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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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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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Hage B, Britton B, Daniels D, Heilman K, Porges SW, Halaris A. Diminution of Heart Rate Variability in Bipolar Depression. Front Public Health 2017; 5:312. [PMID: 29270399 PMCID: PMC5723669 DOI: 10.3389/fpubh.2017.00312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023] Open
Abstract
Autonomic nervous system (ANS) dysregulation in depression is associated with symptoms associated with the ANS. The beat-to-beat pattern of heart rate defined as heart rate variability (HRV) provides a noninvasive portal to ANS function and has been proposed to represent a means of quantifying resting vagal tone. We quantified HRV in bipolar depressed (BDD) patients as a measure of ANS dysregulation seeking to establish HRV as a potential diagnostic and prognostic biomarker for treatment outcome. Forty-seven BDD patients were enrolled. They were randomized to receive either escitalopram-celecoxib or escitalopram-placebo over 8 weeks in a double-blind study design. Thirty-five patients completed the HRV studies. Thirty-six healthy subjects served as controls. HRV was assessed at pretreatment and end of study and compared with that of controls. HRV was quantified and corrected for artifacts using an algorithm that incorporates time and frequency domains to address non-stationarity of the beat-to-beat heart rate pattern. Baseline high frequency-HRV (i.e., respiratory sinus arrhythmia) was lower in BDD patients than controls, although the difference did not reach significance. Baseline low-frequency HRV was significantly lower in BDD patients (ln4.20) than controls (ln = 5.50) (p < 0.01). Baseline heart period was significantly shorter (i.e., faster heart rate) in BDD patients than controls. No significant change in HRV parameters were detected over the course of the study with either treatment. These findings suggest that components of HRV may be diminished in BDD patients.
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Affiliation(s)
- Brandon Hage
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Briana Britton
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - David Daniels
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Keri Heilman
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Stephen W Porges
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States.,Kinsey Institute, Indiana University Bloomington, Bloomington, IN, United States
| | - Angelos Halaris
- Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
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Delacrétaz A, Vandenberghe F, Gholam-Rezaee M, Saigi Morgui N, Glatard A, Thonney J, Solida-Tozzi A, Kolly S, Gallo SF, Baumann P, Berney S, Zulauff SV, Aubry JM, Hasler R, Ebbing K, von Gunten A, Conus P, Eap CB. Early changes of blood lipid levels during psychotropic drug treatment as predictors of long-term lipid changes and of new onset dyslipidemia. J Clin Lipidol 2017; 12:219-229. [PMID: 29128242 DOI: 10.1016/j.jacl.2017.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiovascular diseases and dyslipidemia represent a major health issue in psychiatry. Many psychotropic drugs can induce a rapid and substantial increase of blood lipid levels. OBJECTIVE This study aimed to determine the potential predictive power of an early change of blood lipid levels during psychotropic treatment on long-term change and on dyslipidemia development. METHODS Data were obtained from a prospective study including 181 psychiatric patients with metabolic parameters monitored during the first year of treatment and with adherence ascertained. Blood lipid levels (ie, total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], non-high-density lipoprotein cholesterol [non-HDL-C], and fasting triglycerides [TGs]) were measured at baseline and after 1, 3, and/or 12 months of treatment. RESULTS Receiver-operating characteristic analyses indicated that early (ie, after 1 month of psychotropic treatment) increases (≥5%) for TC, LDL-C, TG, and non-HDL-C and decrease (≥5%) for HDL-C were the best predictors for clinically relevant modifications of blood lipid levels after 3 months of treatment (≥30% TC, ≥40% LDL-C, ≥45% TG, ≥55% non-HDL-C increase, and ≥20% HDL-C decrease; sensitivity 70%-100%, specificity 53%-72%). Predictive powers of these models were confirmed by fitting longitudinal multivariate models in the same cohort (P ≤ .03) as well as in a replication cohort (n = 79; P ≤ .003). Survival models showed significantly higher incidences of new onset dyslipidemia (TC, LDL-C, and non-HDL-C hypercholesterolemia, HDL-C hypocholesterolemia, and hypertriglyceridemia) for patients with early changes of blood lipid levels compared to others (P ≤ .01). CONCLUSION Early modifications of blood lipid levels following prescription of psychotropic drugs inducing dyslipidemia should therefore raise questions on clinical strategies to control long-term dyslipidemia.
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Affiliation(s)
- Aurélie Delacrétaz
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Frederik Vandenberghe
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Mehdi Gholam-Rezaee
- Centre of Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Nuria Saigi Morgui
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Anaïs Glatard
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Jacques Thonney
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Alessandra Solida-Tozzi
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Stéphane Kolly
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Sylfa Fassassi Gallo
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Philipp Baumann
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Sylvie Berney
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Sandrine Valloton Zulauff
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Jean-Michel Aubry
- Division of Psychiatric Specialties, University Hospital of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Division of Psychiatric Specialties, University Hospital of Geneva, Geneva, Switzerland
| | - Karsten Ebbing
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
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Olanzapine-induced weight gain plays a key role in the potential cardiovascular risk: evidence from heart rate variability analysis. Sci Rep 2014; 4:7394. [PMID: 25487560 PMCID: PMC4260225 DOI: 10.1038/srep07394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/20/2014] [Indexed: 12/02/2022] Open
Abstract
Patients with schizophrenia have a higher risk for cardiovascular disease (CVD) than the general population. Research has suggested that autonomic imbalance is a common pathway to increased morbidity and mortality for CVD. Heart rate variability (HRV) analysis is a non-invasive method that assesses autonomic imbalance, and low HRV is correlated with high cardiovascular risk. Olanzapine, a widely used antipsychotic drug, is considered to have good cardiac safety because of not causing significant corrected QT-interval (QTc) prolongation; however, it is still unclear whether olanzapine affects HRV. We recruited 83 patients with schizophrenia who were medication-free for at least 1 month and tested their HRV at the baseline and 4 weeks after treatment with olanzapine. We found that patients who had substantial weight gain (EWG) manifested significantly lower HRV than those who had non-substantial weight gain (NWG) and that HRV decrease was positively correlated to an increase in body mass index (BMI) and weight gain. Our results indicate that olanzapine-induced weight gain may play an important role in its potential cardiovascular risk. Since olanzapine has a very high potential for weight gain compared with other antipsychotics, further research is needed to explore its cardiovascular safety profile, specifically long-term cardiac safety.
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Boudebesse C, Geoffroy PA, Henry C, Germain A, Scott J, Lajnef M, Leboyer M, Bellivier F, Etain B. Links between sleep and body mass index in bipolar disorders: an exploratory study. Eur Psychiatry 2014; 30:89-93. [PMID: 24908150 DOI: 10.1016/j.eurpsy.2014.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/23/2014] [Accepted: 04/19/2014] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES Obesity and excess bodyweight are highly prevalent in individuals with bipolar disorders (BD) and are associated with adverse consequences. Multiple factors may explain increased bodyweight in BD including side effects of psychotropic medications, and reduced physical activity. Research in the general population demonstrates that sleep disturbances may also contribute to metabolic burden. We present a cross-sectional study of the associations between body mass index (BMI) and sleep parameters in patients with BD as compared with healthy controls (HC). METHODS Twenty-six French outpatients with remitted BD and 29 HC with a similar BMI completed a 21-day study of sleep parameters using objective (actigraphy) and subjective (PSQI: Pittsburgh Sleep Quality Index) assessments. RESULTS In BD cases, but not in HC, higher BMI was significantly correlated with lower sleep efficiency (P=0.009) and with several other sleep parameters: shorter total sleep time (P=0.01), longer sleep onset latency (P=0.05), higher fragmentation index (P=0.008), higher inter-day variability (P=0.05) and higher PSQI total score (P=0.004). CONCLUSIONS The findings suggest a link between a high BMI and several sleep disturbances in BD, including lower sleep efficiency. Physiological mechanisms in BD cases may include an exaggeration of phenomena observed in non-clinical populations. However, larger scale studies are required to clarify the links between metabolic and sleep-wake cycle disturbances in BD.
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Affiliation(s)
- C Boudebesse
- Inserm, U955, Créteil, France; AP-HP, Hôpital H.-Mondor-A.-Chenevier, Pôle de Psychiatrie, DHU PePSY, Créteil, France; Fondation Fondamental, Créteil, France.
| | - P-A Geoffroy
- Inserm, U955, Créteil, France; Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Université Lille Nord de France, CHRU de Lille, Lille, France
| | - C Henry
- Inserm, U955, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpital H.-Mondor-A.-Chenevier, Pôle de Psychiatrie, DHU PePSY, Créteil, France; Fondation Fondamental, Créteil, France
| | - A Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - J Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | | | - M Leboyer
- Inserm, U955, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpital H.-Mondor-A.-Chenevier, Pôle de Psychiatrie, DHU PePSY, Créteil, France; Fondation Fondamental, Créteil, France
| | - F Bellivier
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Pôle Neurosciences, Paris, France; Université Paris-7 Paris-Diderot, UFR de Médecine, Paris, France
| | - B Etain
- Inserm, U955, Créteil, France; AP-HP, Hôpital H.-Mondor-A.-Chenevier, Pôle de Psychiatrie, DHU PePSY, Créteil, France; Fondation Fondamental, Créteil, France
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Bak M, Fransen A, Janssen J, van Os J, Drukker M. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS One 2014; 9:e94112. [PMID: 24763306 PMCID: PMC3998960 DOI: 10.1371/journal.pone.0094112] [Citation(s) in RCA: 308] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 03/12/2014] [Indexed: 02/08/2023] Open
Abstract
Introduction Antipsychotics (AP) induce weight gain. However, reviews and meta-analyses generally are restricted to second generation antipsychotics (SGA) and do not stratify for duration of AP use. It is hypothesised that patients gain more weight if duration of AP use is longer. Method A meta-analysis was conducted of clinical trials of AP that reported weight change. Outcome measures were body weight change, change in BMI and clinically relevant weight change (7% weight gain or loss). Duration of AP-use was stratified as follows: ≤6 weeks, 6–16 weeks, 16–38 weeks and >38 weeks. Forest plots stratified by AP as well as by duration of use were generated and results were summarised in figures. Results 307 articles met inclusion criteria. The majority were AP switch studies. Almost all AP showed a degree of weight gain after prolonged use, except for amisulpride, aripiprazole and ziprasidone, for which prolonged exposure resulted in negligible weight change. The level of weight gain per AP varied from discrete to severe. Contrary to expectations, switch of AP did not result in weight loss for amisulpride, aripiprazole or ziprasidone. In AP-naive patients, weight gain was much more pronounced for all AP. Conclusion Given prolonged exposure, virtually all AP are associated with weight gain. The rational of switching AP to achieve weight reduction may be overrated. In AP-naive patients, weight gain is more pronounced.
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Affiliation(s)
- Maarten Bak
- Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands
- * E-mail:
| | - Annemarie Fransen
- Maxima Medical Centre Dep. of gynaecology, Veldhoven, The Netherlands
| | - Jouke Janssen
- Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands
| | - Jim van Os
- Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Marjan Drukker
- Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands
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Bobo WV. Asenapine, iloperidone and lurasidone: critical appraisal of the most recently approved pharmacotherapies for schizophrenia in adults. Expert Rev Clin Pharmacol 2013; 6:61-91. [PMID: 23272794 DOI: 10.1586/ecp.12.70] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This article reviews the pharmacological profile and published efficacy and tolerability/safety data of iloperidone, asenapine and lurasidone, the most recent atypical antipsychotics to be approved in the USA for the treatment of schizophrenia. All three agents are similar in terms of overall efficacy and low propensity for clinically significant weight gain or adverse changes in glycemic or lipid profile. However, these agents differ from one another in terms of formulations, pharmacokinetics, and dosing and nonmetabolic adverse effect profile. For each drug, comparative and real-world effectiveness studies are lacking, as are effectiveness and safety data in elderly, young and pregnant/nursing patients. As such, the exact place of iloperidone, asenapine and lurasidone within the broader antipsychotic armamentarium is currently difficult to establish.
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Affiliation(s)
- William V Bobo
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Mukundan A, Faulkner G, Cohn T, Remington G. Antipsychotic switching for people with schizophrenia who have neuroleptic-induced weight or metabolic problems. Cochrane Database Syst Rev 2010; 2010:CD006629. [PMID: 21154372 PMCID: PMC11322911 DOI: 10.1002/14651858.cd006629.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Weight gain is common for people with schizophrenia and this has serious implications for a patient's health and well being. Switching strategies have been recommended as a management option. OBJECTIVES To determine the effects of antipsychotic medication switching as a strategy for reducing or preventing weight gain and metabolic problems in people with schizophrenia. SEARCH STRATEGY We searched key databases and the Cochrane Schizophrenia Group's trials register (January 2005 and June 2007), reference sections within relevant papers and contacted the first author of each relevant study and other experts to collect further information. SELECTION CRITERIA All clinical randomised controlled trials comparing switching of antipsychotic medication as an intervention for antipsychotic induced weight gain and metabolic problems with continuation of medication and/or other weight loss treatments (pharmacological and non pharmacological) in people with schizophrenia or schizophrenia-like illnesses. DATA COLLECTION AND ANALYSIS Studies were reliably selected, quality assessed and data extracted. For dichotomous data we calculated risk ratio (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed-effect model. The primary outcome measures were weight loss, metabolic syndrome, relapse and general mental state. MAIN RESULTS We included four studies for the review with a total of 636 participants. All except one study had a duration of 26 weeks or less. There was a mean weight loss of 1.94 kg (2 RCT, n = 287, CI -3.9 to 0.08) when switched to aripiprazole or quetiapine from olanzapine. BMI also decreased when switched to quetiapine (1 RCT, n = 129, MD -0.52 CI -1.26 to 0.22) and aripiprazole (1 RCT, n = 173, RR 0.28 CI 0.13 to 0.57) from olanzapine.Fasting blood glucose showed a significant decrease when switched to aripiprazole or quetiapine from olanzapine. (2 RCT, MD -2.53 n = 280 CI -2.94 to -2.11). One RCT also showed a favourable lipid profile when switched to aripiprazole but these measures were reported as percentage changes, rather than means with standard deviation.People are less likely to leave the study early if they remain on olanzapine compared to switching to quetiapine or aripiprazole.There was no significant difference in outcomes of mental state, global state, and adverse events between groups which switched medications and those that remained on previous medication. Three different switching strategies were compared and no strategy was found to be superior to the others for outcomes of weight gain, mental state and global state. AUTHORS' CONCLUSIONS Evidence from this review suggests that switching antipsychotic medication to one with lesser potential for causing weight gain or metabolic problems could be an effective way to manage these side effects, but the data were weak due to the limited number of trials in this area and small sample sizes. Poor reporting of data also hindered using some trials and outcomes. There was no difference in mental state, global state and other treatment related adverse events between switching to another medication and continuing on the previous one. When the three switching strategies were compared none of them had an advantage over the others in their effects on the primary outcomes considered in this review. Better designed trials with adequate power would provide more convincing evidence for using medication switching as an intervention strategy.
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Affiliation(s)
- Anitha Mukundan
- Horton Park CentreCity Mental Health TeamHorton Park AvenueBradfordUKBD7 3EG
| | - Guy Faulkner
- University of TorontoFaculty of Kinesiology and Physical Education55 Harbord StTorontoCanadaOn M5S 2W6
| | - Tony Cohn
- Centre for Addiction and Mental HealthSchizophrenia Program and MAPS1001 Queen Street WestTorontoOntarioCanadaM6J1H4
| | - Gary Remington
- University of TorontoCentre for Addiction and Mental Health250 College StTorontoOntarioCanadaM5T 1R8
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Tosh G, Clifton A, Mala S, Bachner M. Physical health care monitoring for people with serious mental illness. Cochrane Database Syst Rev 2010:CD008298. [PMID: 20238365 DOI: 10.1002/14651858.cd008298.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Current guidance suggests that we should monitor the physical health of people with serious mental illness and there has been a significant financial investment over recent years to provide this. OBJECTIVES To assess the effectiveness of physical health monitoring as a means of reducing morbidity, mortality and reduction in quality of life in people with serious mental illness. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group Trials Register (October 2009) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. SELECTION CRITERIA All randomised or quasi-randomised clinical trials focusing on physical health monitoring versus standard care or comparing i) self monitoring vs monitoring by health care professional; ii) simple vs complex monitoring; iii) specific vs non-specific checks iv) once only vs regular checks or v) comparison of different guidance. DATA COLLECTION AND ANALYSIS The authors (GT, AC, SM) independently screened search results and identified three studies as possibly fulfilling the review's criteria. On examination, however, all three were subsequently excluded. MAIN RESULTS We did not identify any randomised trials which assessed the effectiveness of physical health monitoring in people with serious mental illness. AUTHORS' CONCLUSIONS There is no evidence from randomised trials to support current guidance and practice. Guidance and practice are based on expert consensus, clinical experience and good intentions rather than high quality evidence.
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Affiliation(s)
- Graeme Tosh
- East Midlands Workforce Deanery, Nottingham, UK
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