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Tanzer T, Pham B, Warren N, Barras M, Kisely S, Siskind D. Overcoming clozapine's adverse events: a narrative review of systematic reviews and meta-analyses. Expert Opin Drug Saf 2024; 23:811-831. [PMID: 38814794 DOI: 10.1080/14740338.2024.2362796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/29/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Clozapine is the gold standard treatment for treatment-resistant schizophrenia, however adverse events remain a clinical challenge. AREAS COVERED This review presents a narrative synthesis of systematic reviews and meta-analyses that have reported the onset, incidence, prevalence, and management of clozapine's adverse events. We conducted a systematic literature search using PubMed, Embase, PsycINFO, OvidMEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews from inception to April 2024. EXPERT OPINION Effective management of clozapine's adverse events necessitates multi-faceted, individualized, and shared-decision strategies. Despite a lack of high-quality systematic evidence, expert inter-disciplinary solutions are provided to help address a critical need for clinical guidance. This 35-year update offers an evidence-based framework to assist clinicians, patients, and caregivers navigate the adverse events associated with clozapine therapy.
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Affiliation(s)
- Timothy Tanzer
- Princess Alexandra Hospital, Department of Pharmacy, Brisbane, Australia
- Medicine, University of Queensland, Brisbane, Australia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Betty Pham
- Department of Pharmacy, Metro South Community and Oral Health, Brisbane, Australia
| | - Nicola Warren
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Michael Barras
- Princess Alexandra Hospital, Department of Pharmacy, Brisbane, Australia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Steve Kisely
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Dan Siskind
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
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Verdoux H, Quiles C, de Leon J. Optimizing co-prescription of clozapine and antiseizure medications: a systematic review and expert recommendations for clinical practice. Expert Opin Drug Metab Toxicol 2024; 20:347-358. [PMID: 38613254 DOI: 10.1080/17425255.2024.2343020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/10/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Antiseizure medication (ASM) add-on to clozapine may be efficient to target clozapine-resistant mood or psychotic symptoms or clozapine-related adverse drug reactions (ADR) such as seizures. We aimed to synthesize the information relevant for clinical practice on the risks and benefits of clozapine-ASM co-prescription. AREAS COVERED Articles were identified with MEDLINE, Web of Sciences and PsycINFO search from inception through October 2023. The review was restricted to ASM with mood-stabilizing properties or with potential efficacy for resistant psychotic symptoms (valproate (VPA), lamotrigine, topiramate, carbamazepine, oxcarbazepine). EXPERT OPINION VPA add-on to clozapine is associated with a high risk of serious ADR (myocarditis, neutropenia, pneumonia) mostly explained by complex time-dependent drug-drug interactions. The initial inhibitory effects on clozapine metabolism require slow titration to avoid immuno-allergic reactions. After the titration period, VPA has mainly inductive effects on clozapine metabolism that are more marked in smokers requiring therapeutic drug monitoring. Lamotrigine and topiramate add-on may be recommended as the first-line treatment for clozapine-related seizures, but there is limited evidence regarding the efficacy of this strategy for clozapine-resistant psychotic symptoms. Carbamazepine should not be co-prescribed with clozapine because of its potential for agranulocytosis and for inducing clozapine metabolism.
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Affiliation(s)
- Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, Bordeaux, France
| | - Clélia Quiles
- Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, USA
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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Kang N, Yoon HS, Kim SH, Jeong JH, Kim M, Kwon JS. Comparative Study of the Efficacy and Side Effects of Brand-Name and Generic Clozapine for Long-Term Maintenance Treatment Among Korean Patients With Schizophrenia: A Retrospective Naturalistic Mirror-Image Study. Psychiatry Investig 2024; 21:311-320. [PMID: 38569589 PMCID: PMC10990625 DOI: 10.30773/pi.2023.0413] [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: 11/24/2023] [Revised: 01/01/2024] [Accepted: 01/17/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Clozapine is considered the most reliable drug for treatment-resistant schizophrenia. In 2014, a generic formulation of clozapine (Clzapine) was introduced in Korea. This study was performed to provide clinical information regarding the use of clozapine and to compare efficacy and tolerability when converting from the brand-name formulation (Clozaril) to the generic formulation during longterm maintenance treatment among Korean patients with schizophrenia. METHODS This mirror-image study retrospectively investigated the electronic medical records of patients who had switched from Clozaril to Clzapine with a ≥1-year duration for each formulation. Clinical data were collected, including information regarding clozapine use, psychiatric hospitalization, co-medications, and blood test findings. Data before and after the switch were compared using paired t-tests. RESULTS Among 332 patients, the mean 1-year dosages were 233.32±149.35 mg/day for Clozaril and 217.36±136.66 mg/day for Clzapine. The mean clozapine concentration-to-dose ratios were similar before and after the switch (Clozaril, 1.33±0.68; Clzapine, 1.26±0.80). Switching from Clozaril to Clzapine resulted in no significant differences in the hospitalization rate, hospitalization duration, or laboratory findings (liver function parameters, serum cholesterol level, and serum glucose level). Equivalent doses of co-prescribed antidepressants were decreased, but concomitant medications otherwise showed no significant differences. CONCLUSION Clinical efficacy and tolerability appear comparable when switching to Clzapine during clozapine maintenance treatment. This study offers descriptive real-world clinical insights into clozapine maintenance treatment in Korea, thereby providing patients with more treatment options and contributing to the development of maintenance guidelines tailored to the Korean population.
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Affiliation(s)
- Nuree Kang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Soo Yoon
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Jeong
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Fukuyama K, Motomura E, Okada M. A Novel Gliotransmitter, L-β-Aminoisobutyric Acid, Contributes to Pathophysiology of Clinical Efficacies and Adverse Reactions of Clozapine. Biomolecules 2023; 13:1288. [PMID: 37759688 PMCID: PMC10526296 DOI: 10.3390/biom13091288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Clozapine is listed as one of the most effective antipsychotics and has been approved for treating treatment-resistant schizophrenia (TRS); however, several type A and B adverse reactions, including weight gain, metabolic complications, cardiotoxicity, convulsions, and discontinuation syndromes, exist. The critical mechanisms of clinical efficacy for schizophrenia, TRS, and adverse reactions of clozapine have not been elucidated. Recently, the GABA isomer L-β-aminoisobutyric acid (L-BAIBA), a protective myokine in the peripheral organs, was identified as a candidate novel transmission modulator in the central nervous system (CNS). L-BAIBA activates adenosine monophosphate-activated protein kinase (AMPK) signalling in both the peripheral organs and CNS. Activated AMPK signalling in peripheral organs is an established major target for treating insulin-resistant diabetes, whereas activated AMPK signalling in the hypothalamus contributes to the pathophysiology of weight gain and metabolic disturbances. Clozapine increases L-BAIBA synthesis in the hypothalamus. In addition, the various functions of L-BAIBA in the CNS have recently been elucidated, including as an activator of GABA-B and group-III metabotropic glutamate (III-mGlu) receptors. Considering the expressions of GABA-B and III-mGlu receptors (localised in the presynaptic regions), the activation of GABA-B and III-mGlu receptors can explain the distinct therapeutic advantages of clozapine in schizophrenia or TRS associated with N-methyl-D-aspartate (NMDA) receptor disturbance compared with other atypical antipsychotics via the inhibition of the persistent tonic hyperactivation of thalamocortical glutamatergic transmission in the prefrontal cortex. L-BAIBA has also been identified as a gliotransmitter, and a detailed exploration of the function of L-BAIBA in tripartite synaptic transmission can further elucidate the pathophysiology of effectiveness for treating TRS and/or specific adverse reactions of clozapine.
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Affiliation(s)
| | | | - Motohiro Okada
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (K.F.); (E.M.)
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Godin O, Pignon B, Szoke A, Boyer L, Aouizerate B, Schorr B, André M, Capdevielle D, Chereau I, Coulon N, Dassing R, Dubertret C, Etain B, Leignier S, Llorca PM, Mallet J, Misdrahi D, Passerieux C, Rey R, Urbach M, Schürhoff F, Leboyer M, Fond G, Andre M, Andrieu-Haller C, Aouizerate B, Berna F, Blanc O, Bourguignon E, Capdevielle D, Chereau-Boudet I, Clauss-Kobayashi J, Coulon N, D'Amato T, Dassing R, Dorey JM, Dubertret C, Esselin A, Fond G, Gabayet F, Jarroir M, Lacelle D, Lançon C, Laouamri H, Leboyer M, Leignier S, Llorca, Mallet J, Metairie E, Michel T, Misdrahi D, Passerieux C, Petrucci J, Pignon B, Peri P, Portalier C, Rey R, Roman C, Schorr B, Schürhoff F, Szöke A, Tessier A, Urbach M, Wachiche G, Zinetti-Bertschy A. 3-year incidence and predictors of metabolic syndrome in schizophrenia in the national FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110641. [PMID: 36122839 DOI: 10.1016/j.pnpbp.2022.110641] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 12/01/2022]
Abstract
AIMS Metabolic Syndrome (MetS) is a major health epidemic of Western countries and patients with schizophrenia is a particularly vulnerable population due to lifestyle, mental illness and treatment factors. However, we lack prospective data to guide prevention. The aim of our study is then to determine MetS incidence and predictors in schizophrenia. METHOD Participants were recruited in 10 expert centers at a national level and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Inverse probability weighting methods were used to correct for attrition bias. RESULTS Among the 512 participants followed-up for 3 years, 77.9% had at least one metabolic disturbance. 27.5% were identified with MetS at baseline and excluded from the analyses. Among the rest of participants (N = 371, mean aged 31.2 (SD = 9.1) years, with mean illness duration of 10.0 (SD = 7.6) years and 273 (73.6%) men), MetS incidence was 20.8% at 3 years and raised to 23.6% in tobacco smokers, 29.4% in participants receiving antidepressant prescription at baseline and 42.0% for those with 2 disturbed metabolic disturbances at baseline. Our multivariate analyses confirmed tobacco smoking and antidepressant consumption as independent predictors of MetS onset (adjusted odds ratios (aOR) = 3.82 [1.27-11.45], p = 0.016, and aOR = 3.50 [1.26-9.70], p = 0.0158). Antidepressant prescription predicted more specifically increased lipid disturbances and paroxetine was associated with the highest risk of MetS onset. CONCLUSION These results are an alarm call to prioritize MetS prevention and research in schizophrenia. We have listed interventions that should be actively promoted in clinical practice.
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Affiliation(s)
- O Godin
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - B Pignon
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - A Szoke
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - L Boyer
- Fondation FondaMental, Créteil, France; AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux F-33076, France; INRAE, NutriNeuro, University of Bordeaux, U1286, Bordeaux F-33076, France
| | - B Schorr
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - M André
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - N Coulon
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - R Dassing
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - B Etain
- Fondation FondaMental, Créteil, France; Assistance Publique des Hopitaux de Paris (AP-HP), GHU Saint-Louis - Lariboisiere - Fernand Widal, DMU Neurosciences, Departement de Psychiatrie et de Medecine Addictologique, INSERM UMRS 1144, Universite de Paris, Paris, France
| | - S Leignier
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - J Mallet
- Fondation FondaMental, Créteil, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France; University of Bordeaux, CNRS UMR 5287-INCIA «Neuroimagerie et Cognition Humaine», France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Service Universitaire de psychiatrie et d'addictologie du Centre Hospitalier de Versailles, INSERM UMR1018, CESP, Team "DevPsy", Université de Versailles Saint-Quentin-en-Yvelines, Paris, Saclay, France
| | - R Rey
- Fondation FondaMental, Créteil, France; INSERM U1028 CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service Universitaire de psychiatrie et d'addictologie du Centre Hospitalier de Versailles, INSERM UMR1018, CESP, Team "DevPsy", Université de Versailles Saint-Quentin-en-Yvelines, Paris, Saclay, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - G Fond
- Fondation FondaMental, Créteil, France; AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | | | - M Andre
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - C Andrieu-Haller
- Fondation Fondamental, France; AP-HM, La Conception Hospital, Aix-Marseille Univ., School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - B Aouizerate
- Fondation Fondamental, France; University Department of General Psychiatry), Charles Perrens Hospital, F-33076 Bordeaux, France; Laboratory of Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, Bordeaux, France
| | - F Berna
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - O Blanc
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - E Bourguignon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - D Capdevielle
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau-Boudet
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - J Clauss-Kobayashi
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - N Coulon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - T D'Amato
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - R Dassing
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - J M Dorey
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - C Dubertret
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - A Esselin
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - G Fond
- Fondation Fondamental, France; AP-HM, La Conception Hospital, Aix-Marseille Univ., School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - F Gabayet
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - M Jarroir
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - D Lacelle
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - C Lançon
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | | | - M Leboyer
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - S Leignier
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - Llorca
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - J Mallet
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - E Metairie
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - T Michel
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - D Misdrahi
- Fondation Fondamental, France; University Department of General Psychiatry, Charles Perrens Hospital, F-33076, Bordeaux, France; CNRS UMR 5287-INCIA, Bordeaux, France
| | - C Passerieux
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - J Petrucci
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - B Pignon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - P Peri
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - C Portalier
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - R Rey
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - C Roman
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - B Schorr
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - F Schürhoff
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Szöke
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Tessier
- Fondation Fondamental, France; University Department of General Psychiatry, Charles Perrens Hospital, F-33076, Bordeaux, France; CNRS UMR 5287-INCIA, Bordeaux, France
| | - M Urbach
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - G Wachiche
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Zinetti-Bertschy
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
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6
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Qubad M, Bittner RA. Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia. Ther Adv Psychopharmacol 2023; 13:20451253231158152. [PMID: 36994117 PMCID: PMC10041648 DOI: 10.1177/20451253231158152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/24/2023] [Indexed: 03/31/2023] Open
Abstract
Despite its enduring relevance as the single most effective and important evidence-based treatment for schizophrenia, underutilization of clozapine remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to offer clozapine due to its relatively large side-effect burden and the complexity of its use. This underscores the necessity for continued education regarding both the vital nature and the intricacies of clozapine treatment. This narrative review summarizes all clinically relevant areas of evidence, which support clozapine's wide-ranging superior efficacy - for treatment-resistant schizophrenia (TRS) and beyond - and make its safe use eminently feasible. Converging evidence indicates that TRS constitutes a distinct albeit heterogeneous subgroup of schizophrenias primarily responsive to clozapine. Most importantly, the predominantly early onset of treatment resistance and the considerable decline in response rates associated with its delayed initiation make clozapine an essential treatment option throughout the course of illness, beginning with the first psychotic episode. To maximize patients' benefits, systematic early recognition efforts based on stringent use of TRS criteria, a timely offer of clozapine, thorough side-effect screening and management as well as consistent use of therapeutic drug monitoring and established augmentation strategies for suboptimal responders are crucial. To minimize permanent all-cause discontinuation, re-challenges after neutropenia or myocarditis should be considered. Owing to clozapine's unique efficacy, comorbid conditions including substance use and most somatic disorders should not dissuade but rather encourage clinicians to consider clozapine. Moreover, treatment decisions need to be informed by the late onset of clozapine's full effects, which for reduced suicidality and mortality rates may not even be readily apparent. Overall, the singular extent of its efficacy combined with the high level of patient satisfaction continues to distinguish clozapine from all other available antipsychotics.
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Affiliation(s)
- Mishal Qubad
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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El Hayek SA, Shatila MA, Adnan JA, Geagea LE, Kobeissy F, Talih FR. Is there a therapeutic potential in combining bupropion and naltrexone in schizophrenia? Expert Rev Neurother 2022; 22:737-749. [PMID: 36093756 DOI: 10.1080/14737175.2022.2124369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION A sustained-release tablet composed of a combination of the dopamine and norepinephrine reuptake inhibitor bupropion (BUP) and the µ-opioid receptor antagonist naltrexone (NAT) is marketed under the brand name Contrave by Orexigen Therapeutics for appetite control. Minimal literature is available regarding the use of combination bupropion and naltrexone (BUPNAT) in individuals with schizophrenia. AREAS COVERED In this review, we propose a theoretical model where BUPNAT may have a therapeutic effect in the treatment of schizophrenia. We explore the pathways targeted by the constituent drugs BUP and NAT and summarize the literature on their efficacy and possible adverse effects. We then look at the potential use of BUPNAT in schizophrenia. EXPERT OPINION Research has hinted that BUP's dopaminergic properties affect the same striatal pathways involved in schizophrenia. NAT, via opioid receptor antagonism, indirectly increases striatal dopamine release by disinhibiting nicotinic acetylcholine receptors. As such, we hypothesize that BUPNAT can have a therapeutic effect in schizophrenia, particularly on negative symptoms. We also suggest that it may ameliorate comorbidities frequently seen in this group of patients, including obesity, smoking, and substance use. Further research and clinical data are needed to elucidate the potential clinical benefits of BUPNAT in the treatment of schizophrenia.
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Affiliation(s)
- Samer A. El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Malek A. Shatila
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jana A. Adnan
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Luna E. Geagea
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Farid R. Talih
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
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8
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de Boer N, Cahn W. Antipsychotic-induced weight gain: Is the weight over? New guidelines needed. Acta Psychiatr Scand 2022; 146:185-189. [PMID: 35951775 DOI: 10.1111/acps.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nini de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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9
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Gurrera RJ, Gearin PF, Love J, Li KJ, Xu A, Donaghey FH, Gerace MR. Recognition and management of clozapine adverse effects: A systematic review and qualitative synthesis. Acta Psychiatr Scand 2022; 145:423-441. [PMID: 35178700 DOI: 10.1111/acps.13406] [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: 10/03/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Clozapine is substantially underutilized in most countries and clinician factors including lack of knowledge and concerns about adverse drug effects (ADEs) contribute strongly to treatment reluctance. The aim of this systematic review was to provide clinicians with a comprehensive information source regarding clozapine ADEs. METHODS PubMed and Embase databases were searched for English language reviews concerned with clozapine ADEs; publications identified by the automated search were manually searched for additional relevant citations. Following exclusion of redundant and irrelevant reports, pertinent information was summarized in evidence tables corresponding to each of six major ADE domains; two authors reviewed all citations for each ADE domain and summarized their content by consensus in the corresponding evidence table. This study was conducted in accordance with PRISMA principles. RESULTS Primary and secondary searches identified a total of 305 unique reports, of which 152 were included in the qualitative synthesis. Most clozapine ADEs emerge within 3 months, and almost all appear within 6 months, after initiation. Notable exceptions are weight gain, diabetic ketoacidosis (DKA), severe clozapine-induced gastrointestinal hypomotility (CIGH), clozapine-induced cardiomyopathy (CICM), seizures, and clozapine-induced neutropenia (CIN). Most clozapine ADEs subside gradually or respond to dose reduction; those that prompt discontinuation generally do not preclude rechallenge. Rechallenge is generally inadvisable for clozapine-induced myocarditis (CIM), CICM, and clozapine-induced agranulocytosis (CIA). Clozapine plasma levels >600-1000 μg/L appear more likely to cause certain ADEs (e.g., seizures) and, although there is no clear toxicity threshold, risk/benefit ratios are generally unfavorable above 1000 μg/L. CONCLUSION Clozapine ADEs rarely require discontinuation.
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Affiliation(s)
- Ronald J Gurrera
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Priya F Gearin
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jonathan Love
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin J Li
- Department of Psychiatry, Kaiser Permanente Fremont Medical Center, Fremont, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Ashley Xu
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Faith H Donaghey
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew R Gerace
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Tanzer T, Warren N, McMahon L, Barras M, Kisely S, Brooks E, Wong E, Siskind D. Treatment strategies for clozapine-induced nocturnal enuresis and urinary incontinence: a systematic review. CNS Spectr 2022; 28:1-12. [PMID: 35086595 DOI: 10.1017/s1092852922000050] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Clozapine is the most effective medication for treatment-refractory schizophrenia but is associated with significant adverse drug reactions, including nocturnal enuresis and urinary incontinence. This side effect can be burdensome and lead to medication nonadherence and psychotic relapse. Evidence to guide treatment of clozapine-induced nocturnal enuresis and urinary incontinence is sparse. We therefore aimed to synthesize the evidence base to guide management for clinicians, patients, and their carers. METHODS We systematically searched PubMed, Embase, PsycInfo, CINAHL, and the Cochrane Trial Registry databases from inception to May 2021 for publications on management of clozapine-induced nocturnal enuresis and urinary incontinence using a PROSPERO preregistered search strategy. RESULTS We identified 22 case reports and case series describing 74 patients. Interventions included clozapine dose reduction, nonpharmacological treatment, and pharmacological treatments. Among pharmacological treatments, desmopressin, oxybutynin, trihexyphenidyl, tolterodine, imipramine, amitriptyline, ephedrine, pseudoephedrine, aripiprazole, and verapamil were associated with complete resolution of nocturnal enuresis and urinary incontinence. Balancing evidence for effectiveness against risk of adverse effects, we developed a management framework for clozapine-induced nocturnal enuresis and urinary incontinence. CONCLUSIONS Following assessment of urological, psychiatric, pharmacological, and common comorbid medical issues, first-line treatments should be nonpharmacological, including bathroom alarms, voiding before bedtime, and nocturnal fluid restriction. If these interventions do not provide adequate relief, aripiprazole should be trialed. Desmopressin may be considered for severe refractory cases, but monitoring for hyponatremia is essential.
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Affiliation(s)
- Timothy Tanzer
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Nicola Warren
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Laura McMahon
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Barras
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Steve Kisely
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Brooks
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Emily Wong
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Dan Siskind
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
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11
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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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Wagner E, Siafis S, Fernando P, Falkai P, Honer WG, Röh A, Siskind D, Leucht S, Hasan A. Efficacy and safety of clozapine in psychotic disorders-a systematic quantitative meta-review. Transl Psychiatry 2021; 11:487. [PMID: 34552059 PMCID: PMC8458455 DOI: 10.1038/s41398-021-01613-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/19/2021] [Accepted: 09/07/2021] [Indexed: 02/08/2023] Open
Abstract
A recent increase in the literature regarding the evidence base for clozapine has made it increasingly difficult for clinicians to judge "best evidence" for clozapine use. As such, we aimed at elucidating the state-of-the-art for clozapine with regard to efficacy, effectiveness, tolerability, and management of clozapine and clozapine-related adverse events in neuropsychiatric disorders. We conducted a systematic PRISMA-conforming quantitative meta-review of available meta-analytic evidence regarding clozapine use. Primary outcome effect sizes were extracted and transformed into relative risk ratios (RR) and standardized mean differences (SMD). The methodological quality of meta-analyses was assessed using the AMSTAR-2 checklist. Of the 112 meta-analyses included in our review, 61 (54.5%) had an overall high methodological quality according to AMSTAR-2. Clozapine appears to have superior effects on positive, negative, and overall symptoms and relapse rates in schizophrenia (treatment-resistant and non-treatment-resistant subpopulations) compared to first-generation antipsychotics (FGAs) and to pooled FGAs/second-generation antipsychotics (SGAs) in treatment-resistant schizophrenia (TRS). Despite an unfavorable metabolic and hematological adverse-event profile compared to other antipsychotics, hospitalization, mortality and all-cause discontinuation (ACD) rates of clozapine surprisingly show a pattern of superiority. Our meta-review outlines the superior overall efficacy of clozapine compared to FGAs and most other SGAs in schizophrenia and suggests beneficial efficacy outcomes in bipolar disorder and Parkinson's disease psychosis (PDP). More clinical studies and subsequent meta-analyses are needed beyond the application of clozapine in schizophrenia-spectrum disorders and future studies should be directed into multidimensional clozapine side-effect management to foster evidence and to inform future guidelines.
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Spyridon Siafis
- grid.15474.330000 0004 0477 2438Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Piyumi Fernando
- grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Peter Falkai
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - William G. Honer
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, The University of British Columbia, Vancouver, Canada
| | - Astrid Röh
- grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Dan Siskind
- grid.1003.20000 0000 9320 7537School of Medicine, University of Queensland, Brisbane, Australia ,Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Stefan Leucht
- grid.15474.330000 0004 0477 2438Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Alkomiet Hasan
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany ,grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
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The Effect of Clozapine on Self-reported Duration of Sleep and Its Interaction With 23 Other Medications: A 5-Year Naturalistic Study. J Clin Psychopharmacol 2021; 41:534-539. [PMID: 34519455 DOI: 10.1097/jcp.0000000000001432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sedation is a common and incapacitating clozapine adverse effect, but the factors associated with sedation and its pharmacological management remain poorly studied. METHODS We conducted a retrospective cohort study based on deidentified electronic clinical records of clozapine-treated patients from the secondary mental health care provider for Cambridgeshire and Peterborough, United Kingdom. We first evaluated cross-sectionally the influence of clozapine dose, clozapine, and norclozapine plasma levels on self-reported hours slept, as a proxy for sedation, using bivariate correlation and then the longitudinal effect of changes in clozapine dose and other 23 medications using linear mixed effect models. We followed 241 clozapine-treated patients for 56 months on average, with 2237 face-to-face assessments in total. RESULTS Patients slept for a mean of 9.35 h/d, with 46% reporting 10 h/d or more. Cross-sectionally, sleep duration did not correlate with clozapine dose (r = 0.14, P = 0.106), but with clozapine plasma levels (r = 0.38, P < 0.0001) and norclozapine plasma levels (r = 0.25, P = 0.005). Longitudinally, the final mixed-effects model revealed 4 pharmacological variables that had a significant impact on hours slept: clozapine, risperidone augmentation, and atenolol were associated with increased sleep, whereas aripiprazole augmentation was associated with decreased sleep. We found that 20 other psychotropic medications measured were not associated with changes in sleep when added to clozapine. Excess sleep is a clozapine level-dependent adverse effect. CONCLUSIONS The impact of different augmentation strategies might help clinicians decide on the most adequate strategy, albeit further studies should confirm our results.
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Chakrabarti S. Clozapine resistant schizophrenia: Newer avenues of management. World J Psychiatry 2021; 11:429-448. [PMID: 34513606 PMCID: PMC8394694 DOI: 10.5498/wjp.v11.i8.429] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/12/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
About 40%-70% of the patients with treatment-resistant schizophrenia have a poor response to adequate treatment with clozapine. The impact of clozapine-resistant schizophrenia (CRS) is even greater than that of treatment resistance in terms of severe and persistent symptoms, relapses and hospitalizations, poorer quality of life, and healthcare costs. Such serious consequences often compel clinicians to try different augmentation strategies to enhance the inadequate clozapine response in CRS. Unfortunately, a large body of evidence has shown that antipsychotics, antidepressants, mood stabilizers, electroconvulsive therapy, and cognitive-behavioural therapy are mostly ineffective in augmenting clozapine response. When beneficial effects of augmentation have been found, they are usually small and of doubtful clinical significance or based on low-quality evidence. Therefore, newer treatment approaches that go beyond the evidence are needed. The options proposed include developing a clinical consensus about the augmentation strategies that are most likely to be effective and using them sequentially in patients with CRS. Secondly, newer approaches such as augmentation with long-acting antipsychotic injections or multi-component psychosocial interventions could be considered. Lastly, perhaps the most effective way to deal with CRS would be to optimize clozapine treatment, which might prevent clozapine resistance from developing. Personalized dosing, adequate treatment durations, management of side effects and non-adherence, collaboration with patients and caregivers, and addressing clinician barriers to clozapine use are the principal ways of ensuring optimal clozapine treatment. At present, these three options could the best way to manage CRS until research provides more firm directions about the effective options for augmenting clozapine response.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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15
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Does the Starting of Clozapine Influence Coprescription of Other Medications?: A Study From India. J Clin Psychopharmacol 2021; 41:148-154. [PMID: 33666401 DOI: 10.1097/jcp.0000000000001348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE/BACKGROUND Little is understood about the prescription load before and after the starting of clozapine. Accordingly, this study aimed to evaluate the medication load of patients receiving clozapine, just before starting clozapine and after being on clozapine for at least 1 year. Additionally, the impact of clozapine on severity of illness was evaluated. METHODS/PROCEDURES Two hundred seventy-seven outpatients receiving clozapine were prospectively evaluated for their prescription after at least 1 year of starting clozapine. Additionally, these patients were assessed on the Clinical Global Impression-Improvement scale to evaluate the overall clinical benefit with clozapine. FINDINGS/RESULTS They had been receiving clozapine for 6.55 (SD, 4.8; range, 1-24; median, 5) years at the time of assessment. At the start of clozapine, more than one third of the patients were receiving 2 antipsychotics. A small proportion was receiving other psychotropics, such as antidepressants, mood stabilizers, and benzodiazepines. After being on clozapine for 1 year, there was a significant reduction in the number of patients receiving two antipsychotic medications (P < 0.001), number of patients receiving antidepressants (if amitriptyline was left out), benzodiazepine (P < 0.001), and anticholinergic medications (P < 0.001). Further, there was a reduction in the mean chlorpromazine equivalent of antipsychotics (P < 0.001) and the total number of medications received by the patients (P < 0.001). However, there was an increase in the prescription rates of antihypertensive drugs (P = 0.03), anti-diabetic medications (P < 0.01), and anti-dyslipidemic medications. At follow-up, there was a significant improvement in symptoms as assessed by Clinical Global Impression-Improvement scale. IMPLICATIONS/CONCLUSIONS This study suggests that long-term use of clozapine is associated with substantial improvement in symptoms with a reduction in the medication load.
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Vancampfort D, Firth J, Correll CU, Solmi M, Siskind D, De Hert M, Carney R, Koyanagi A, Carvalho AF, Gaughran F, Stubbs B. The Impact of Pharmacological and Non-Pharmacological Interventions to Improve Physical Health Outcomes in People With Schizophrenia: A Meta-Review of Meta-Analyses of Randomized Controlled Trials. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:116-128. [PMID: 34483776 DOI: 10.1176/appi.focus.19103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from World Psychiatry 2019;18:53-66).
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Kimura H, Kanahara N, Iyo M. Rationale and neurobiological effects of treatment with antipsychotics in patients with chronic schizophrenia considering dopamine supersensitivity. Behav Brain Res 2021; 403:113126. [PMID: 33460681 DOI: 10.1016/j.bbr.2021.113126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
The long-term treatment of patients with schizophrenia often involves the management of relapses for most patients and the development of treatment resistance in some patients. To stabilize the clinical course and allow as many patients as possible to recover, clinicians need to recognize dopamine supersensitivity, which can be provoked by administration of high dosages of antipsychotics, and deal with it properly. However, no treatment guidelines have addressed this issue. The present review summarized the characteristics of long-acting injectable antipsychotics, dopamine partial agonists, and clozapine in relation to dopamine supersensitivity from the viewpoints of receptor profiles and pharmacokinetics. The potential merits and limitations of these medicines are discussed, as well as the risks of treating patients with established dopamine supersensitivity with these classes of drugs. Finally, the review discussed the biological influence of antipsychotic treatment on the human brain based on findings regarding the relationship between the hippocampus and antipsychotics.
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Affiliation(s)
- Hiroshi Kimura
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan.
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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de Boer N, Guloksuz S, van Baal C, Willebrands L, Deenik J, Vinkers CH, Rossum IWV, Zinkstok J, Wilting I, Zantvoord JB, Backx F, Swildens WE, Schouw M, Bogers J, Hulshof F, de Knijff R, Duindam P, Veereschild M, Bak M, Frederix G, de Haan L, van Os J, Cahn W, Luykx JJ. Study protocol of a randomized, double-blind, placebo-controlled, multi-center trial to treat antipsychotic-induced weight gain: the Metformin-Lifestyle in antipsychotic users (MELIA) trial. BMC Psychiatry 2021; 21:4. [PMID: 33402159 PMCID: PMC7783702 DOI: 10.1186/s12888-020-02992-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Antipsychotic-induced Weight Gain (AiWG) is a debilitating and common adverse effect of antipsychotics. AiWG negatively impacts life expectancy, quality of life, treatment adherence, likelihood of developing type-2 diabetes and readmission. Treatment of AiWG is currently challenging, and there is no consensus on the optimal management strategy. In this study, we aim to evaluate the use of metformin for the treatment of AiWG by comparing metformin with placebo in those receiving treatment as usual, which includes a lifestyle intervention. METHODS In this randomized, double-blind, multicenter, placebo-controlled, pragmatic trial with a follow-up of 52 weeks, we aim to include 256 overweight participants (Body Mass Index (BMI) > 25 kg/m2) of at least 16 years of age. Patients are eligible if they have been diagnosed with schizophrenia spectrum disorder and if they have been using an antipsychotic for at least three months. Participants will be randomized with a 1:1 allocation to placebo or metformin, and will be treated for a total of 26 weeks. Metformin will be started at 500 mg b.i.d. and escalated to 1000 mg b.i.d. 2 weeks thereafter (up to a maximum of 2000 mg daily). In addition, all participants will undergo a lifestyle intervention as part of the usual treatment consisting of a combination of an exercise program and dietary consultations. The primary outcome measure is difference in body weight as a continuous trait between the two arms from treatment inception until 26 weeks of treatment, compared to baseline. Secondary outcome measures include: 1) Any element of metabolic syndrome (MetS); 2) Response, defined as ≥5% body weight loss at 26 weeks relative to treatment inception; 3) Quality of life; 4) General mental and physical health; and 5) Cost-effectiveness. Finally, we aim to assess whether genetic liability to BMI and MetS may help estimate the amount of weight reduction following initiation of metformin treatment. DISCUSSION The pragmatic design of the current trial allows for a comparison of the efficacy and safety of metformin in combination with a lifestyle intervention in the treatment of AiWG, facilitating the development of guidelines on the interventions for this major health problem. TRIAL REGISTRATION This trial was registered in the Netherlands Trial Register (NTR) at https://www.trialregister.nl/trial/8440 as NTR NL8840 on March 8, 2020.
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Affiliation(s)
- Nini de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508, Utrecht, GA, The Netherlands.
| | - Sinan Guloksuz
- grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Caroline van Baal
- Department of Biostatistics and Research Support, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leonie Willebrands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands
| | - Jeroen Deenik
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,grid.491215.a0000 0004 0468 1456GGz Centraal Mental Health, Amersfoort, The Netherlands
| | - Christiaan H. Vinkers
- grid.7177.60000000084992262Department of Psychiatry and Department of Anatomy and Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands ,GGZinGeest Mental Health, Amsterdam, The Netherlands
| | - Inge Winter-van Rossum
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands
| | - Janneke Zinkstok
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands
| | - Ingeborg Wilting
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jasper B. Zantvoord
- grid.7177.60000000084992262Department of Psychiatry and Department of Anatomy and Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Backx
- Department of Rehabilitation, Physiotherapy Science & Sport, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilma E. Swildens
- grid.413664.2Altrecht Mental Health Care Institute, Utrecht, The Netherlands ,grid.448984.d0000 0003 9872 5642Inholland University of Applied Sciences, Interprofessional Mental Health Care, department Nursing, Amsterdam, The Netherlands
| | - Marieke Schouw
- grid.413664.2Altrecht Mental Health Care Institute, Utrecht, The Netherlands
| | - Jan Bogers
- grid.468622.c0000 0004 0501 8787GGZ Rivierduinen, Oegstgeest, The Netherlands
| | | | | | | | | | - Maarten Bak
- grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,Mondriaan Mental Health, Maastricht, The Netherlands
| | - Geert Frederix
- Department of Public Health, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lieuwe de Haan
- grid.7177.60000000084992262Department of Psychiatry and Department of Anatomy and Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands ,Arkin GGZ, Amsterdam, The Netherlands
| | - Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands ,grid.413664.2Altrecht Mental Health Care Institute, Utrecht, The Netherlands
| | - Jurjen J. Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, HP A01.126, P.O. Box 85500, 3508 Utrecht, GA The Netherlands ,GGNet Mental Health, Warnsveld, The Netherlands ,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Faden J, Kiryankova-Dalseth N, Barghini R, Citrome L. Does antipsychotic combination therapy reduce the risk of hospitalization in schizophrenia? Expert Opin Pharmacother 2020; 22:635-646. [PMID: 33251870 DOI: 10.1080/14656566.2020.1847274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION : Despite treatment with antipsychotic medication, approximately 1/3 of individuals with schizophrenia will fail to have an adequate response. To treat these patients, a commonly utilized approach is antipsychotic combination therapy. Antipsychotic combination therapy is controversial with mixed efficacy and tolerability results. It is also unclear if antipsychotic combination therapy reduces or increases the risk of psychiatric hospitalization. AREAS COVERED : The authors review the prevalence, efficacy and tolerability concerns, and rationale behind antipsychotic combination therapy. Evidence comparing antipsychotic monotherapy vs polypharmacy using hospitalization as an outcome measure is summarized. EXPERT OPINION : Psychiatric rehospitalization is a useful measure of treatment effectiveness, incorporating aspects of treatment efficacy and tolerability. The evidence comparing the impact of antipsychotic monotherapy vs combination therapy on rehospitalization is mixed. Evidence is primarily retrospective in nature, and there is high heterogeneity between studies, which could partially explain the mixed results. There is likely a subset of patients for whom antipsychotic combination therapy reduces the risk of hospitalization greater than antipsychotic monotherapy. Patients should be treated individually taking into account their specific pattern of response.
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Affiliation(s)
- Justin Faden
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Ruby Barghini
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Leslie Citrome
- Department of Psychiatry & Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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Endocrine disruption and obesity: A current review on environmental obesogens. CURRENT RESEARCH IN GREEN AND SUSTAINABLE CHEMISTRY 2020; 3. [PMCID: PMC7326440 DOI: 10.1016/j.crgsc.2020.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Obesity represents an important public health concern because it substantially increases the risk of multiple chronic diseases and thereby contributing to a decline in both quality of life and life expectancy. Besides unhealthy diet, physical inactivity and genetic susceptibility, environmental pollutants also contribute to the rising prevalence of obesity epidemic. An environmental obesogen is defined as a chemical that can alter lipid homeostasis to promote adipogenesis and lipid accumulation whereas an endocrine disrupting chemical (EDC) is defined as a synthetic chemical that can interfere with the endocrine function and cause adverse health effects. Many obesogens are EDCs that interfere with normal endocrine regulation of metabolism, adipose tissue development and maintenance, appetite, weight and energy balance. An expanding body of scientific evidence from animal and epidemiological studies has begun to provide links between exposure to EDCs and obesity. Despite the significance of environmental obesogens in the pathogenesis of metabolic diseases, the contribution of synthetic chemical exposure to obesity epidemic remains largely unrecognised. Hence, the purpose of this review is to provide a current update on the evidences from animal and human studies on the role of fourteen environmental obesogens in obesity, a comprehensive view of the mechanisms of action of these obesogens and current green and sustainable chemistry strategies to overcome chemical exposure to prevent obesity. Designing of safer version of obesogens through green chemistry approaches requires a collaborative undertaking to evaluate the toxicity of endocrine disruptors using appropriate experimental methods, which will help in developing a new generation of inherently safer chemicals. Many environmental obesogens are endocrine disrupting chemicals that interfere with normal endocrine regulation of metabolism. Understanding the role of environmental obesogens in the epidemics of obesity is in an infant stage. Green chemistry approach aims to design a safer version of these chemicals by understanding their hazardous effects. Further studies are necessary to fully establish the hazardous effects of obesogens and their association to human obesity.
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21
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Tang BL. Could metformin be therapeutically useful in Huntington's disease? Rev Neurosci 2020; 31:297-317. [PMID: 31751298 DOI: 10.1515/revneuro-2019-0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
Abstract
Emerging evidence suggest that dimethylbiguanide (metformin), a first-line drug for type 2 diabetes mellitus, could be neuroprotective in a range of brain pathologies, which include neurodegenerative diseases and brain injury. However, there are also contraindications that associate metformin treatment with cognitive impairment as well as adverse outcomes in Alzheimer's disease and Parkinson's disease animal models. Recently, a beneficial effect of metformin in animal models of Huntington's disease (HD) has been strengthened by multiple reports. In this brief review, the findings associated with the effects of metformin in attenuating neurodegenerative diseases are discussed, focusing on HD-associated pathology and the potential underlying mechanisms highlighted by these studies. The mechanism of action of metformin is complex, and its therapeutic efficacy is therefore expected to be dependent on the disease context. The key metabolic pathways that are effectively affected by metformin, such as AMP-activated protein kinase activation, may be altered in the later decades of the human lifespan. In this regard, metformin may nonetheless be therapeutically useful for neurological diseases with early pathological onsets, such as HD.
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Affiliation(s)
- Bor Luen Tang
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University Health System, Singapore 117596, Singapore.,NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Medical Drive, Singapore 119077, Singapore
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22
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Jiang WL, Cai DB, Yin F, Zhang L, Zhao XW, He J, Ng CH, Ungvari GS, Sim K, Hu ML, Zheng W, Xiang YT. Adjunctive metformin for antipsychotic-induced dyslipidemia: a meta-analysis of randomized, double-blind, placebo-controlled trials. Transl Psychiatry 2020; 10:117. [PMID: 32327628 PMCID: PMC7181777 DOI: 10.1038/s41398-020-0785-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/24/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
Antipsychotic-induced dyslipidemia could increase the risk of cardiovascular diseases. This is a meta-analysis of randomized double-blind placebo-controlled trials to examine the efficacy and safety of adjunctive metformin for dyslipidemia induced by antipsychotics in schizophrenia. The standardized mean differences (SMDs) and risk ratios (RRs) with their 95% confidence intervals (CIs) were calculated using the random-effects model with the RevMan 5.3 version software. The primary outcome was the change of serum lipid level. Twelve studies with 1215 schizophrenia patients (592 in metformin group and 623 in placebo group) were included and analyzed. Adjunctive metformin was significantly superior to placebo with regards to low density lipoprotein cholesterol (LDL-C) [SMD: -0.37 (95%CI:-0.69, -0.05), P = 0.02; I2 = 78%], total cholesterol [SMD: -0.47 (95%CI:-0.66, -0.29), P < 0.00001; I2 = 49%], triglyceride [SMD: -0.33 (95%CI:-0.45, -0.20), P < 0.00001; I2 = 0%], and high density lipoprotein cholesterol [SMD: 0.29 (95%CI:0.02, 0.57), P = 0.03; I2 = 69%]. The superiority of metformin in improving LDL-C level disappeared in a sensitivity analysis and 80% (8/10) of subgroup analyses. Metformin was significantly superior to placebo with regards to decrease in body weight, body mass index, glycated hemoglobin A1c, fasting insulin, and homeostasis model assessment-insulin resistance (P = 0.002-0.01), but not regarding changes in waist circumference, waist-to-hip rate, leptin, fasting glucose, and blood pressure (P = 0.07-0.33). The rates of discontinuation due to any reason [RR: 0.97 (95%CI: 0.66, 1.43), P = 0.89; I2 = 0%] was similar between the two groups. Adjunctive metformin could be useful to improve total cholesterol and triglyceride levels, but it was not effective in improving LDL-C level in schizophrenia.
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Affiliation(s)
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Fei Yin
- grid.410736.70000 0001 2204 9268Harbin Medical University Daqing Campus, Daqing, China
| | - Ling Zhang
- grid.412558.f0000 0004 1762 1794The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xi-Wu Zhao
- The Third People’s Hospital of Daqing, Daqing, China
| | - Jie He
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Chee H. Ng
- grid.1008.90000 0001 2179 088XDepartment of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, Victoria Australia
| | - Gabor S. Ungvari
- grid.266886.40000 0004 0402 6494University of Notre Dame Australia, Fremantle, Australia ,grid.1012.20000 0004 1936 7910Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Kang Sim
- grid.414752.10000 0004 0469 9592West Region, Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Mei-Ling Hu
- The Fifth People’s Hospital of Shangrao, Shangrao, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR, China.
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Fernandez-Egea E, Walker R, Ziauddeen H, Cardinal RN, Bullmore ET. Birth weight, family history of diabetes and diabetes onset in schizophrenia. BMJ Open Diabetes Res Care 2020; 8:8/1/e001036. [PMID: 32049635 PMCID: PMC7039608 DOI: 10.1136/bmjdrc-2019-001036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The prevalence of diabetes in schizophrenia is twice that in the general population, but there are few reliable predictors of which individuals will develop glucose dysregulation. OBJECTIVE To test if abnormal birth weight (either too low or too high) and parental diabetes, both variables that can be ascertained in the clinic, can predict diabetes onset in patients with schizophrenia. RESEARCH DESIGN AND METHODS Electronic records of a cohort of 190 clozapine-treated patients (37% treated for more than 20 years) and Cox regression survival analysis (with any type of glucose dysregulation as the event) to account for differences in length of treatment before the event and age at clozapine treatment initiation. RESULTS Age at clozapine initiation (Exp(B)=1.098; p<0.001), family history of diabetes (Exp(B)=2.299; p=0.049) and birth weight2 (Exp(B)=0.999; p=0.013) were significant predictors of glucose dysregulation onset, while gender was not (Exp(B)=0.1.350; p=0.517). Among individuals with 10 years of follow-up, 80% of those with both abnormal birth weight and a family history of diabetes developed diabetes compared with 56% with only abnormal birth weight, 40% with only a family history of diabetes and 20% in those with neither. CONCLUSIONS Since 48% of cases had at least one risk factor and 6% had both risk factors, there is a substantial proportion of patients for whom preventive strategies could be implemented.
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Affiliation(s)
- Emilio Fernandez-Egea
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ryan Walker
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Hisham Ziauddeen
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK
| | - Rudolf N Cardinal
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Edward T Bullmore
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Assessment of Long Term Metabolic Effects of Atypical Antipsychotics in Schizophrenia Patients. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2019. [DOI: 10.2478/rjdnmd-2019-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims. Patients with schizophrenia have a shorter life expectancy than normal population partially due to the metabolic side effects of antipsychotic treatment. The aim of this study is to evaluate the long-term evolution of the metabolic syndrome in chronic schizophrenia patients on fixed second generation antipsychotics (SGA).
Material and method. The components of metabolic syndrome were evaluated repeatedly in a minimum 6 months and maximum 2 years follow-up period. The presence of metabolic syndrome (MetS) and metabolic risk scores (cMetS) according to National Cholesterol Education Program Adult Treatment Panel III were calculated and compared in time. In the prevalence, incidence and normalization logistic regression studies included all the known risk factors together with the follow-up period. Finally, all these rates were compared depending on the type of SGA.
Results. Only cMetS, waist circumference and diastolic blood pressure presented significant increase in the follow-up period which was in average 385.5 days. The prevalence of MetS at base-line was 39.4%, which increased to 48.5% after the follow-up period. The calculated incidence of 30% was associated with a 23.1% rate of normalization. Logistic regression studies revealed as independent risk factors the age and base-line cMetS/weight for incidence and for normalization. In the aripiprazole group the normalization rate exceeded the incidence rate (33.3% vs 20%).
Conclusions. The results emphasize the highly dynamic character of the metabolic syndrome even in chronic schizophrenia patients with fixed SGA regimen. The normalization of MetS is a possibility that should not ignored. The age and weight continue to remain independent risk factors, thus close monitoring in elderly and strict weight control plan are necessary. Aripiprazole showed better safety profile, but more extensive studies are required for definitive conclusions.
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A comparison of the effects of clozapine and its metabolite norclozapine on metabolic dysregulation in rodent models. Neuropharmacology 2019; 175:107717. [PMID: 31348941 DOI: 10.1016/j.neuropharm.2019.107717] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/13/2019] [Accepted: 07/22/2019] [Indexed: 01/11/2023]
Abstract
RATIONALE The second generation antipsychotic drug clozapine is a psychotherapeutic agent with superior efficacy for treatment-resistant schizophrenia. Clozapine is associated with a low likelihood of neurological side-effects, but a high propensity to induce weight gain and metabolic dysregulation. The primary metabolite of clozapine is norclozapine (N-Desmethylclozapine), which has psychoactive properties itself, but its effects on metabolic function remains unknown. The goal of the present study was to determine whether directly administered norclozapine could cause metabolic dysregulation, similar to clozapine. METHODS Adult female rats were treated with a range of doses of clozapine and norclozapine (0.5, 2, 8 & 20 mg/kg, i.p.) and then subjected to the intraperitoneal glucose tolerance test (IGTT), where glucose levels were recorded for 2 h following a glucose challenge. In parallel, rats were tested with two doses of clozapine and norclozapine (2 & 20 mg/kg, i.p.) in the hyperinsulinemic-euglycemic clamp (HIEC), to measure whole body insulin resistance. RESULTS In the IGTT, clozapine demonstrated dose-dependent effects on fasting glucose levels and total glucose area-under-the-curve following the glucose challenge, with the two highest doses strongly increasing glucose levels. Only the highest dose of norclozapine increased fasting glucose levels, and caused a non-significant increase in glucose levels following the challenge. By contrast, both doses of clozapine and norclozapine caused a potent and long-lasting decrease in the glucose infusion rate in the HIEC, indicating that both compounds cause whole body insulin resistance. ABSTRACT While not as potent as its parent compound, norclozapine clearly exerts acute metabolic effects, particularly on insulin resistance. This article is part of the issue entitled 'Special Issue on Antipsychotics'.
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Abstract
Aging, as a physiological process mediated by numerous regulatory pathways and transcription factors, is manifested by continuous progressive functional decline and increasing risk of chronic diseases. There is an increasing interest to identify pharmacological agents for treatment and prevention of age-related disease in humans. Animal models play an important role in identification and testing of anti-aging compounds; this step is crucial before the drug will enter human clinical trial or will be introduced to human medicine. One of the main goals of animal studies is better understanding of mechanistic targets, therapeutic implications and side-effects of the drug, which may be later translated into humans. In this chapter, we summarized the effects of different drugs reported to extend the lifespan in model organisms from round worms to rodents. Resveratrol, rapamycin, metformin and aspirin, showing effectiveness in model organism life- and healthspan extension mainly target the master regulators of aging such as mTOR, FOXO and PGC1α, affecting autophagy, inflammation and oxidative stress. In humans, these drugs were demonstrated to reduce inflammation, prevent CVD, and slow down the functional decline in certain organs. Additionally, potential anti-aging pharmacologic agents inhibit cancerogenesis, interfering with certain aspects of cell metabolism, proliferation, angioneogenesis and apoptosis.
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Goh KK, Chen CH, Lu ML. Topiramate mitigates weight gain in antipsychotic-treated patients with schizophrenia: meta-analysis of randomised controlled trials. Int J Psychiatry Clin Pract 2019; 23:14-32. [PMID: 29557263 DOI: 10.1080/13651501.2018.1449864] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Weight gain is one of the most challenging issues in patients with schizophrenia treated with antipsychotics. Several meta-analyses have been conducted to review the efficacy of topiramate in reducing weight, however, several issues regarding the methodology had arisen of which make the results remain ambiguous. METHODS We conducted a meta-analysis of randomised controlled trials about the use of topiramate in patients with schizophrenia for weight reduction. Ten double-blinded randomised placebo-controlled trials and seven open-label randomised controlled trials included 905 patients. RESULTS Patients treated with topiramate experienced a greater reduction in body weight and BMI. Patients in countries of the lower overweight population showed more significant BMI reduction. Besides, studies from the Middle East and South Asia showed the greatest effect in body weight change, followed by East Asia, then Europe/America. Topiramate group was outperformed control group with significant psychopathology improvement. No difference between two groups regarding the overall side effects. CONCLUSIONS Topiramate was significantly superior to control group in mitigating weight gain and psychopathology in antipsychotic-treated patients with schizophrenia. The effects of topiramate augmentation need further investigations in larger definitive studies using methodological rigor and thorough assessments.
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Affiliation(s)
- Kah Kheng Goh
- a Department of Psychiatry , Wan-Fang Hospital, Taipei Medical University , Taipei , Taiwan
| | - Chun-Hsin Chen
- a Department of Psychiatry , Wan-Fang Hospital, Taipei Medical University , Taipei , Taiwan.,b Department of Psychiatry , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
| | - Mong-Liang Lu
- a Department of Psychiatry , Wan-Fang Hospital, Taipei Medical University , Taipei , Taiwan.,b Department of Psychiatry , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
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Vancampfort D, Firth J, Correll CU, Solmi M, Siskind D, De Hert M, Carney R, Koyanagi A, Carvalho AF, Gaughran F, Stubbs B. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry 2019; 18:53-66. [PMID: 30600626 PMCID: PMC6313230 DOI: 10.1002/wps.20614] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We summarized and compared meta-analyses of pharmacological and non-pharmacological interventions targeting physical health outcomes among people with schizophrenia spectrum disorders. Major databases were searched until June 1, 2018. Of 3,709 search engine hits, 27 meta-analyses were included, representing 128 meta-analyzed trials and 47,231 study participants. While meta-analyses were generally of adequate or high quality, meta-analyzed studies were less so. The most effective weight reduction interventions were individual lifestyle counseling (standardized mean difference, SMD=-0.98) and exercise interventions (SMD=-0.96), followed by psychoeducation (SMD=-0.77), aripiprazole augmentation (SMD=-0.73), topiramate (SMD=-0.72), d-fenfluramine (SMD=-0.54) and metformin (SMD=-0.53). Regarding waist circumference reduction, aripiprazole augmentation (SMD=-1.10) and topiramate (SMD=-0.69) demonstrated the best evidence, followed by dietary interventions (SMD=-0.39). Dietary interventions were the only to significantly improve (diastolic) blood pressure (SMD=-0.39). Switching from olanzapine to quetiapine or aripiprazole (SMD=-0.71) and metformin (SMD=-0.65) demonstrated best efficacy for reducing glucose levels, followed by glucagon-like peptide-1 receptor agonists (SMD=-0.39), dietary interventions (SMD=-0.37) and aripiprazole augmentation (SMD=-0.34), whereas insulin resistance improved the most with metformin (SMD=-0.75) and rosiglitazone (SMD=-0.44). Topiramate had the greatest efficacy for triglycerides (SMD=-0.68) and low-density lipoprotein (LDL)-cholesterol (SMD=-0.80), whereas metformin had the greatest beneficial effects on total cholesterol (SMD=-0.51) and high-density lipoprotein (HDL)-cholesterol (SMD=0.45). Lifestyle interventions yielded small effects for triglycerides, total cholesterol and LDL-cholesterol (SMD=-0.35 to -0.37). Only exercise interventions increased exercise capacity (SMD=1.81). Despite frequent physical comorbidities and premature mortality mainly due to these increased physical health risks, the current evidence for pharmacological and non-pharmacological interventions in people with schizophrenia to prevent and treat these conditions is still limited and more larger trials are urgently needed.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation SciencesLeuvenBelgium,University Psychiatric Centre KU LeuvenKortenbergBelgium
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney UniversityWestmeadAustralia,Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christoph U. Correll
- Hofstra Northwell School of Medicine HempsteadNew YorkNY, USA,Department of PsychiatryZucker Hillside HospitalNew YorkNYUSA,Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
| | - Marco Solmi
- Department of NeurosciencesUniversity of PaduaPaduaItaly
| | - Dan Siskind
- Metro South Addiction and Mental Health ServiceBrisbaneAustralia,School of Medicine, University of QueenslandBrisbaneAustralia
| | - Marc De Hert
- University Psychiatric Centre KU LeuvenKortenbergBelgium,KU Leuven Department of NeurosciencesLeuvenBelgium
| | - Rebekah Carney
- Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
| | - André F. Carvalho
- Centre for Addiction and Mental HealthTorontoOntarioCanada,Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation TrustLondonUK,Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation TrustLondonUK,Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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Fernandez-Egea E, Worbe Y, Bernardo M, Robbins TW. Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia. Psychol Med 2018; 48:2668-2675. [PMID: 29455687 PMCID: PMC6236440 DOI: 10.1017/s003329171800017x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/17/2017] [Accepted: 01/11/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is common in clozapine-treated patients although the actual prevalence, phenomenology and risk factors remain unclear. The aim of the present study was to address the three aforementioned questions. METHODS The electronic records of a large cohort of clozapine-medicated schizophrenia patients routinely screened for OCD were used. The Obsessive Compulsive Inventory Revised version (OCI-R) was available from 118 cases and a 21 points cut-off threshold for OCD was defined. RESULTS OCD prevalence was 47%, higher in patients on poly-pharmacy than on monotherapy (64% vs 31%; p = 0.001). Two OCI-R factors had significantly higher scores and distinct risk factors: checking behaviour (mean = 5.1; SD = 3.6) correlated with length of clozapine treatment (r = 0.21; p = 0.026), and obsessing factor (mean = 4.8; SD = 3.6) correlated with psychosis severity (r = 0.59; p = 0.001). These factors along with total OCI-R, did not correlate with either clozapine dose or plasma levels, after correcting for psychosis severity. CONCLUSIONS Screening for OCD in clozapine patients, and probably in those treated with structurally similar drugs with potent antiserotoninergic properties, should be widely adopted by clinicians. Further research is needed to understand the pathophysiology underlying repetitive behavior onset in clozapine-treated patients.
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Affiliation(s)
- Emilio Fernandez-Egea
- Clozapine Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Yulia Worbe
- Sorbonne Université, 75005 Paris, France; Department of Physiology, Neurophysiology Unit, Hospital Saint-Antoine, Paris, France; Institute du Cerveau et de Moelle Epigniere, Paris, France
| | - Miguel Bernardo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Psychiatry, University of Barcelona, Barcelona, Spain
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
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Zhuo C, Xu Y, Liu S, Li J, Zheng Q, Gao X, Li S, Jing R, Song X, Yue W, Zhou C, Upthegrove R. Topiramate and Metformin Are Effective Add-On Treatments in Controlling Antipsychotic-Induced Weight Gain: A Systematic Review and Network Meta-Analysis. Front Pharmacol 2018; 9:1393. [PMID: 30546312 PMCID: PMC6280187 DOI: 10.3389/fphar.2018.01393] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Antipsychotic drugs may lead to side effects such as obesity, diabetes, dyslipidemia, and cardiovascular disease. The current systematic review and network meta-analysis analyzes and provides an update on the clinical performance of these add-ons in comparison to placebo on body weight and body mass index (BMI) reductions. Methods: A comprehensive literature search was performed on electronic databases: PubMed (1946-), Embase (1974-), Cochrane library (1992-), and OpenGrey (2000-) until 31 July 2018. Network meta-analyses, comparing the body weight change, BMI change and withdrawn due to adverse events of different pharmacological add-ons, was performed using a multivariate meta-regression model with random-effects, adopting a frequentist approach. To rank the prognosis for all add-ons, we used surface under the cumulative ranking (SUCRA) values. Outcomes: From 614 potential studies identified, 27 eligible studies (n = 1,349 subjects) were included. All the studies demonstrated low to moderate risk of bias. For the analysis of body weight change, all add-ons except Ranitidine showed significant weight reductions comparing to placebo. The effectiveness rank based on SUCRA results from highest to lowest was Sibutramine, Topiramate, Metformin, Reboxetine, Ranitidine, and placebo. A similar pattern was seen for BMI change. The analysis of safety outcome did not detect significantly increased withdrawn number from the add-ons. Current evidence showed relatively good tolerance and safety of using the pharmacological add-ons. Interpretation: Topiramate and Metformin are effective add-on treatments in controlling antipsychotic-induced weight gain, comparing to placebo. They are well tolerated in short-term period. Although Sibutramine has the highest rank of the effectiveness, its license has been withdrawn in many countries due to its adverse effects. Hence, Sibutramine should not be adopted to treat antipsychotic-induced weight gain.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry and Morbidity, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China.,Department of Psychiatry, Jining Medical University, Jining, China.,Department of Psychiatry, Tianjin Medical University, Tianjin, China.,Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Neurobiology, National Key Disciplines, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Neurobiology, National Key Disciplines, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Neurobiology, National Key Disciplines, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Jing Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Neurobiology, National Key Disciplines, Key Laboratory for Cellular Physiology of Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Qishi Zheng
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore
| | - Xiangyang Gao
- Health Management Institute, Big Data Analysis Center, Chinese PLA General Hospital, Beijing, China
| | - Shen Li
- Department of Psychiatry, Tianjin Medical University, Tianjin, China
| | - Rixing Jing
- Department of Pattern Recognition, China National Key Laboratory, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Xueqin Song
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weihua Yue
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China.,Key Laboratory of Mental Health, Ministry of Health & National Clinical Research Center for Mental Disorders, Peking University, Beijing, China
| | - Chunhua Zhou
- Department of Pharmacy, Hebei Medical University First Hospital, Shijiazhuang, China
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom.,Early Intervention Service, Forward Thinking Birmingham, Birmingham, United Kingdom
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Lee H, Scolieri BB, Mullick PK. Learned lessons from patients who take clozapine: A case study. Perspect Psychiatr Care 2018; 54:457-461. [PMID: 28926097 DOI: 10.1111/ppc.12245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/08/2017] [Accepted: 09/03/2017] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this report is to provide clinical strategies to manage patients with schizophrenia taking clozapine. CONCLUSIONS Serious side effects and required blood monitoring impede the use of clozapine, despite the benefits of clozapine for managing psychiatric symptoms. Well-managed patients receiving evidence-based interventions exhibit reduced symptoms, improved functioning, and better adherence to treatment. PRACTICE IMPLICATIONS Preexisting medical conditions should be considered before prescribing clozapine. Ongoing education on medication and mental illness for patients and family members is essential to prepare them for adherence to management plans. Healthcare providers are responsible for monitoring the side effects of clozapine.
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Affiliation(s)
- Heeyoung Lee
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Britney B Scolieri
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Prabir K Mullick
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,P.K. Mullick MD & Associates PC, Pittsburgh, Pennsylvania, USA
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Jeong SH, Lee NY, Kim SH, Chung IW, Youn T, Kang UG, Ahn YM, You HY, Kim YS. Long-Term Evolution of Metabolic Status in Patients with Schizophrenia Stably Maintained on Second-Generation Antipsychotics. Psychiatry Investig 2018; 15:628-637. [PMID: 29940717 PMCID: PMC6018140 DOI: 10.30773/pi.2018.01.18.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/18/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Second-generation antipsychotics (SGAs) increase the risk of metabolic syndrome (MetS). Despite the risk of MetS, SGAs may have to be continued with change in some patients. The aim of this study was to trace the evolution of MetS in these patients. METHODS Patients with schizophrenia who had been maintained on a fixed SGA regimen for more than a year were followed-up without changing the regimen. Metabolic indicators were evaluated at baseline and at follow-up. Prevalence, incidence and spontaneous normalization rate of MetS were estimated. Risk factors that might have influenced the evolution were scrutinized. RESULTS A total of 151 subjects were included. During the mean observation period of 389.9±162.4 days, the prevalence of MetS was increased from 35.1 to 45.0%. The incidence rate was 29.6%, while the normalization rate was 26.4%, risk factors affecting incidence were age (OR=1.09, 95% CI: 1.03-1.17), baseline continuous values of metabolic syndrome risk scores (cMetS, OR=1.77, 95% CI:1.29-2.55) and baseline body weight (OR=1.06, 95% CI: 1.01-1.13). Normalization was influenced by age (OR=0.74, 95% CI: 0.57-0.89) and baseline body weight (OR=0.85, 95% CI: 0.72-0.95). CONCLUSION The prevalence of MetS steadily increased with the continuous use of SGAs. However, individual difference was extensive and about a quarter of the patients were able to recover naturally without specific measurements.
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Affiliation(s)
- Seong Hoon Jeong
- Department of Psychiatry, Eulji University School of Medicine, Eulji University Hospital, Daejeon, Republic of Korea
| | - Nam Young Lee
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Se Hyun Kim
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
| | - In Won Chung
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Tak Youn
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Ung Gu Kang
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Min Ahn
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han Young You
- College of Nursing Science, Ewha Woman's University, Seoul, Republic of Korea
| | - Yong Sik Kim
- Department of Neuropsychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Republic of Korea
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Franco-Tormo MJ, Salas-Crisostomo M, Rocha NB, Budde H, Machado S, Murillo-Rodríguez E. CRISPR/Cas9, the Powerful New Genome-Editing Tool for Putative Therapeutics in Obesity. J Mol Neurosci 2018; 65:10-16. [PMID: 29732484 DOI: 10.1007/s12031-018-1076-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/20/2018] [Indexed: 12/12/2022]
Abstract
The molecular technology known as clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR-associated protein (Cas) is revolutionizing the field of medical research and deepening our understanding of numerous biological processes. The attraction of CRISPR/Cas9 lies in its ability to efficiently edit DNA or modulate gene expression in living eukaryotic cells and organisms, a technology that was once considered either too expensive or scientifically risky. CRISPR/Cas9 has been successfully applied in agriculture to develop the next generation of disease-resistant plants. Now, the capability of gene editing has been translated to the biomedical area, focusing on the future of medicine faced with drug-resistant microbes by selectively targeting genes involved in antibiotic resistance, for example, or finding the ultimate strategy for cancer or HIV. In this regard, it was recently demonstrated that an injection of cancer-fighting CRISPR-modified white blood cells in a patient suffering from metastatic lung cancer could lead to promising results. Researchers and bioethicists are debating questions about the regulation of CRISPR/Cas9 that must be addressed. While legal challenges surround the use of this technique for genetically modifying cell lines in humans, we review the basic understanding of CRISPR/Cas9 and discuss how this technology could represent a candidate for treatment of non-communicable diseases in nutrition, such as obesity.
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Affiliation(s)
- María José Franco-Tormo
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud, Universidad Anáhuac Mayab, A.P. 96 Cordemex C.P, 97310, Mérida, Yucatán, Mexico.,Intercontinental Neuroscience Research Group, Mérida, Yucatán, Mexico
| | - Mireille Salas-Crisostomo
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud, Universidad Anáhuac Mayab, A.P. 96 Cordemex C.P, 97310, Mérida, Yucatán, Mexico.,Intercontinental Neuroscience Research Group, Mérida, Yucatán, Mexico
| | - Nuno Barbosa Rocha
- Intercontinental Neuroscience Research Group, Mérida, Yucatán, Mexico.,Health School, Polytechnic Institute of Porto, Porto, Portugal
| | - Henning Budde
- Intercontinental Neuroscience Research Group, Mérida, Yucatán, Mexico.,Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany.,Physical Activity, Physical Education, Health and Sport Research Centre (PAPESH), Sports Science Department, School of Science and Engineering, Reykjavik University, Reykjavik, Iceland.,Lithuanian Sports University, Kaunas, Lithuania
| | - Sérgio Machado
- Intercontinental Neuroscience Research Group, Mérida, Yucatán, Mexico.,Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Physical Activity Neuroscience Laboratory, Physical Activity Sciences Postgraduate Program of Salgado de Oliveira University, Niterói, Brazil
| | - Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud, Universidad Anáhuac Mayab, A.P. 96 Cordemex C.P, 97310, Mérida, Yucatán, Mexico. .,Intercontinental Neuroscience Research Group, Mérida, Yucatán, Mexico.
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Mezquida G, Savulich G, Garcia-Rizo C, Garcia-Portilla MP, Toll A, Garcia-Alvarez L, Bobes J, Mané A, Bernardo M, Fernandez-Egea E. Inverse association between negative symptoms and body mass index in chronic schizophrenia. Schizophr Res 2018; 192:69-74. [PMID: 28412089 DOI: 10.1016/j.schres.2017.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/15/2017] [Accepted: 04/01/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND We investigated whether negative symptoms, such as poor motivation or anhedonia, were associated with higher body mass index (BMI) in stable patients with schizophrenia chronically treated with antipsychotic medication. METHODS 62 olanzapine- or clozapine-treated patients with illness duration of at least four years were selected from an international multicenter study on the characterization of negative symptoms. All participants completed the Brief Negative Symptom Scale (BNSS) and the Positive and Negative Syndrome Scale (PANSS). Bivariate correlations between BMI and negative symptoms (BNSS) were explored, as well as multiple regression analyses. We further explored the association of two principal component factors of the BNSS and BMI. Subsidiary analyses re-modeled the above using the negative symptoms subscale of the PANSS and the EMSLEY factor for negative symptoms for convergent validity. RESULTS Lower negative symptoms (BNSS score) were associated with higher BMI (r=-0.31; p=0.015). A multiple regression analysis showed that negative symptoms (BNSS score) and age were significant predictors of BMI (p=0.037). This was mostly driven by the motivation/pleasure factor of the BNSS. Within this second factor, BMI was negatively associated with anhedonia (r=-0.254; p=0.046) and asociality (r=-0.253; p=0.048), but not avolition (r=-0.169; p=0.188). EMSLEY score was positively associated with BNSS (r=0.873, p<0.001), but negatively associated with BMI (r=-0.308; p=0.015). The association between PANSS and BMI did not reach significance (r=-224, p=0.080). CONCLUSIONS We conclude that lower negative symptoms were associated with higher BMI (assessed using both the BNSS and EMSLEY) in chronic stable schizophrenia patients, mostly due to lower anhedonia and asociality levels.
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Affiliation(s)
- G Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain
| | - G Savulich
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom
| | - C Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M P Garcia-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Oviedo, Spain
| | - A Toll
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - L Garcia-Alvarez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - J Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Oviedo, Spain
| | - A Mané
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Spain
| | - E Fernandez-Egea
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Cambridgeshire and Peterborough NHS Foundation Trust, United Kingdom.
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