Personnel Section, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Shuang Yin
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Yiqi Xie
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Hongyan Liu
- Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine, Beijing 101300, China
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26
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Actions of Metformin in the Brain: A New Perspective of Metformin Treatments in Related Neurological Disorders. Int J Mol Sci 2022; 23:ijms23158281. [PMID: 35955427 PMCID: PMC9368983 DOI: 10.3390/ijms23158281] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Metformin is a first-line drug for treating type 2 diabetes mellitus (T2DM) and one of the most commonly prescribed drugs in the world. Besides its hypoglycemic effects, metformin also can improve cognitive or mood functions in some T2DM patients; moreover, it has been reported that metformin exerts beneficial effects on many neurological disorders, including major depressive disorder (MDD), Alzheimer’s disease (AD) and Fragile X syndrome (FXS); however, the mechanism underlying metformin in the brain is not fully understood. Neurotransmission between neurons is fundamental for brain functions, and its defects have been implicated in many neurological disorders. Recent studies suggest that metformin appears not only to regulate synaptic transmission or plasticity in pathological conditions but also to regulate the balance of excitation and inhibition (E/I balance) in neural networks. In this review, we focused on and reviewed the roles of metformin in brain functions and related neurological disorders, which would give us a deeper understanding of the actions of metformin in the brain.
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27
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Vitamin D Deficiency and Risk Factors Related to Acute Psychiatric Relapses in Patients with Severe Mental Disorders: A Preliminary Study. Brain Sci 2022; 12:brainsci12080973. [PMID: 35892414 PMCID: PMC9329760 DOI: 10.3390/brainsci12080973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 12/10/2022] Open
Abstract
Previous studies have indicated that vitamin (Vit) D deficiency is frequent in psychiatric patients, regardless of diagnostic category. We aimed to assess whether acute psychiatric relapses in inpatients was associated with Vit D deficiency compared to stabilized outpatients. The cohort (152 total patients, 75 males and 77 females) had a mean age of 47.3 ± 14.4 years at admission and was grouped according to psychiatric diagnosis. Psychopathological symptom severity was assessed by the Brief Psychiatric Rating Scale (BPRS), a multidimensional symptom inventory. Total calcium serum levels were measured using standard laboratory methods, while plasma levels of 25-OH-Vit D and parathyroid hormone (PTH) were measured by automated chemiluminescence immunoassays. The psychiatric inpatient subgroup showed a significant difference in serum levels of 25-OH-Vit D and PTH (p < 0.001). Correlation analysis between serum levels of 25-OH-Vit D and BPRS total and subitem scores indicated a significantly negative relationship. In addition, linear regression analysis evidenced that the inpatient condition might predict low PTH and 25-OH-Vit D serum levels. Hospitalized psychiatric patients are at increased risk for Vit D deficiency regardless of their diagnostic categories. The mechanism underlying the association between acute psychiatric relapses and Vit D deficiency remains unclear. Therefore, screening for Vit D deficiency should pertain to the health assessment of patients with major psychiatric disorders.
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28
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Li X, Yuan X, Pang L, Zhang S, Li Y, Huang X, Fan X, Song X. The effect of serum lipids and short-chain fatty acids on cognitive functioning in drug-naïve, first episode schizophrenia patients. Psychiatry Res 2022; 313:114582. [PMID: 35526421 DOI: 10.1016/j.psychres.2022.114582] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Many studies have reported the important role of serum levels of short-chain fatty acids (SCFAs) in lipid metabolism and cognitive dysfunction. This study investigated the role of plasma lipids and SCFAs on cognitive functioning in drug- naïve first episode schizophrenia. METHODS This study recruited 44 schizophrenia inpatients and 35 healthy controls. Plasma lipid metabolism was characterized using standard enzymatic methods and an automated analyzer. Serum levels of SCFAs were measured by Gas chromatography mass spectrometry (GC-MS). Cognitive performance was evaluated by the MATRICS Consensus Cognitive Battery (MCCB). RESULTS The patient group showed significantly higher serum levels of total SCFAs, acetic acid, acetic acid/ propionic acid ratio, and poorer cognitive scores compared with the control group (p's < 0.05). Within the patient group, the lipid levels were positively associated with acetic acid/ propionic acid ratio (p's < 0.05). Furthermore, multiple regression analysis revealed that the interactions of LDL level × acetic acid/ propionic acid ratio was a significant predictor of the MCCB working memory, and processing speed subscale scores within the patient group. CONCLUSIONS Cognitive dysfunction and abnormal serum levels of SCFAs occur in the early phase of schizophrenia. Lipid metabolism and serum levels of SCFAs might be, both independently or interactively, associated with cognitive dysfunction in schizophrenia.
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Affiliation(s)
- Xue Li
- Department of Psychiatry, the First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Zhengzhou, China; Henan Psychiatric Transformation Research Key Laboratory/Zhengzhou University, Zhengzhou, China
| | - Xiuxia Yuan
- Department of Psychiatry, the First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Zhengzhou, China; Henan Psychiatric Transformation Research Key Laboratory/Zhengzhou University, Zhengzhou, China
| | - Lijuan Pang
- Department of Psychiatry, the First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Zhengzhou, China; Henan Psychiatric Transformation Research Key Laboratory/Zhengzhou University, Zhengzhou, China
| | - Siwei Zhang
- Department of Psychiatry, the First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Zhengzhou, China; Henan Psychiatric Transformation Research Key Laboratory/Zhengzhou University, Zhengzhou, China
| | - Yajun Li
- Department of Psychiatry, the First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Zhengzhou, China; Henan Psychiatric Transformation Research Key Laboratory/Zhengzhou University, Zhengzhou, China
| | - Xufeng Huang
- Illawarra Health and Medical Research Institute, University of Wollongong, NSW 2522, Australia
| | - Xiaoduo Fan
- Psychotic Disorders Program, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Xueqin Song
- Department of Psychiatry, the First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Zhengzhou, China; Henan Psychiatric Transformation Research Key Laboratory/Zhengzhou University, Zhengzhou, China.
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29
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Kakko K, Keskinen P, Pihlakoski L, Salmelin R, Puura K. In search of measures to improve the detection of increased cardiometabolic risk in children using second-generation antipsychotic medications. Nord J Psychiatry 2022; 76:316-322. [PMID: 34431750 DOI: 10.1080/08039488.2021.1968489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Second-generation antipsychotic medications (SGAs) are widely used in child psychiatry. SGA-induced metabolic disturbances are common in children, but monitoring practices need systematisation. The study's aims were to test an SGA-monitoring protocol, examine the distributions of metabolic measurements compared to reference values in child psychiatry patients, and determine whether using a homeostasis model for the assessment of insulin resistance (HOMA-IR) and triglyceride/high-density lipoprotein (TG/HDL) ratio could improve the detection of increased cardiometabolic risk. MATERIALS AND METHODS A systematic monitoring protocol was implemented. Weight and height, blood pressure, fasting glucose, insulin, HDL, and TG were measured at baseline and four times during follow-up. HOMA-IR, TG/HDL ratio and zBMI were calculated. Age-, gender- and BMI-specific percentile curves for HOMA-IR were used to define elevated cardiometabolic risk. RESULTS The study patients (n = 55, mean age 9.9 years) were followed for a median of 9 months. A disadvantageous, statistically significant shift, often appearing within the reference range, was seen in zBMI, TG, HDL, glucose, insulin, HOMA-IR, and TG/HDL ratio. The increase in HOMA-IR appeared earlier than individual laboratory values and was more evident than the TG/HDL ratio increase. An HOMA-IR cut point of 1.98 resulted in a sensitivity and specificity of 83%. Compared to a previous study performed in the same location, the monitoring rates of metabolic parameters improved. CONCLUSION The monitoring protocol implementation improved the monitoring of metabolic parameters in child psychiatric patients using SGAs. Using HOMA-IR as part of systematic SGA monitoring could help detect metabolic adverse effects.
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Affiliation(s)
- Kirsi Kakko
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Keskinen
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland.,Center for Child Health Research, Tampere University, Tampere, Finland
| | - Leena Pihlakoski
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Raili Salmelin
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences/Health Sciences, Tampere University, Tampere, Finland
| | - Kaija Puura
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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30
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Yang J, Zhang Z, Xie Z, Bai L, Xiong P, Chen F, Zhu T, Peng Q, Wu H, Zhou Y, Ma Y, Zhang Y, Chen M, Gao J, Tian W, Shi K, Du Y, Duan Y, Wang H, Xu Y, Kuang YQ, Zhu M, Yu J, Wang K. Metformin modulates microbiota-derived inosine and ameliorates methamphetamine-induced anxiety and depression-like withdrawal symptoms in mice. Biomed Pharmacother 2022; 149:112837. [PMID: 35339829 DOI: 10.1016/j.biopha.2022.112837] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Metformin exhibits therapeutic potential in behavioural deficits induced by methamphetamine (METH) in rats. Emerging studies suggest gut microbiota may impact psychiatric symptoms, but there is no direct evidence supporting metformin's participation in the pathophysiology of withdrawal symptoms via modulation of gut microbiota. METHODS In order to define the functional impacts of gut microbiota and metformin to the behavioural deficits during METH withdrawal, we utilized a combination of fecal microbiota transplantation (FMT), high-throughput sequencing, and untargeted metabolomics technologies. RESULTS First, METH addicts exhibited higher α diversity and distinct microbial structures compared to healthy controls. In particular, the relative abundance of Rikenellaceae was positively correlated with the severity of anxiety and depression. Second, both human-to-mouse and mouse-to-mouse FMTs confirmed that METH-altered-microbiota transplantation is sufficient to promote anxiety and depression-like behaviours in recipient germ-free mice, and these behavioural disturbances could be ameliorated by metformin. In-depth analysis revealed that METH significantly altered the bacterial composition and structure as well as relative abundance of several bacterial taxa and metabolites, including Rikenellaceae and inosine, respectively, whereas add-on metformin could remodel these alterations. Finally, the inosine complementation successfully restored METH-induced anxiety and depression-like behaviours in mice. CONCLUSION This study demonstrates that METH withdrawal-induced anxiety and depression-like behaviours are reversible and transmissible via gut microbiota in a mouse model. The therapeutic effects of metformin on psychiatric manifestations are associated with microbiota-derived metabolites, highlighting the role of the gut microbiota in substance use disorders and the pathophysiology of withdrawal symptoms.
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Affiliation(s)
- Jiqing Yang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Faculty of Life science and Technology, Kunming University of Science and Technology, Kunming 650500, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Zunyue Zhang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; School of Medicine, Yunnan University, Kunming 650091, China
| | - Zhenrong Xie
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Ling Bai
- Faculty of Life science and Technology, Kunming University of Science and Technology, Kunming 650500, China
| | - Pu Xiong
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Fengrong Chen
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Tailin Zhu
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Qingyan Peng
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Hongjin Wu
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yong Zhou
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yuru Ma
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yongjin Zhang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Minghui Chen
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Jianyuan Gao
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Weiwei Tian
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Kai Shi
- College of Science, Guilin University of Technology, Guilin 541004, China
| | - Yan Du
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yong Duan
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Huawei Wang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yu Xu
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Department of Gastrointestinal Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Mei Zhu
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Juehua Yu
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China.
| | - Kunhua Wang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Faculty of Life science and Technology, Kunming University of Science and Technology, Kunming 650500, China; School of Medicine, Yunnan University, Kunming 650091, China.
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Kameg B, Champion C. Atypical antipsychotics: Managing adverse effects. Perspect Psychiatr Care 2022; 58:691-695. [PMID: 33955013 DOI: 10.1111/ppc.12837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this article is to provide an overview of common adverse effects and management strategies related to atypical antipsychotic use. CONCLUSIONS Atypical antipsychotics are commonly prescribed. While effective, atypical antipsychotics are associated with metabolic syndrome, extrapyramidal symptoms, and tardive dyskinesia, among others adverse effects. Management strategies can mitigate adverse effects and promote optimum quality of life. PRACTICE IMPLICATIONS To be able to identify and manage adverse effects associated with the use of atypical antipsychotics, it is important to build a supportive therapeutic environment at each interaction with patients and their caregivers.
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Affiliation(s)
- Brayden Kameg
- Department of Health and Community Systems, University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Claire Champion
- Department of Health and Community Systems, University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania, USA
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Florida Medicaid Children's Receipt of First-Line Psychosocial Care Prior to Antipsychotic Initiation. Acad Pediatr 2022; 22:S100-S107. [PMID: 35339236 DOI: 10.1016/j.acap.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/05/2021] [Accepted: 11/21/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE First-line, nonpharmacological therapy is recommended for many pediatric mental health (MH) conditions prior to initiating antipsychotic prescription therapies. Many children do not receive these recommended services, despite the known association between antipsychotic medications and metabolic dysfunction. The main objective of this study was to quantify the association among children's MH diagnosis categories, sociodemographic characteristics and receipt of first-line psychosocial care among children in Florida Medicaid METHODS: Florida Medicaid enrollment, healthcare and pharmacy claims were used for this multivariate analysis. Children were assigned to condition clusters wherein related diagnoses were grouped into clinically relevant categories. A total of 7704 children were included in the final analysis. RESULTS Twenty-four percent of children in Florida Medicaid do not receive first-line, nonpharmacological psychosocial care. Age was significantly associated with not receiving psychosocial services, with older children less likely to receive. Non-Hispanic White children as well as those living in rural areas had lower odds of receiving behavioral intervention prior to initiating antipsychotics. Children with mood-disorders, behavior problems, anxiety and stress related disorders were more likely to receive first-line psychosocial care. CONCLUSIONS This study provides an important understanding of the variability in receipt of first-line psychosocial care before antipsychotic medication initiation among children in Medicaid based on sociodemographic and MH health characteristics. These analyses can be used to develop quality improvement initiatives targeted toward children that are most vulnerable for not receiving recommended care.
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Faden J, Serdenes R, Citrome L. Olanzapine-samidorphan combination tablets for the treatment of schizophrenia and bipolar I disorder - what is it, and will it be used? Expert Rev Neurother 2022; 22:365-376. [PMID: 35354374 DOI: 10.1080/14737175.2022.2060742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Although olanzapine remains one of the most efficacious antipsychotic medications for the treatment of schizophrenia, there are significant tolerability concerns related to its weight and metabolic profile. Olanzapine-samidorphan combination tablets (OLZ/SAM), branded as Lybalvi, is a newly FDA approved formulation aimed at attenuating antipsychotic induced weight gain via modulation of the endogenous opioid system with samidorphan, while retaining the robust antipsychotic efficacy of olanzapine. AREAS COVERED : We reviewed the published literature of OLZ/SAM for the management of schizophrenia using the US National Library of Medicine's PubMed.gov resource. Topics covered in this narrative review include the pharmacokinetics, pharmacodynamics, tolerability, and efficacy of OLZ/SAM. EXPERT OPINION : OLZ/SAM is an effective and well tolerated pharmacologic option in mitigating olanzapine induced weight gain while retaining olanzapine's efficacy. It has a limited effect on metabolic laboratory parameters and cumulatively tends to limit weight gain rather than promote weight loss. Additional research will be needed to determine its effectiveness compared to alternative strategies to attenuate antipsychotic induced weight gain.
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Affiliation(s)
- Justin Faden
- Lewis Katz School of Medicine at Temple University, Philadelphia PA 19125, USA
| | - Ryan Serdenes
- Lewis Katz School of Medicine at Temple University, Philadelphia PA 19125, USA
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Liang J, Cai Y, Xue X, Li X, Li Z, Xu C, Xie G, Yu Y. Does Schizophrenia Itself Cause Obesity? Front Psychiatry 2022; 13:934384. [PMID: 35815040 PMCID: PMC9260012 DOI: 10.3389/fpsyt.2022.934384] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/30/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Schizophrenia (SC) is considered the most serious of all mental disorders. Some antipsychotics are associated with weight gain and metabolic abnormalities. Whether SC itself causes obesity remains uncertain. METHODS We collected 185 first-episode drug-naive SC and 59 healthy controls (HCs) from the Third People's Hospital of Foshan, Guangdong, China, and distinguished their course of disease in order to understand the body mass index (BMI) and body fat metabolism of SC. RESULTS We found that excluding the drug factors, the longer the course of SC, the more obvious the increase of BMI and the higher the proportion of obesity. BMI was positively correlated with age, course of disease, fasting blood glucose (FBG), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC), and negatively correlated with high-density lipoprotein (HDL). The results of regression analysis were further proof that age (B = 0.094, p < 0.001), duration (B = 0.081, p = 0.002), FBG (B = 0.987, p = 0.004), and TG (B = 0.918, p = 0.002) were the risk factors for the increase of BMI. HDL (B = -2.875, p < 0.001) was the protective factor. CONCLUSION SC itself can increase BMI and easily lead to obesity. We should pay more attention to the monitoring of blood metabolism indicators, so as to reduce the risk of obesity and improve the quality of life of patients.
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Affiliation(s)
- Jiaquan Liang
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
| | - Yanshan Cai
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
| | - Xiongyan Xue
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
| | - Xiaoling Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
| | - Zaifang Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
| | - Caixia Xu
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
| | - Guojun Xie
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
| | - Yang Yu
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
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Luciano M, Pompili M, Sartorius N, Fiorillo A. Editorial: Mortality of people with severe mental illness: Causes and ways of its reduction. Front Psychiatry 2022; 13:1009772. [PMID: 36061294 PMCID: PMC9434340 DOI: 10.3389/fpsyt.2022.1009772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Penfold RB, Thompson EE, Hilt RJ, Schwartz N, Robb AS, Correll CU, Newton D, Rogalski K, Earls MF, Kowatch RA, Beck A, Yarborough BJH, Crystal S, Vitiello B, Kelleher KJ, Simon GE. Development of a Symptom-Focused Model to Guide the Prescribing of Antipsychotics in Children and Adolescents: Results of the First Phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:93-102. [PMID: 34256967 PMCID: PMC8566327 DOI: 10.1016/j.jaac.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To develop a new approach to prescribing guidelines as part of a pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. METHOD A nominal group technique was used to identify first- to nth-line treatments for target symptoms and potential diagnoses. The panel included US pediatricians, child and adolescent psychiatrists, and psychopharmacology experts. Meeting materials included information about Medicaid review programs, systematic reviews, prescribing guidelines, and a description of the pragmatic trial. Afterward, a series of 4 webinar discussions were held to achieve consensus on recommendations. RESULTS The panel unanimously agreed that the guideline should focus on target symptoms rather than diagnoses. Guidance included recommendations for first- to nth-line treatment of target mental health symptoms, environmental factors to be addressed, possible underlying diagnoses that should first be considered and ruled out, and general considerations for pharmacological and therapeutic treatments. CONCLUSION Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. Our approach addresses some of these concerns. If the approach proves successful in our ongoing pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY), it may serve as a model to state Medicaid programs and health systems to support clinicians in delivering high-quality mental health care to youths. CLINICAL TRIAL REGISTRATION INFORMATION Safer Use of Antipsychotics in Youth; http://clinicaltrials.gov/; NCT03448575.
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Affiliation(s)
- Robert B Penfold
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle.
| | - Ella E Thompson
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle
| | - Robert J Hilt
- Dr. Hilt is with Seattle Children's Hospital, Washington
| | - Nadine Schwartz
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Adelaide S Robb
- Dr. Robb is with Children's National Hospital, Washington, DC
| | - Christoph U Correll
- Dr. Correll is with The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; The Feinstein Institute for Medical Research, Manhasset, New York; and Charité Universitätsmedizin Berlin, Germany
| | - Douglas Newton
- Dr. Newton is with Sondermind, Denver, Colorado. At the time of the study, Dr. Newton was with Optum Behavioral Health, Denver, Colorado
| | - Kelly Rogalski
- Dr. Rogalski is with Henry Ford Health System, Detroit, Michigan
| | - Marian F Earls
- Dr. Earls is with Community Care of North Carolina, Raleigh
| | - Robert A Kowatch
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Arne Beck
- Dr. Beck is with Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Bobbi Jo H Yarborough
- Dr. Yarborough is with Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Stephen Crystal
- Dr. Crystal is with Rutgers University, Brunswick, New Jersey
| | | | - Kelly J Kelleher
- Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio
| | - Gregory E Simon
- Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle
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Sampogna G, Luciano M, Di Vincenzo M, Andriola I, D'Ambrosio E, Amore M, Serafini G, Rossi A, Carmassi C, Dell'Osso L, Di Lorenzo G, Siracusano A, Rossi R, Fiorillo A. The Complex Interplay Between Physical Activity and Recovery Styles in Patients With Severe Mental Disorders in a Real-World Multicentric Study. Front Psychiatry 2022; 13:945650. [PMID: 35898630 PMCID: PMC9309609 DOI: 10.3389/fpsyt.2022.945650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Compared with the general population, people with severe mental disorders have significantly worse physical health and a higher mortality rate, which is partially due to the adoption of unhealthy lifestyle behaviors, such as heavy smoking, use of alcohol or illicit drugs, unbalanced diet, and physical inactivity. These unhealthy behaviors may also play a significant role in the personal and functional recovery of patients with severe mental disorders, although this relationship has been rarely investigated in methodologically robust studies. In this paper, we aim to: a) describe the levels of physical activity and recovery style in a sample of patients with severe mental disorders; b) identify the clinical, social, and illness-related factors that predict the likelihood of patients performing physical activity. The global sample consists of 401 patients, with a main psychiatric diagnosis of bipolar disorder (43.4%, N = 174), psychosis spectrum disorder (29.7%; N = 119), or major depression (26.9%; N = 118). 29.4% (N = 119) of patients reported performing physical activity regularly, most frequently walking (52.1%, N = 62), going to the gym (21.8%, N = 26), and running (10.9%, N = 13). Only 15 patients (3.7%) performed at least 75 min of vigorous physical activity per week. 46.8% of patients adopted sealing over as a recovery style and 37.9% used a mixed style toward integration. Recovery style is influenced by gender (p < 0.05) and age (p < 0.05). The probability to practice regular physical activity is higher in patients with metabolic syndrome (Odds Ratio - OR: 2.1; Confidence Interval - CI 95%: 1.2-3.5; p < 0.050), and significantly lower in those with higher levels of anxiety/depressive symptoms (OR: 0.877; CI 95%: 0.771-0.998; p < 0.01). Globally, patients with severe mental disorders report low levels of physical activities, which are associated with poor recovery styles. Psychoeducational interventions aimed at increasing patients' motivation to adopt healthy lifestyle behaviors and modifying recovery styles may improve the physical health of people with severe mental disorders thus reducing the mortality rates.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Enrico D'Ambrosio
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Claudia Carmassi
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Mansuri Z, Makani R, Trivedi C, Adnan M, Vadukapuram R, Rafael J, Lodhi A, Reddy A. The role of metformin in treatment of weight gain associated with atypical antipsychotic treatment in children and adolescents: A systematic review and meta-analysis of randomized controlled trials. Front Psychiatry 2022; 13:933570. [PMID: 36458118 PMCID: PMC9705964 DOI: 10.3389/fpsyt.2022.933570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Second-generation antipsychotics are associated with significant weight gain. The aim of this systematic review and meta-analysis was to determine the efficacy and safety of metformin for the treatment of weight gain in children and young adults treated with second-generation antipsychotics. METHODS We followed PRISMA guidelines to evaluated studies published before March 2020 in Medline, Google Scholar, PubMed, Cochrane library database, annual scientific sessions of the American Psychiatric Association, American Academy of Child and Adolescent, Psychiatry, and American Society of Clinical Psychopharmacology. Studies included compared metformin with the placebo for management of weight gain in children and adolescents taking atypical antipsychotics. Non-randomized studies, animal experiment studies, editorials, and review studies were excluded. Multiple parameters, including change in anthropometric-biochemical parameters, drug discontinuation rate, and side effects among the groups were assessed. The random-effects method was used for meta-analysis. RESULTS Four studies with were included in the final analysis (213 patients; metformin: 106; control: 107). After pooled analysis, 12-16 weeks of metformin therapy was associated with a significant reduction in weight [(mean difference (MD): -4.53 lbs, confidence interval (CI): -6.19 to -2.87, p-value < 0.001)], and BMI z score [MD, -0.09, CI: -0.16, -0.03, p-value: 0.004] compared to control. Metformin was also associated with a significant reduction in insulin resistance [MD: -1.38, CI: -2.26 to -0.51, p-value: 0.002]. There were higher odds of nausea-vomiting [OR: 4.07, CI: 1.32-12.54, p-value: 0.02] and diarrhea [OR: 2.93, CI: 1.50-5.71, p-value: 0.002] in the metformin group. However, there was no difference in drug discontinuation rate [OR: 1.45, CI: 0.41-5.06, p-value: 0.56]. CONCLUSION Metformin may prove beneficial in the treatment of weight gain in children treated with second-generation antipsychotics. The pooled treatment effect showed a significant reduction in BMI Z-score and weight in just 12-16 weeks. The limitations include small sample size, variation in metformin dose, and duration of treatment. This meta-analysis should be interpreted as promising, and further larger studies are warranted before drawing a conclusion.
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Affiliation(s)
- Zeeshan Mansuri
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ramkrishna Makani
- Department of Psychiatry, AtlantiCare Health System, Egg Harbor Township, NJ, United States
| | - Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Sciences Center at Permian Basin, Odessa, TX, United States
| | - Mahwish Adnan
- Department of Psychiatry, Texas Tech University Health Sciences Center at Permian Basin, Odessa, TX, United States
| | - Ramu Vadukapuram
- The University of Texas Rio Grande Valley, Harlingen, TX, United States
| | - John Rafael
- MS4, Texas Tech University Health Sciences Center at Permian Basin, Odessa, TX, United States
| | | | - Abhishek Reddy
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
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Fiorillo A, Sartorius N. Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Ann Gen Psychiatry 2021; 20:52. [PMID: 34903254 PMCID: PMC8670051 DOI: 10.1186/s12991-021-00374-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients suffering from severe mental disorders, including schizophrenia, major depression and bipolar disorders, have a reduced life expectancy compared to the general population of up to 10-25 years. This mortality gap requires urgent actions from a public health perspective in order to be reduced. MAIN TEXT Factors associated with the high mortality rates in patients with severe mental disorders can be grouped into four groups: those related to the patients, to psychiatrists, to other non-psychiatrist medical doctors and to the healthcare system. Each of these factors should become the target of specific and dedicated interventions, in order to reduce the morbidity and mortality rate in patients with severe mental disorders. All these elements contribute to the neglect of physical comorbidity in patients with severe mental. In particular, the long-standing separation of psychiatry from other branches of medicine and the lack of specific training on this issue further contribute to the poor attention dedicated to management of physical comorbidities. Recently, several professional associations have invited national bodies regulating education of healthcare professionals to include the management of physical health of people with severe mental disorders in undergraduate and postgraduate educational programs. CONCLUSIONS The premature mortality in patients with severe mental disorders is a complex phenomenon resulting by the interaction of several protective and risk factors. Therefore, a multilevel approach is needed, in which the different stakeholders involved in health care provision establish workforces for the long-term management of physical and mental health conditions.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L Vanvitelli", Naples, Italy.
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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Gardner KN. Part I: Interactive case: Adverse effects associated with antipsychotic therapy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Zhuo C, Xu Y, Wang H, Zhou C, Liu J, Yu X, Shao H, Tian H, Fang T, Li Q, Chen J, Xu S, Ma X, Yang W, Yao C, Li B, Yang A, Chen Y, Huang G, Lin C. Clozapine induces metformin-resistant prediabetes/diabetes that is associated with poor clinical efficacy in patients with early treatment-resistant schizophrenia. J Affect Disord 2021; 295:163-172. [PMID: 34464878 DOI: 10.1016/j.jad.2021.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Two distinct subtypes of treatment-resistant schizophrenia (TRS) have been recently reported, including early-treatment resistance (E-TR) and late-treatment resistance (L-TR). This study was to assess clozapine-induced metformin-resistant prediabetes/diabetes and its correlation with clinical efficacy in schizophrenia E-TR subtype. METHODS This prospective cohort study enrolled 230 patients with schizophrenia E-TR subtype and they were treated with adequate doses of clozapine for 16 weeks, during which patients with prediabetes/diabetes were assigned to receive add-on metformin. The main outcomes and measures included incidence of clozapine-induced prediabetes/diabetes and metformin-resistant prediabetes/diabetes, and the efficacy of clozapine as assessed by the Positive and Negative Syndrome Scale (PANSS) score. RESULTS Clozapine-induced prediabetes/diabetes occurred in 76.52% of patients (170 prediabetes and 6 diabetes), of which the blood sugar of 43 (24.43%) patients was controlled with metformin. Despite add-on metformin, 47.06% (74/170) of prediabetes patients progressed to diabetes. In total, the incidence of clozapine-induced metformin-resistant prediabetes/diabetes was 75.57% (133/176). On completion of 16-week clozapine treatment, 16.52% (38/230) patients showed clinical improvement with PANSS scores of ≥50% declining. Furthermore, clozapine-induced prediabetes/diabetes was significantly correlated with the poor clinical efficacy of clozapine for schizophrenia E-TR subtype. CONCLUSIONS The incidence of clozapine-induced metformin-resistant prediabetes/diabetes was considerably high in the schizophrenia E-TR subtype. Clozapine-induced metformin-resistant prediabetes/diabetes represents an independent risk factor that adversely affects the clinical efficacy of clozapine for the schizophrenia E-TR subtype. This study provided new evidence for re-evaluating the use of clozapine for TRS, especially E-TR subtype, and the use of metformin for the glycemic control of clozapine-induced prediabetes/diabetes.
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Affiliation(s)
- Chuanjun Zhuo
- Key Laboratory of Multiple Organ Damages of Major Psychoses (MODMP_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key Laboratory of Psychiatry Neuroimaging-genetics and Co-morbidity (PNGC_Lab), Tianjin Medical University Clinical Hospital of Mental Health, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, China.
| | - Yong Xu
- Department of Psychiatry, First Clinical Medical College, First Hospital of Shanxi Medical University, Taiyuan 030000, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, 100191, China
| | - Chunhua Zhou
- Department of Pharmacoloy, The First Hospital of Hebei Medical University, Shijiazhuang 05000, Hebei Province, China
| | - Jian Liu
- Clinical Laboratory, Tianjin Medical University Clinical Hospital of Mental Health, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, China
| | - Xiaocui Yu
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Clinical Laboratory, Tianjin Medical University Clinical Hospital of Mental Health, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, China
| | - Hailin Shao
- Key Laboratory of Multiple Organ Damages of Major Psychoses (MODMP_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China
| | - Hongjun Tian
- Key Laboratory of Multiple Organ Damages of Major Psychoses (MODMP_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China
| | - Tao Fang
- Key Laboratory of Multiple Organ Damages of Major Psychoses (MODMP_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China
| | - Qianchen Li
- Department of Pharmacoloy, The First Hospital of Hebei Medical University, Shijiazhuang 05000, Hebei Province, China
| | - Jiayue Chen
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key Laboratory of Psychiatry Neuroimaging-genetics and Co-morbidity (PNGC_Lab), Tianjin Medical University Clinical Hospital of Mental Health, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, China
| | - Shuli Xu
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key Laboratory of Psychiatry Neuroimaging-genetics and Co-morbidity (PNGC_Lab), Tianjin Medical University Clinical Hospital of Mental Health, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, China
| | - Xiaoyan Ma
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key Laboratory of Psychiatry Neuroimaging-genetics and Co-morbidity (PNGC_Lab), Tianjin Medical University Clinical Hospital of Mental Health, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, China
| | - Weiliang Yang
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key Laboratory of Psychiatry Neuroimaging-genetics and Co-morbidity (PNGC_Lab), Tianjin Medical University Clinical Hospital of Mental Health, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, China
| | - Cong Yao
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key Laboratory of Psychiatry Neuroimaging-genetics and Co-morbidity (PNGC_Lab), Tianjin Medical University Clinical Hospital of Mental Health, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin 300222, China
| | - Bo Li
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Department of Psychiatry, Tianjin Kangtai Mental Health Hospital, Tianjin 300014, China
| | - Anqu Yang
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Department of Psychiatry, Tianjin Kangtai Mental Health Hospital, Tianjin 300014, China
| | - Yuhui Chen
- National Center of Endocrine and Metabolic Disease Comprehensive Management (MMC), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Key laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin fourth center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China; Department of Psychiatry, Tianjin Kangtai Mental Health Hospital, Tianjin 300014, China
| | - Guoyong Huang
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, 325000
| | - Chongguang Lin
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, 325000
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Sampogna G, Fiorillo A, Wasserman D. How to improve the quality of World Psychiatric Association educational activities? Results from an online survey with World Psychiatric Association zonal representatives. Asia Pac Psychiatry 2021; 13:e12497. [PMID: 34873846 DOI: 10.1111/appy.12497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The World Psychiatric Association (WPA), a global association representing 145 psychiatric societies in 121 countries, has a specific focus on education and learning, promoting educational programs on a regular basis. Education in mental health is a continuously evolving phenomenon, although it happens quite often that it is still based on a knowledge formed in the last century and with the latest scientific updates mainly available in English. The WPA is constantly committed in improving and updating the type of educational materials available and ready to be disseminated worldwide. METHODS An online survey has been developed and sent to the 18 WPA zonal representatives in order: to evaluate the educational needs for mental health, to translate materials into native languages or inclusivity, and to prioritize educational activities to be developed by the WPA in the next years. RESULTS Fifteen out of the 18 zonal representatives participated in the study. According to the public mental health perspective, collaboration with general practitioners (GPs) (80%), communities/stakeholders (66.7%) and programs for promoting mental health in schools (53.3%) are the most prioritized activities carried out. Programs for suicide prevention (86.7%) and promotion of mental health and well-being in the general population (66.7%) are considered as the most relevant to be implemented. From the healthcare perspective, new knowledge on pharmacological and non-pharmacological interventions (73%) was requested. The educational packages are mostly available in the English language, although respondents prioritize the translation of WPA educational material into, at least, Spanish and French. The most preferred formats for educational activities are webinar live (80%) and key opinion lectures (66.7%). CONCLUSIONS These findings represent the first step in the continuing promotion of education carried out by the WPA. We aim to run these kinds of initiatives from time to time in order to adapt themes and topics of these materials to the real educational needs of all mental healthcare professionals worldwide.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.,Chair WPA Section on Education in Psychiatry, World Psychiatric Association, Geneva, Switzerland
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.,WPA President Elect, World Psychiatric Association, Geneva, Switzerland
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Stutzman DL. Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing. Ment Health Clin 2021; 11:320-333. [PMID: 34824957 PMCID: PMC8582767 DOI: 10.9740/mhc.2021.11.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
It is estimated that 8% to 12% of youth are prescribed psychotropic medications. Those in foster care, juvenile justice systems, residential treatment facilities, and with developmental or intellectual disabilities are more likely to be prescribed high-risk regimens. The use of psychotropic medications in this age group is often off-label and can be associated with significant risk, warranting critical evaluation of their role. Landmark trials, pediatric-specific guidelines, and state-driven initiatives play critical roles in supporting evidence-based use of psychotropic medications in children. Overall, there is a lack of literature describing the long-term use of psychotropic medications in youth—particularly with regard to neurobiological, physical, and social changes that occur throughout development. Deprescribing is an important practice in child and adolescent psychiatry, given concerns for over-prescribing, inappropriate polytherapy, and the importance of reevaluating the role of psychotropic medications as children develop.
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Fibbins H, Edwards L, Morell R, Lederman O, Ward P, Curtis J. Implementing an Exercise Physiology Clinic for Consumers Within a Community Mental Health Service: A Real-World Evaluation. Front Psychiatry 2021; 12:791125. [PMID: 34899443 PMCID: PMC8651871 DOI: 10.3389/fpsyt.2021.791125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Physical activity significantly improves mental illness symptoms and physical health for people living with mental illness. Mental health services do not routinely provide their consumers with access to exercise professionals for physical activity engagement. Barriers exist to integrating physical activity as part of standard care including staff culture, finance, and resources. This study examines the feasibility of newly established exercise physiology clinic within a mental health service in Sydney, Australia. Methods: A single site, open trial was conducted in a community centre within a large mental health district. A meeting room was converted into a part-time exercise physiology clinic where individualised physical activity interventions were delivered by an accredited exercise physiologist. Outcome measures including BMI, cardiovascular fitness, and self-reported physical activity were collected. Results: A total of 84 mental health consumers (17% of eligible consumers within the mental health service) participated in the clinic on average for one exercise session weekly. Moderate-to-vigorous physical activity significantly increased and sedentary time significantly decreased (p < 0.001). Conclusions: Exercise physiology clinics are feasible within mental health services and should be incorporated as part of standard care.
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Affiliation(s)
- Hamish Fibbins
- Keeping the Body in Mind, Sydney, NSW, Australia
- School of Psychiatry, UNSW Sydney, Randwick, NSW, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Law Edwards
- Keeping the Body in Mind, Sydney, NSW, Australia
| | - Rachel Morell
- Keeping the Body in Mind, Sydney, NSW, Australia
- School of Psychiatry, UNSW Sydney, Randwick, NSW, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | | | - Philip Ward
- School of Psychiatry, UNSW Sydney, Randwick, NSW, Australia
- Schizophrenia Research Unit, Liverpool Hospital, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Jackie Curtis
- Keeping the Body in Mind, Sydney, NSW, Australia
- School of Psychiatry, UNSW Sydney, Randwick, NSW, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
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Luciano M, Sampogna G, Amore M, Andriola I, Calcagno P, Carmassi C, Del Vecchio V, Dell'Osso L, Di Lorenzo G, Gelao B, Giallonardo V, Rossi A, Rossi R, Siracusano A, Fiorillo A. How to improve the physical health of people with severe mental illness? A multicentric randomized controlled trial on the efficacy of a lifestyle group intervention. Eur Psychiatry 2021; 64:e72. [PMID: 34812136 PMCID: PMC8715281 DOI: 10.1192/j.eurpsy.2021.2253] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients’ body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes.
Methods
This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients’ physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6 months. Anthropometric parameters and blood samples have also been collected.
Results
Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N = 206) or the control group (N = 195). After 6 months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31–2.84; p < 0.001), body weight (OR = 4.78, 95% CI: 0.80–28.27, p < 0.05), and waist circumference (OR = 5.43, 95% CI: 1.45–20.30, p < 0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention.
Conclusions
The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Gelao
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | | | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Lei T, Deng S, Chen P, Xiao Z, Cai S, Hang Z, Yang Y, Zhang X, Li Q, Du H. Metformin enhances the osteogenesis and angiogenesis of human umbilical cord mesenchymal stem cells for tissue regeneration engineering. Int J Biochem Cell Biol 2021; 141:106086. [PMID: 34551339 DOI: 10.1016/j.biocel.2021.106086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022]
Abstract
Human umbilical cord mesenchymal stem cells (hUC-MSCs) are a potential clinical material in regenerative medicine applications. Metformin has shown safety and effectiveness as a clinical drug. However, the effect of metformin as a treatment on hUC-MSCs is unclear. Our research aimed to explore the effects of metformin on the osteogenesis, adipogenesis and angiogenesis of hUC-MSCs, and attempted to explain the molecular fluctuations of metformin through the mapping of protein profiles. Proliferation assay, osteogenic and adipogenic differentiation induction, cell cycle, flow cytometry, quantitative proteomics techniques and bioinformatics analysis were used to detect the influences of metformin treatment on hUC-MSCs. Our results demonstrated that low concentrations of metformin promoted the proliferation of hUC-MSCs, but high concentrations of metformin inhibited it. Metformin exhibited promotion of osteogenesis but inhibition of adipogenesis. Metformin treated hUC-MSCs up-regulated the expression of osteogenic marker ALP, OCN and RUNX2, but down-regulated the expression of adipogenic markers PPARγ and LPL. Proteomics analysis found that up-regulation of differentially expressed proteins in metformin treatment group involved the biological process of cell migration in Gene Ontology analysis. Metformin enhanced cell migration of HUVEC in a co-culture system, and hUC-MSCs treated with metformin exhibited stronger angiogenesis in vitro and in vivo compared to the hUC-MSCs group. The results of RT-qPCR revealed that the SCF and VEGFR2 were raised in metformin treatment. This study can promote the application of hUC-MSCs treated with metformin to tissue engineering for vascular reconstruction and angiogenesis.
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Affiliation(s)
- Tong Lei
- Daxing Research Institute, University of Science and Technology Beijing. Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Shiwen Deng
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Peng Chen
- Robot Intelligent Laboratory of Traditional Chinese Medicine, Experimental Research Center, China Academy of Chinese Medical Sciences & MEGAROBO, Dongcheng District, Beijing 100700, China
| | - Zhuangzhuang Xiao
- Daxing Research Institute, University of Science and Technology Beijing. Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Shanglin Cai
- Daxing Research Institute, University of Science and Technology Beijing. Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Zhongci Hang
- Daxing Research Institute, University of Science and Technology Beijing. Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Yanjie Yang
- Daxing Research Institute, University of Science and Technology Beijing. Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Xiaoshuang Zhang
- Daxing Research Institute, University of Science and Technology Beijing. Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Quanhai Li
- Cell Therapy Laboratory, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China; Department of Immunology, Basic Medical College, Hebei Medical University, Shijiazhuang, Hebei 050017, China.
| | - Hongwu Du
- Daxing Research Institute, University of Science and Technology Beijing. Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China.
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Managing glucose-related adverse events of antipsychotics is worth the effort. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00856-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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The impact of clinical and social factors on the physical health of people with severe mental illness: Results from an Italian multicentre study. Psychiatry Res 2021; 303:114073. [PMID: 34198214 DOI: 10.1016/j.psychres.2021.114073] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/15/2021] [Accepted: 06/19/2021] [Indexed: 12/18/2022]
Abstract
Our manuscript aims to: 1) assess physical health in a sample of patients with severe mental disorders; and 2) identify the psychopathological and psychosocial characteristics associated with an increased likelihood of having a poor physical health. The study, funded by the Italian Ministry of Education, has been carried out in psychiatric outpatient units of six Italian University sites. All recruited patients have been assessed through standardized assessment instruments. Moreover, anthropometric parameters have been obtained at recruitment and a blood samples have been collected to assess cardiometabolic parameters. Four-hundred and two patients with a primary diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were recruited. Internalized stigma, psychosocial functioning, quality of life, psychiatric hospitalizations, depressive/anxiety and manic symptoms and cognition were those domains more strongly associated with poor metabolic parameters, including high body mass index, HOMA and Framingham indexes and waist circumference. There were no statistically significant differences among the three diagnostic groups. Our findings highlight the importance of perceived stigma and quality of life on patients' physical health. This should be taken into account when developing plans for reducing the mortality rate in patients with severe mental disorders.
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Pochiero I, Calisti F, Comandini A, Del Vecchio A, Costamagna I, Rosignoli MT, Cattaneo A, Nunna S, Peduto I, Heiman F, Chang HC, Chen CC, Correll C. Impact of Lurasidone and Other Antipsychotics on Body Weight: Real-World, Retrospective, Comparative Study of 15,323 Adults with Schizophrenia. Int J Gen Med 2021; 14:4081-4094. [PMID: 34366678 PMCID: PMC8336993 DOI: 10.2147/ijgm.s320611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose The primary objectives were to describe weight changes following initiation of lurasidone versus other antipsychotics and estimate the risk of clinically relevant (≥7%) weight changes. Patients and Methods This retrospective, longitudinal comparative cohort study was based on electronic medical records (EMRs) of United States (US) adult patients with schizophrenia who were prescribed lurasidone or other antipsychotics as monotherapy between 1 April 2013 and 30 June 2019. Results Overall, the study included 15,323 patients with a diagnosis of schizophrenia; 6.1% of patients received lurasidone, 60.4% received antipsychotics associated with a medium-high risk of weight gain (clozapine, olanzapine, quetiapine, risperidone, paliperidone) and 33.5% received antipsychotics with a low risk of weight gain (aripiprazole, first-generation antipsychotics, ziprasidone). Lurasidone was associated with the smallest proportion of patients experiencing clinically relevant weight gain and the greatest proportion of patients with clinically relevant weight loss. The risk of clinically relevant weight gain was numerically higher with all antipsychotics versus lurasidone and was statistically significant for olanzapine (hazard ratio [HR]=1.541; 95% confidence interval [CI]=1.121; 2.119; p=0.0078) versus lurasidone. The likelihood of ≥7% weight loss was significantly greater with lurasidone versus all antipsychotics (p<0.05), except ziprasidone. Conclusion This real-world study suggests that lurasidone has a lower risk of clinically relevant weight gain and a higher likelihood of clinically relevant weight loss than other commonly used antipsychotics.
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Affiliation(s)
- Ilena Pochiero
- Angelini Regulatory, Research & Development, Angelini Pharma S.p.A., Rome, Italy
| | - Fabrizio Calisti
- Angelini Regulatory, Research & Development, Angelini Pharma S.p.A., Rome, Italy
| | - Alessandro Comandini
- Angelini Regulatory, Research & Development, Angelini Pharma S.p.A., Rome, Italy
| | | | - Isabella Costamagna
- Angelini Regulatory, Research & Development, Angelini Pharma S.p.A., Rome, Italy
| | | | - Agnese Cattaneo
- Angelini Regulatory, Research & Development, Angelini Pharma S.p.A., Rome, Italy
| | | | | | | | | | | | - Christoph Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Cernea S, Dima L, Correll CU, Manu P. Pharmacological Management of Glucose Dysregulation in Patients Treated with Second-Generation Antipsychotics. Drugs 2021; 80:1763-1781. [PMID: 32930957 DOI: 10.1007/s40265-020-01393-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fasting hyperglycemia, impaired glucose tolerance, prediabetes, and diabetes are frequently present in patients treated with second-generation antipsychotics (SGAPs) for schizophrenia, bipolar disorder, and other severe mental illnesses. These drugs are known to produce weight gain, which may lead to insulin resistance, glucose intolerance, and metabolic syndrome, which constitute important risk factors for the emergence of diabetes. The aim of this review was to formulate therapeutic guidelines for the management of diabetes in patients treated with SGAPs, based on the association between SGAP-induced weight gain and glucose dysregulation. A systematic search in PubMed from inception to March 2020 for randomized controlled trials (RCTs) of diabetes or prediabetes in patients treated with SGAPs was performed. PubMed was also searched for the most recent clinical practice guidelines of interventions for co-morbid conditions associated with diabetes mellitus (DM) (arterial hypertension and dyslipidemia), lifestyle interventions and switching from high metabolic liability SGAPs to safer SGAPs. The search identified 14 RCTs in patients treated with SGAPs. Drug therapy using metformin as first-line therapy and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or perhaps sodium-glucose cotransporter-2 (SGLT2) inhibitors as add-on therapy, might be preferred in these patients as well, as they favorably influence glucose metabolism and body mass index, and provide cardio-renal benefits in general to the DM population, although for the SGLT-2 inhibitors there are no RCTs in this specific patient category so far. Metformin is also useful for treatment of prediabetes. Arterial hypertension should be treated with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and statins should be used for correction of dyslipidemia. The outcome of lifestyle-changing interventions has been disappointing. Switching from clozapine, olanzapine, or quetiapine to lower cardiometabolic-risk SGAPs, like aripiprazole, brexpiprazole, cariprazine, lurasidone, or ziprasidone, has been recommended.
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Affiliation(s)
- Simona Cernea
- Faculty of Medicine/Department M4/Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania.,Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Târgu Mureş, Romania
| | - Lorena Dima
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Universitatea Transilvania, Nicolae Balcescu Str 59, Brașov, 500019, Romania.
| | - Christoph U Correll
- Charite Universitaetsmedizin, Department of Child and Adolescent Psychiatry, Berlin, and Campus Virchow-Klinikum, Mittelallee 5A, Berlin, 13353, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry and Molecular Medicine, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA
| | - Peter Manu
- Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,South Oaks Hospital, Northwell Health System, Amityville, NY, USA
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