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Khalid J, Aparasu RR. Adverse effects associated with antipsychotic use in older adults. Expert Opin Drug Saf 2024:1-15. [PMID: 39076106 DOI: 10.1080/14740338.2024.2386377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/17/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Antipsychotic (AP) medications are extensively utilized for diverse psychiatric and non-psychiatric conditions, but they are associated with significant adverse effects in older adults. This expert opinion review provides an updated profile of adverse effects associated with AP medications in older adults. AREAS COVERED This review specifically examines real-world evidence for adverse events associated with AP use, including all-cause mortality, falls and fractures, diabetes, cardiovascular and cerebrovascular events, acute kidney injury, venous thromboembolism/pulmonary embolism, extrapyramidal symptoms, and infections based on real-world evidence. EXPERT OPINION This comprehensive safety review of AP revealed multiple adverse events in older adults. All-cause mortality, more associated with typical APs than atypicals, underscores a dose-dependent risk, urging cautious prescribing practices and avoidance of typical APs. Falls/fractures associated with atypical APs highlight the importance of judicious dosing and -close monitoring, especially after initiation. Cardiovascular risks, particularly stroke, with AP use emphasize the need for vigilant monitoring. Extrapyramidal symptoms, more linked to typical APs, also pose a significant risk in older adults. Pneumonia and pulmonary embolism/venous thromboembolism demand cautious consideration of APs, prompting the need for additional real-world studies to inform clinical practice. Conflicting evidence on diabetes and acute kidney injury necessitates ongoing studies and further research in older adults.
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Affiliation(s)
- Javeria Khalid
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
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Salari N, Maghami N, Ammari T, Mosafer H, Abdullahi R, Rasoulpoor S, Babajani F, Mahmodzadeh B, Mohammadi M. Global Prevalence of Metabolic Syndrome in Schizophrenia Patients: A Systematic Review and Meta-Analysis. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00798-8. [PMID: 39048892 DOI: 10.1007/s10935-024-00798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
The prevalence of metabolic syndrome in patients with schizophrenia has significantly increased and can be associated with severe complications such as chronic diseases and mortality. Despite numerous studies, a comprehensive estimate of the prevalence of metabolic syndrome in schizophrenia patients is lacking. Therefore, this study aimed to estimate the global prevalence of metabolic syndrome in schizophrenia patients through a systematic review and meta-analysis. This study was conducted as a systematic review and meta-analysis based on PRISMA guidelines without time restrictions until April 1, 2024. Relevant articles were identified through searches in databases including Scopus, Web of Science (WoS), PubMed, Science Direct, Embase, and Google Scholar, using key terms combined with AND & OR operators. After removing duplicates and conducting primary and secondary screening, 12 studies were included in the meta-analysis. Data were analysed using the random-effects model in Comprehensive Meta-Analysis Version 2 software. This analysis included 12 studies with 1,953 participants. The pooled prevalence of metabolic syndrome was 41.3% (95% CI: 28.8-55.1), with significant heterogeneity (I2: 96.3%). The highest prevalence was reported in France (79.1%) and the lowest in China (18.03%). Over one-third of patients with schizophrenia are affected by metabolic syndrome. Hence, greater attention should be paid to the prevention and reduction of complications and mortality associated with metabolic syndrome in schizophrenia patients.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Medical Biology Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nima Maghami
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Theo Ammari
- Academic Development (Assessment), University of Sunderland, London, UK
| | - Hadis Mosafer
- Medical Biology Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Abdullahi
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Nursing, Urmia, Iran
| | - Shabnam Rasoulpoor
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Nursing, Urmia, Iran
| | - Fateme Babajani
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahareh Mahmodzadeh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Research Center for NonCommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
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Ying J, Chew QH, Wang Y, Sim K. Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review. Brain Sci 2023; 14:6. [PMID: 38275511 PMCID: PMC10813099 DOI: 10.3390/brainsci14010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
It is important to examine the psychotropic prescription practices in schizophrenia, as it can inform regarding changing treatment choices and related patient profiles. No recent reviews have evaluated the global neuropsychopharmacological prescription patterns in adults with schizophrenia. A systematic search of the literature published from 2002 to 2023 found 88 empirical papers pertinent to the utilization of psychotropic agents. Globally, there were wide inter-country and inter-regional variations in the prescription of psychotropic agents. Overall, over time there was an absolute increase in the prescription rate of second-generation antipsychotics (up to 50%), mood stabilizers (up to 15%), and antidepressants (up to 17%), with an observed absolute decrease in the rate of antipsychotic polypharmacy (up to 15%), use of high dose antipsychotic (up to 12% in Asia), clozapine (up to 9%) and antipsychotic long-acting injectables (up to 10%). Prescription patterns were mainly associated with specific socio-demographic (such as age), illness (such as illness duration), and treatment factors (such as adherence). Further work, including more evidence in adjunctive neuropsychopharmacological treatments, pharmaco-economic considerations, and examination of cohorts in prospective studies, can proffer insights into changing prescription trends relevant to different treatment settings and predictors of such trends for enhancement of clinical management in schizophrenia.
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Affiliation(s)
- Jiangbo Ying
- East Region, Institute of Mental Health, Singapore 539747, Singapore
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | - Yuxi Wang
- East Region, Institute of Mental Health, Singapore 539747, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore 539747, Singapore
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Examining Factors Associated with Dynapenia/Sarcopenia in Patients with Schizophrenia: A Pilot Case-Control Study. Healthcare (Basel) 2023; 11:healthcare11050684. [PMID: 36900689 PMCID: PMC10000555 DOI: 10.3390/healthcare11050684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Sedentary behavior in patients with schizophrenia causes muscle weakness, is associated with a higher risk of metabolic syndrome, and contributes to mortality risk. This pilot case-control study aims to examine the associated factors for dynapenia/sarcopenia in patients with schizophrenia. The participants were 30 healthy individuals (healthy group) and 30 patients with schizophrenia (patient group), who were matched for age and sex. Descriptive statistics, Welch's t-test, cross-tabulations, adjusted residuals, Fisher's exact probability test (extended), and/or odds ratios (ORs) were calculated. In this study, dynapenia was significantly more prevalent in patients with schizophrenia than in healthy individuals. Regarding body water, Pearson's chi-square value was 4.41 (p = 0.04), and significantly more patients with dynapenia were below the normal range. In particular, body water and dynapenia showed a significant association, with an OR = 3.42 and 95% confidence interval [1.06, 11.09]. Notably, compared with participants of the healthy group, patients with schizophrenia were overweight, had less body water, and were at a higher risk for dynapenia. The impedance method and the digital grip dynamometer used in this study were simple and useful tools for evaluating muscle quality. To improve health conditions for patients with schizophrenia, additional attention should be paid to muscle weakness, nutritional status, and physical rehabilitation.
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Tanaka M, Okamoto M, Yamashita K. Cardiac surgery for patients with schizophrenia: clinical experience of six patients. Surg Today 2022; 52:567-573. [PMID: 34480648 PMCID: PMC8948118 DOI: 10.1007/s00595-021-02369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/03/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE The incidence of schizophrenia in Japan is 0.7%, which is similar to the worldwide incidence. The mortality rate of patients with schizophrenia is reported to be higher than that of the general population, and cardiovascular disease is high among the causes of death. Hence, strategies for cardiovascular surgery for patients with schizophrenia are necessary. METHODS We studied six patients with schizophrenia (five males, one female) who underwent cardiac surgery in our hospital between April 2008 and December 2019. RESULT The mean age was 63.6 years. The surgical procedures were coronary artery bypass grafting (CABG) (n = 4), CABG concomitant with valve procedures (n = 1), and resection of myxoma (n = 1). There were no major cardiovascular complications and no other fatal complications. The mean observation period was 1510.6 ± 1430.1 (140-4068) days, the mean post-operative hospital stay was 17.8 ± 3.5 (13-22) days, and there was no mortality within 30 days after surgery. During the observation period, one patient died. The survival rate was 83.3% at 1, 3, and 5 years. CONCLUSION Cardiac surgery for patients with schizophrenia is possible with careful monitoring of indications and perioperative management.
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Affiliation(s)
- Mutsuo Tanaka
- Department of Cardiovascular Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuou-ku, Kumamoto, 860-0008, Japan.
| | - Minoru Okamoto
- Department of Cardiovascular Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuou-ku, Kumamoto, 860-0008, Japan
| | - Kensho Yamashita
- Department of Psychiatry, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuou-ku, Kumamoto, 860-0008, Japan
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Kusumi I, Inoue S, Baba K, Nosaka T, Anzai T. A propensity score matching analysis for cardio metabolic risk of antipsychotics in patients with schizophrenia using Japanese claims data. BMC Psychiatry 2020; 20:584. [PMID: 33298025 PMCID: PMC7724711 DOI: 10.1186/s12888-020-02987-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the cardio-metabolic risk in schizophrenia patients treated by atypical antipsychotic drugs compared with that in those treated without atypical antipsychotic drugs using a nationwide insurance claims database and medical examination database in Japan. METHODS Eligible patients were defined as those meeting the following two criteria: (i) A diagnosis of schizophrenia (ICD-10 code: F20) was made between 1 January 2005 and 31 December 2017, with data available for at least 6 months before the diagnosis was made (index month), and (ii) health check-up data were available within ±3 months of the index month. The primary endpoint was changes in cardio-metabolic risk based on the Suita score at 1 year, and the secondary endpoints were changes in medical examination data related to cardio-metabolic risk (total cholesterol [TC], triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, body mass index [BMI], and hemoglobin A1c) at 1 year. The primary endpoint was evaluated by multivariate analysis, with the cumulative chlorpromazine equivalent amount and the baseline Suita score added as covariates. RESULTS One-hundred eighty five pairs of propensity score (PS)-matched patients were evaluated. Patients receiving atypical antipsychotic drugs exhibited a greater change in the Suita score and a risk of coronary heart disease based on the Suita score of 0.530 and 0.098%, respectively, than patients not receiving atypical antipsychotic drugs, but there was no significant difference (p = 0.412 and 0.610). The significant changes in TC and BMI were determined as 6.525 mg/dL and 0.380 kg/m2 greater, respectively, in patients treated with atypical antipsychotic drugs (p = 0.037 and 0.011). CONCLUSIONS There were no significant increases in changes in the Suita score at 1 year by treatment with atypical antipsychotic drugs compared with treatment without atypical antipsychotic drugs. However, the TC and BMI were significantly higher in patients treated with atypical antipsychotic drugs.
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Affiliation(s)
- Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido Japan
| | - Sachie Inoue
- CRECON Medical Assessment Inc, 2-12-15, Shibuya, Shibuya-ku, Tokyo, Japan
| | - Kenji Baba
- Sumitomo Dainippon Pharma Co., Ltd., 13-1, Kyobashi 1-Chome, Chuo-ku, Tokyo, Japan
| | - Tadashi Nosaka
- Sumitomo Dainippon Pharma Co., Ltd., 13-1, Kyobashi 1-Chome, Chuo-ku, Tokyo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido Japan
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Uju Y, Kanzaki T, Yamasaki Y, Kondo T, Nanasawa H, Takeuchi Y, Yanagisawa Y, Kusanishi S, Nakano C, Enomoto T, Sako A, Yanai H, Mishima S, Mimori S, Igarashi K, Takizawa T, Hayakawa T. A cross-sectional study on metabolic similarities and differences between inpatients with schizophrenia and those with mood disorders. Ann Gen Psychiatry 2020; 19:53. [PMID: 32983246 PMCID: PMC7510094 DOI: 10.1186/s12991-020-00303-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the main causes of death in psychiatric patients is cardiovascular diseases which are closely related with lifestyle-related diseases. Psychiatric disorders include schizophrenia and mood disorders, whose symptoms and treatment medicines are different, suggesting that they might have different metabolic disorders. Thus, we studied the differences of lifestyle-related diseases between schizophrenia and mood disorders in Japan. METHODS This cross-sectional study was performed from 2015 to 2017. Study participants were 189 Japanese hospitalized patients (144 schizophrenia group, 45 mood disorders group) in the department of psychiatry at Kohnodai hospital. We examined physical disorders, metabolic status of glucose and lipid, estimated glomerular filtration rate (eGFR) and brain magnetic resonance imaging. We compared these data between schizophrenia and mood disorders groups using analysis of covariance or logistic regression analysis. In comparisons between inpatients with schizophrenia or mood disorders group and the standard, we quoted 'The National Health and Nutrition Survey in Japan 2015' by Ministry of Health, Labor and Welfare as the standard. RESULTS eGFR and prevalence of smoking were significantly lower in patients with mood disorder group than those with schizophrenia group by adjustment for age. In comparisons between patients with schizophrenia group or mood disorders group and each standard, the ratio of silent brain infarction (SBI) and cerebral infarction were significantly high in both groups. Schizophrenia group showed significantly higher prevalence of diabetes, low high-density lipoprotein (HDL) cholesterolemia, metabolic syndrome and smoking than the standard. Mood disorders group had significantly high prevalence of low HDL-cholesterolemia compared with the standard. Fasting blood glucose and HbA1c were significantly higher in schizophrenia group and female mood disorders group than the standard. Female mood disorders group had significantly decreased eGFR with increased ratio of eGFR < 60 ml/min than the standard. CONCLUSIONS Participants of both groups had increased ratio of SBI and cerebral infarction, accompanied with glucose and lipid disorders. Compared with schizophrenia group, mood disorders group showed significantly low eGFR and prevalence of smoking.
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Affiliation(s)
- Yoriyasu Uju
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Tetsuto Kanzaki
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Japan
| | - Yuki Yamasaki
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Japan
| | - Tadayuki Kondo
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Hideki Nanasawa
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Yu Takeuchi
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Yuta Yanagisawa
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Shun Kusanishi
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Chieko Nakano
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Tetsuro Enomoto
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Akahito Sako
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Hidekazu Yanai
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Shunichi Mishima
- Department of Diabetes, Endocrinology and Metabolism, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
| | - Seisuke Mimori
- Department of Clinical Medicine, Faculty of Pharmacy, Chiba Institute of Science, 15-8, Shiomi-cho, Choshi, Japan
| | - Kazuei Igarashi
- Amine Pharma Research Institute, Innovation Plaza at Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Japan
| | - Tsuyoshi Takizawa
- Department of Biostatistics, Faculty of Pharmacy, Chiba Institute of Science, 15-8, Shiomi-cho, Choshi, Japan
| | - Tatsuro Hayakawa
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Japan
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Takahashi T, Otsubo T, Kunisawa S, Sasaki N, Imanaka Y. Factors associated with high-dose antipsychotic prescriptions in outpatients with schizophrenia: An analysis of claims data from a Japanese prefecture. Neuropsychopharmacol Rep 2020; 40:224-231. [PMID: 32452649 PMCID: PMC7722669 DOI: 10.1002/npr2.12109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Antipsychotics are commonly prescribed in high doses in combination with multiple psychotropic drugs. This study focused on the high‐dose antipsychotic prescriptions in patients with schizophrenia, while aiming to identify their associations with patients’ characteristics and concurrent psychotropic prescriptions. Methods This cross‐sectional study used claims data from a prefecture in Japan, between October 2014 and March 2015, to investigate antipsychotic prescriptions in adult outpatients with schizophrenia. The objective variable was the presence/absence of a high‐dose prescription. The explanatory variables included sex, age (category), presence of comorbid conditions, and the use of psychiatrist's therapy. Results After exclusion, a total of 13 471 patients with schizophrenia were analyzed. The frequency of high‐dose prescriptions was higher in men, with chlorpromazine‐equivalent values highest in the age ranges of 45‐54 and 35‐44 years for men and women, respectively. Patients aged below 65 years with cerebrovascular diseases showed a decrease in high‐dose prescriptions. There was a high frequency of polypharmacy psychotropic drug use in combination with a high‐dose antipsychotic prescription in patients aged below 65 years. Conclusion High‐dose antipsychotics are often used in combination with several psychotropic agents in patients with schizophrenia. Our findings emphasize the need to evaluate the prescribing behavior of physicians to avoid high‐dose antipsychotic prescriptions for improved patient care. This study aimed to identify the association between concurrent psychotropic prescriptions and high‐dose antipsychotic prescriptions in patients with schizophrenia in Japan. In this study, high‐dose antipsychotics were often used in combination with several psychotropic agents in patients with schizophrenia. Our findings emphasize the need to evaluate the prescribing behavior of physicians to avoid high‐dose antipsychotic prescriptions for improved patient care.
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Affiliation(s)
- Tatsuichiro Takahashi
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuya Otsubo
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Huo L, Zhang G, Du XD, Jia Q, Qian ZK, Chen D, Xiu M, Wu F, Soares JC, Huang X, Cassidy RM, Ning Y, Zhang XY. The prevalence, risk factors and clinical correlates of diabetes mellitus in Chinese patients with schizophrenia. Schizophr Res 2020; 218:262-266. [PMID: 31987695 DOI: 10.1016/j.schres.2019.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 12/21/2019] [Indexed: 01/19/2023]
Abstract
Diabetes is one of the most common comorbid diseases in patients with schizophrenia. The present study examined the prevalence of diabetes and its clinical correlates in a large sample of Chinese patients with schizophrenia, which has not been examined systemically. In this cross-sectional study, a total of 1189 patients (males/females = 938/251; average age: 48.51 ± 10.09 years) were recruited. Fasting blood samples were collected to diagnose diabetes. Psychiatric symptoms were measured with the Positive and Negative Syndrome Scale (PANSS). The prevalence of diabetes was 12.53% with a significant gender difference (males: 10.87% versus females: 18.73%). Compared to patients without diabetes, those with diabetes were older, had a later age of onset, had a higher BMI, had higher positive symptom scores and had higher level of metabolic indices, including triglyceride, cholesterol and HDL cholesterol. After stepwise binary logistic regression analysis, age, BMI, and triglyceride level remained significantly associated with diabetes. This study suggests that diabetes occur with high prevalence in Chinese schizophrenia patients. In addition, age, BMI, and triglyceride level possibly are useful markers predicting an increased risk for diabetes.
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Affiliation(s)
- Lijuan Huo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Guangya Zhang
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiang-Dong Du
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qiaqiufang Jia
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zheng-Kang Qian
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Dachun Chen
- Beijing HuilongGuan Hosptial, Beijing, China
| | - Meihong Xiu
- Beijing HuilongGuan Hosptial, Beijing, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xingbing Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ryan M Cassidy
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Kusumi I, Arai Y, Okubo R, Honda M, Matsuda Y, Matsuda Y, Tochigi A, Takekita Y, Yamanaka H, Uemura K, Ito K, Tsuchiya K, Yamada J, Yoshimura B, Mitsui N, Matsubara S, Segawa T, Nishi N, Sugawara Y, Kako Y, Shinkawa I, Shinohara K, Konishi A, Iga J, Hashimoto N, Inomata S, Tsukamoto N, Ito H, Ito YM, Sato N. Predictive factors for hyperglycaemic progression in patients with schizophrenia or bipolar disorder. BJPsych Open 2018; 4:454-460. [PMID: 30450224 PMCID: PMC6235992 DOI: 10.1192/bjo.2018.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/26/2018] [Accepted: 08/22/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Patients with schizophrenia or bipolar disorder have a high risk of developing type 2 diabetes. AIMS To identify predictive factors for hyperglycaemic progression in individuals with schizophrenia or bipolar disorder and to determine whether hyperglycaemic progression rates differ among antipsychotics in regular clinical practice. METHOD We recruited 1166 patients who initially had normal or prediabetic glucose levels for a nationwide, multisite, l-year prospective cohort study to determine predictive factors for hyperglycaemic progression. We also examined whether hyperglycaemic progression varied among patients receiving monotherapy with the six most frequently used antipsychotics. RESULTS High baseline serum triglycerides and coexisting hypertension significantly predicted hyperglycaemic progression. The six most frequently used antipsychotics did not significantly differ in their associated hyperglycaemic progression rates over the 1-year observation period. CONCLUSIONS Clinicians should carefully evaluate baseline serum triglycerides and coexisting hypertension and perform strict longitudinal monitoring irrespective of the antipsychotic used. DECLARATION OF INTEREST The authors report no financial or other relationship that is relevant to the subject of this article. Relevant financial activities outside the submitted work are as follows. I.K. has received honoraria from Astellas, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Nippon Chemiphar, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin; has received research/grant support from AbbVie GK, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, GlaxoSmithKline, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Takeda Pharmaceutical, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin; and is a member of the advisory boards of Dainippon Sumitomo Pharma and Tanabe Mitsubishi Pharma. Y.T. has received speaker's honoraria from Dainippon-Sumitomo Pharma, Otsuka, Meiji-Seika Pharma, Janssen Pharmaceutical, Daiichi-Sankyo Company, UCB Japan and Ono Pharmaceutical. K.U. has received honoraria from Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin. B.Y. has received speaker's honoraria from Otsuka Pharmaceutical and Janssen Pharmaceutical. J. I. has received honoraria from Dainippon Sumitomo Pharma, Eli Lilly, Janssen Pharmaceutical, Meiji Seika Pharma, MSD, Novartis Pharma, Otsuka Pharmaceutical and Mochida Pharma.
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Affiliation(s)
- Ichiro Kusumi
- Professor, Department of Psychiatry, Hokkaido University Graduate School of Medicine, Japan
| | - Yuki Arai
- Doctor, Department of Psychiatry, Wakkanai City Hospital, Japan
| | - Ryo Okubo
- Doctor, Department of Psychiatry, Hokkaido University Graduate School of Medicine and Honda Memorial Hospital, Japan
| | | | - Yasuhiro Matsuda
- Assistant Professor, Department of Psychiatry, Nara Medical University, Japan
| | | | | | - Yoshiteru Takekita
- Lecturer, Department of Neuropsychiatry, Kansai Medical University, Japan
| | | | - Keiichi Uemura
- Doctor, Department of Psychiatry, Sapporo City General Hospital, Japan
| | - Koichi Ito
- Vice Director, Sapporo Hanazono Hospital, Japan
| | | | | | | | - Nobuyuki Mitsui
- Assistant Professor, Department of Psychiatry, Hokkaido University Graduate School of Medicine and Department of Psychiatry, Wakkanai City Hospital, Japan
| | - Sigehiro Matsubara
- General Manager, Department of Neuropsychiatry, Obihiro National Hospital, Japan
| | | | | | | | - Yuki Kako
- Lecturer, Department of Psychiatry, Hokkaido University Graduate School of Medicine, Japan
| | | | | | | | - Junichi Iga
- Associate Professor, Department of Psychiatry, Tokushima University and Department of Psychiatry, Ehime University, Japan
| | - Naoki Hashimoto
- Associate Professor, Department of Psychiatry, Hokkaido University Graduate School of Medicine, Japan
| | | | | | - Hiroto Ito
- Director, National Institute of Occupational Safety and Health, National Center of Neurology and Psychiatry, Japan
| | - Yoichi M Ito
- Associate Professor, Department of Biostatistics, Hokkaido University Graduate School of Medicine, Japan
| | - Norihiro Sato
- Professor, Hokkaido University Hospital Clinical Research and Medical Innovation Center, Japan
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11
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Mamakou V, Hackinger S, Zengini E, Tsompanaki E, Marouli E, Serafetinidis I, Prins B, Karabela A, Glezou E, Southam L, Rayner NW, Kuchenbaecker K, Lamnissou K, Kontaxakis V, Dedoussis G, Gonidakis F, Thanopoulou A, Tentolouris N, Zeggini E. Combination therapy as a potential risk factor for the development of type 2 diabetes in patients with schizophrenia: the GOMAP study. BMC Psychiatry 2018; 18:249. [PMID: 30071838 PMCID: PMC6090901 DOI: 10.1186/s12888-018-1826-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Schizophrenia (SCZ) is associated with increased risk of type 2 diabetes (T2D). The potential diabetogenic effect of concomitant application of psychotropic treatment classes in patients with SCZ has not yet been evaluated. The overarching goal of the Genetic Overlap between Metabolic and Psychiatric disease (GOMAP) study is to assess the effect of pharmacological, anthropometric, lifestyle and clinical measurements, helping elucidate the mechanisms underlying the aetiology of T2D. METHODS The GOMAP case-control study (Genetic Overlap between Metabolic and Psychiatric disease) includes hospitalized patients with SCZ, some of whom have T2D. We enrolled 1653 patients with SCZ; 611 with T2D and 1042 patients without T2D. This is the first study of SCZ and T2D comorbidity at this scale in the Greek population. We retrieved detailed information on first- and second-generation antipsychotics (FGA, SGA), antidepressants and mood stabilizers, applied as monotherapy, 2-drug combination, or as 3- or more drug combination. We assessed the effects of psychotropic medication, body mass index, duration of schizophrenia, number of hospitalizations and physical activity on risk of T2D. Using logistic regression, we calculated crude and adjusted odds ratios (OR) to identify associations between demographic factors and the psychiatric medications. RESULTS Patients with SCZ on a combination of at least three different classes of psychiatric drugs had a higher risk of T2D [OR 1.81 (95% CI 1.22-2.69); p = 0.003] compared to FGA alone therapy, after adjustment for age, BMI, sex, duration of SCZ and number of hospitalizations. We did not find evidence for an association of SGA use or the combination of drugs belonging to two different classes of psychiatric medications with increased risk of T2D [1.27 (0.84-1.93), p = 0.259 and 0.98 (0.71-1.35), p = 0.885, respectively] compared to FGA use. CONCLUSIONS We find an increased risk of T2D in patients with SCZ who take a combination of at least three different psychotropic medication classes compared to patients whose medication consists only of one or two classes of drugs.
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Affiliation(s)
- Vasiliki Mamakou
- Medical School, National and Kapodistrian University Athens, 75 M. Assias Street, 115 27, Athens, Greece. .,Dromokaiteio Psychiatric Hospital, 124 61, Athens, Greece.
| | - Sophie Hackinger
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | - Eleni Zengini
- Dromokaiteio Psychiatric Hospital, 124 61 Athens, Greece ,0000 0004 1936 9262grid.11835.3eDepartment of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Evgenia Tsompanaki
- 0000 0001 2179 8267grid.16299.35School of Information Sciences and Technology, Department of Statistics, Athens University of Economics and Business, 10434 Athens, Greece
| | - Eirini Marouli
- 0000 0001 2171 1133grid.4868.2William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQ, London, UK
| | - Ioannis Serafetinidis
- grid.414012.2Department of Gastroenterology, Gennimatas General Hospital, 11527 Athens, Greece
| | - Bram Prins
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | | | - Eirini Glezou
- Dromokaiteio Psychiatric Hospital, 124 61 Athens, Greece
| | - Lorraine Southam
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK ,0000 0004 1936 8948grid.4991.5Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Nigel W. Rayner
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK ,0000 0004 1936 8948grid.4991.5Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK ,0000 0004 0606 4224grid.470392.bOxford Centre for Diabetes Endocrinology and Metabolism, Oxford, UK
| | - Karoline Kuchenbaecker
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | - Klea Lamnissou
- 0000 0001 2155 0800grid.5216.0National and Kapodistrian University of Athens, Department of Biology, Athens, Panepistimioupolis, AnoIlisia, 15771 Athens, Greece
| | - Vassilis Kontaxakis
- 0000 0001 2155 0800grid.5216.0Early Psychosis Unit, 1st Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Dedoussis
- 0000 0004 0622 2843grid.15823.3dDepartment of Nutrition-Dietetics, Harokopio University, 17671 Athens, Greece
| | - Fragiskos Gonidakis
- 0000 0001 2155 0800grid.5216.01st Psychiatric Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasia Thanopoulou
- 0000 0001 2155 0800grid.5216.0Diabetes Centre, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, 11527 Athens, Greece
| | - Eleftheria Zeggini
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
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Moullan M, Denis F. [Schizophrenia and oral health]. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:115-118. [PMID: 28345513 DOI: 10.1016/j.jormas.2016.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 07/22/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022]
Abstract
Mental health is an essential component of general health. Schizophrenia is a severe and chronic mental illness that affects higher brain functions. It is characterized by the presence of a mental dissociation, dampened or inappropriate affects, hallucinations and delirium. Schizophrenia has also a negative impact on oral health. As schizophrenia affects 1% of the population, every practitioner concerned with oral sphere will be confronted one day or another with a patient suffering from this disease. It is therefore important to acquire essential notions. The aim of our work was to make an update about factors that may affect oral health in patients with schizophrenia.
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Affiliation(s)
- M Moullan
- Service d'odontologie de médecine buccale et chirurgie orale, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France.
| | - F Denis
- Centre hospitalier La Chartreuse, 1, boulevard Chanoine-Kir, BP 23314, 21033 Dijon cedex, France; Centre de soins d'enseignement et de recherche dentaires, université de Reims Champagne-Ardennes, 9, boulevard de la Paix, 51100 Reims, France
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13
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Sado J, Kitamura T, Noma N, Saito M, Azuma H, Azuma T, Sobue T, Kitamura Y. Socio-environmental factors associated with diabetes mellitus among patients hospitalized with schizophrenia in Japan. Environ Health Prev Med 2016; 21:460-469. [PMID: 27448295 DOI: 10.1007/s12199-016-0550-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/03/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE This study aimed to examine epidemiologically socio-environmental factors associated with diabetes mellitus among patients hospitalized with schizophrenia in Japan. METHODS This was a cross-sectional study from a single psychiatric hospital. Study patients were adults aged ≥20 years who were hospitalized with schizophrenia one or more times between January 2013 and December 2014. From electronic medical records or health insurance claims, we extracted schizophrenia patients with an F2 code according to ICD-10, and assessed the association of various factors with diabetes mellitus among these patients in a multivariable analysis. RESULTS During the 2-year period, there were 1899 patients hospitalized with a psychiatric disorder one or more times. Of them, a total of 770 adults with schizophrenia (285 men and 485 women) were eligible for our analysis. The standardized prevalence ratio of diabetes mellitus was 2.0 [95 % confidence interval (CI) 1.6-2.5] among men and 3.0 (95 % CI 2.5-3.6) among women in this hospital. There were no socio-environmental factors associated with diabetes mellitus among men. Among women, factors such as a 730-day hospitalization [adjusted odds ratio (OR) 3.82: 95 % confidence interval (CI) 1.52-9.64], and a medical protection/compulsory/discrimination hospitalization (adjusted OR 0.60, 95 % CI 0.36-0.99) were associated with diabetes mellitus. Compared with women living alone, those who were unmarried and lived together with someone had a significantly lower adjusted OR (0.41, 95 % CI 0.21-0.81). CONCLUSIONS Socio-environmental factors such as length of hospitalization, type of hospitalization, and marital status and living arrangement were associated with diabetes mellitus among hospitalized women with schizophrenia.
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Affiliation(s)
- Junya Sado
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Norio Noma
- Social Welfare Corporation, Kosaka Hospital, 2-7-30 Eiwa, Higashi-Osaka, 577-0809, Osaka, Japan
| | - Makiko Saito
- Social Welfare Corporation, Kosaka Hospital, 2-7-30 Eiwa, Higashi-Osaka, 577-0809, Osaka, Japan
| | - Hitoshi Azuma
- Social Welfare Corporation, Kosaka Hospital, 2-7-30 Eiwa, Higashi-Osaka, 577-0809, Osaka, Japan
| | - Tsukasa Azuma
- Social Welfare Corporation, Kosaka Hospital, 2-7-30 Eiwa, Higashi-Osaka, 577-0809, Osaka, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, 565-0871, Osaka, Japan.
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14
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Abstract
BACKGROUND There is little expert consensus as to which drugs should comprise the first-line pharmacological treatment for delirium. We sought to assess experts' opinions on the first-line oral and injection drugs for delirium associated with a diverse range of clinical features using a rating-based conjoint analysis. METHODS We conducted a cross-sectional study. We mailed a questionnaire to all consultation-liaison psychiatrists/educators certified by the Japanese Society of General Hospital Psychiatry. RESULTS Of 136 experts (response rate: 27.5%), more than 68% recommended the use of risperidone or quetiapine administered orally for hyperactive delirium, except in patients with comorbid diabetes and renal dysfunction. More than 67% recommended the use of haloperidol administered intravenously for hyperactive delirium if an intravenous line has been placed. No oral or injection drugs were recommended by over half of experts for treatment of hypoactive delirium with any clinical features. CONCLUSIONS In the absence of a definitive treatment trial, there are both areas of agreement and a lack of consensus regarding the first-line drug. Efforts are needed to routinely collect information that would allow a comparison of the effectiveness and safety of various drugs in real-world clinical practice.
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15
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Stubbs B, Vancampfort D, De Hert M, Mitchell AJ. The prevalence and predictors of type two diabetes mellitus in people with schizophrenia: a systematic review and comparative meta-analysis. Acta Psychiatr Scand 2015; 132:144-57. [PMID: 25943829 DOI: 10.1111/acps.12439] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To conduct a meta-analysis investigating the prevalence of type two diabetes mellitus (T2DM) in people with schizophrenia compared to controls. METHOD Systematic review of electronic databases from inception till November 2014. Articles reporting the prevalence of T2DM in people with schizophrenia and healthy controls (without mental illness) were included. Two independent authors conducted searches and extracted data. A random effects relative risks (RR) meta-analysis was conducted. RESULTS Twenty-five studies including 145,718 individuals with schizophrenia (22.5-54.4 years) and 4,343,407 controls were included. The prevalence of T2DM in people with schizophrenia was 9.5% (95% CI = 7.0-12.8, n = 145,718) and 10.75% (95% CI 7.44-14.5%, n = 2698) in studies capturing T2DM according to recognized criteria. The pooled RR across all studies was 1.82 (95% CI = 1.56-2.13; = 4,489,125). Subgroup analyses found a RR of 2.53 (95% CI = 1.68-3.799, n = 17,727) in studies ascertaining T2DM according to recognized criteria and RR 1.65 (95% CI = 1.34-2.03, n = 4,243,389) in studies relying on T2DM determined through medical records. CONCLUSION People with schizophrenia are at least double the risk of developing T2DM according to recognized T2DM criteria. Proactive lifestyle and screening programmes should be given clinical priority.
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Affiliation(s)
- B Stubbs
- Faculty of Education and Health, University of Greenwich, London, UK
| | - D Vancampfort
- University Psychiatric Centre, KU Leuven, Kortenberg, Belgium.,Departement of Neurosciences, KU Leuven, Kortenberg, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Kortenberg, Belgium
| | - M De Hert
- University Psychiatric Centre, KU Leuven, Kortenberg, Belgium.,Departement of Neurosciences, KU Leuven, Kortenberg, Belgium
| | - A J Mitchell
- Department of Psycho-Oncology, Leicestershire Partnership NHS Trust, University of Leicester, Leicester, UK
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16
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Ko CY, Liu YP. Isolation rearing impaired sensorimotor gating but increased pro-inflammatory cytokines and disrupted metabolic parameters in both sexes of rats. Psychoneuroendocrinology 2015; 55:173-83. [PMID: 25770703 DOI: 10.1016/j.psyneuen.2015.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 12/18/2022]
Abstract
Social isolation rearing (SIR) is an early stress paradigm of deprivation of the social contact since weaning. SIR has been used to investigate the mechanisms behind certain mental illnesses with neurodevelopmental origins, including schizophrenia. In schizophrenia, metabolic dysfunction has become a critical issue with increasing evidence for a possible connection between metabolism and immune systems in which metabolic changes are associated with pro-inflammatory cytokine (pro-CK) levels. The present study employed a rat model of SIR with both sexes to examine behaviors [locomotor activity and prepulse inhibition (PPI)], inflammatory markers [C-reactive protein, interleukin (IL)-1 beta, IL-6, IL-10, tumor necrosis factor (TNF)-alpha and interferon-gamma], and metabolism-related variables (body weight, blood pressure, and the profiles of glycemia and lipid). Our results revealed that around puberty, SIR rats of both sexes exhibited behaviorally a higher locomotor activity and a lower PPI performance. Biochemically, SIR rats had an elevated level of pro-CKs (IL-1 beta, IL-6, TNF-alpha, and interferon-gamma), and metabolic abnormalities (increased insulin resistance, decreased insulin sensitivity, and high blood pressure) in a time-dependent manner. The relationships between pro-CKs and metabolism were sex specific as IL-1 beta and interferon-gamma were correlated to glycemia metabolic indexes in males. The present study demonstrated SIR-induced longitudinal concomitant changes of pro-CKs and metabolic abnormalities, implying a more direct role of these two things in mental dysfunctions with a developmental origin.
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Affiliation(s)
- Chih-Yuan Ko
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yia-Ping Liu
- Department of Physiology and Biophysics, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.
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17
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Young SL, Taylor M, Lawrie SM. "First do no harm." A systematic review of the prevalence and management of antipsychotic adverse effects. J Psychopharmacol 2015; 29:353-62. [PMID: 25516373 DOI: 10.1177/0269881114562090] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS We aim to identify the prevalence and management strategies of nine clinically important categories of antipsychotic adverse effects, namely: extrapyramidal symptoms; sedation; weight gain; type II diabetes; hyperprolactinaemia; metabolic syndrome, dyslipidaemia; sexual dysfunction; and cardiovascular effects. BACKGROUND Antipsychotic drugs are widely prescribed for schizophrenia and other mental disorders. The adverse effects of antipsychotics are common, with a potential negative impact on adherence and engagement. Despite this, the scientific study of the prevalence or management of adverse antipsychotic effects is a neglected area. METHOD A systematic review was undertaken using pre-defined search criteria and three databases, with hand searching of citations and references. Inclusion was agreed on by two independent researchers after review of abstracts or full text. Quality analysis of included studies was conducted using pre-agreed criteria. RESULTS In total, 53 studies met inclusion criteria, revealing the following: (1) antipsychotic polypharmacy was associated with increased frequency of adverse effects, and (2) a longer duration of treatment is associated with greater severity (e.g. higher BMI); (3) clozapine was more strongly associated with metabolic disturbance than other antipsychotics in three studies and olanzapine was associated with the most weight gain in three studies; (4) hyperprolactinaemia was more common in women than men, but 50% men noted sexual dysfunction versus 25-50% in women; (5) despite clinical guideline recommendations there is a low rate of baseline testing for lipids and glucose; and (6) seven studies described adverse effect management strategies, but only two examined their efficacy - one found a significant reduction in weight with non-pharmacological group therapy and the other found a significant reduction in dyslipidaemia with statins. CONCLUSIONS Antipsychotic adverse effects are diverse and frequently experienced, but are not often systematically assessed. There is a need for further scientific study concerning the management of these side effects.
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18
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Kanzaki T, Uju Y, Sekine K, Ishii Y, Yoshimi T, Yasui R, Yasukawa A, Sato M, Okamoto S, Hisaoka T, Miura M, Kusanishi S, Murakami K, Nakano C, Mizuta Y, Mimori S, Mishima S, Igarashi K, Takizawa T, Hayakawa T, Tsukada K. Increased Silent Brain Infarction Accompanied With High Prevalence of Diabetes and Dyslipidemia in Psychiatric Inpatients: A Cross-Sectional Study. Prim Care Companion CNS Disord 2015; 17:14m01713. [PMID: 26445690 DOI: 10.4088/pcc.14m01713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/22/2014] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Patients with schizophrenia have increased risk of atherosclerotic diseases. It is already known that lifestyle-related disorders and the use of antipsychotics are closely related with the progression of atherosclerosis in psychiatric patients. Stroke as well as coronary heart disease play an important role in the cause of death in Asia and Japan. Thus, we studied the prevalence of cerebrovascular disease in psychiatric inpatients in Japan using brain magnetic resonance imaging (MRI). METHOD This cross-sectional study was performed from January 2012 to December 2013. Study participants were 152 hospitalized patients (61 men and 91 women) in the Department of Psychiatry at Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City, Japan. Mean ages were 50.0 and 57.1 years old for men and women, respectively. The diagnoses (DSM-IV-TR criteria) of participants were schizophrenia (69.1%), mood disorder (18.4%), and other mental disorders (12.5%). We checked physical status, metabolic status of glucose and lipid levels, and brain MRI within 1 week of admission. RESULTS The study group showed a significantly high prevalence of diabetes and low high-density lipoprotein (HDL) cholesterolemia in both sexes (n = 61 in men, n = 91 in women, P < .05). In the study group, serum fasting plasma glucose and hemoglobin A1c levels were significantly high (n = 152, P < .05), but serum HDL cholesterol and total cholesterol were significantly low in both sexes (n = 61 in men, n = 90 in women, P < .05), and triglycerides were low in men (n = 61, P < .05). Silent brain infarction was recognized at a higher rate (n = 98, P < .05) compared with healthy controls. CONCLUSIONS Participants in this study had an increased ratio of silent brain infarction compared with Japanese healthy controls, accompanied with higher ratios of diabetes and low HDL cholesterol.
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Affiliation(s)
- Tetsuto Kanzaki
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Yoriyasu Uju
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Keisuke Sekine
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Yukihiro Ishii
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Taro Yoshimi
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Reiko Yasui
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Asuka Yasukawa
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Mamoru Sato
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Seiko Okamoto
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Tetsuya Hisaoka
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Masafumi Miura
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Shun Kusanishi
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Kanako Murakami
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Chieko Nakano
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Yasuhiko Mizuta
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Seisuke Mimori
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Shunichi Mishima
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Kazuei Igarashi
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Tsuyoshi Takizawa
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Tatsuro Hayakawa
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
| | - Kazumi Tsukada
- Department of Clinical Medicine (Drs Kanzaki and Mimori) and Department of Biostatistics (Dr Takizawa), Faculty of Pharmacy, Chiba Institute of Science, Choshi City; Department of Psychiatry (Drs Uju, Sekine, Ishii, Yoshimi, Yasui, Yasukawa, Sato, Okamoto, Hisaoka, Miura, Kusanishi, Murakami, Nakano, Mizuta, Hayakawa, and Tsukada) and Department of Internal Medicine (Dr Mishima), Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City; and Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba City (Dr Igarashi), Japan
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Abitbol R, Rej S, Segal M, Looper KJ. Diabetes mellitus onset in geriatric patients: does long-term atypical antipsychotic exposure increase risk? Psychogeriatrics 2015; 15:43-50. [PMID: 25369990 DOI: 10.1111/psyg.12081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/10/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) in common in adults using psychotropic medications. However, it remains largely unknown whether there is an additional risk of diabetes mellitus (DM) in elderly psychiatric outpatients, particularly those with long-term exposure to atypical antipsychotics (AP). METHODS In this retrospective longitudinal study, 61 atypical AP-exposed and 64 atypical AP-unexposed geriatric psychiatric patients were compared to a group of 200 psychotropic-naïve controls. Our main composite outcome was diabetes incidence over a 4-year period, defined by fasting blood glucose ≥ 7.0 mmol/L or a new-onset oral hypoglycaemic or insulin prescription during the 4-year period. RESULTS The 4-year incidence of DM did not differ significantly between groups: 12.3%, 6.7%, and 11.9% in the atypical AP-exposed, atypical AP-unexposed, and control groups, respectively (χ(2) = 1.40, P = 0.50). Depression and antidepressant, cholinesterase inhibitor, and valproate use were independently associated with increases in fasting glucose. However, hyperglycaemia and hypoglycaemic prescriptions were not more common in geriatric psychiatric patients. CONCLUSIONS DM does not appear to be more common in geriatric psychiatric patients than similarly aged controls and is not more common in atypical AP users. However, depression and antidepressant, cholinesterase inhibitor, and valproate use may increase fasting glucose levels, and the clinical significance of this warrants further investigation. Nonetheless, given the rates of untreated and undertreated fasting hyperglycaemia in both our geriatric psychiatric and control samples (>10% of all patients), we recommend regular screening for DM in these populations.
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Affiliation(s)
- Roza Abitbol
- Faculty of Medicine, Laval University, Laval, Quebec, Canada
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Vancampfort D, Wampers M, Mitchell AJ, Correll CU, De Herdt A, Probst M, De Hert M. A meta-analysis of cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia versus general population controls. World Psychiatry 2013; 12:240-50. [PMID: 24096790 PMCID: PMC3799255 DOI: 10.1002/wps.20069] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A meta-analysis was conducted to explore the risk for cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia and age- and gender- or cohort-matched general population controls. Our literature search generated 203 relevant studies, of which 136 were included. The final dataset comprised 185,606 unique patients with schizophrenia, and 28 studies provided data for age- and gender-matched or cohort-matched general population controls (n=3,898,739). We found that multi-episode patients with schizophrenia were at increased risk for abdominal obesity (OR=4.43; CI=2.52-7.82; p<0.001), hypertension (OR=1.36; CI=1.21-1.53; p<0.001), low high-density lipoprotein cholesterol (OR=2.35; CI=1.78-3.10; p<0.001), hypertriglyceridemia (OR=2.73; CI=1.95-3.83; p<0.001), metabolic syndrome (OR=2.35; CI=1.68-3.29; p<0.001), and diabetes (OR=1.99; CI=1.55-2.54; p<0.001), compared to controls. Multi-episode patients with schizophrenia were also at increased risk, compared to first-episode (p<0.001) and drug-naïve (p<0.001) patients, for the above abnormalities, with the exception of hypertension and diabetes. Our data provide further evidence supporting WPA recommendations on screening, follow-up, health education and lifestyle changes in people with schizophrenia.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Centre KU Leuven, Campus Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
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21
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Rate of general medical conditions in a sample of psychiatric outpatients in a general hospital. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000426531.96773.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Takayanagi Y, Cascella NG, Sawa A, Eaton WW. Diabetes is associated with lower global cognitive function in schizophrenia. Schizophr Res 2012; 142:183-7. [PMID: 23031192 PMCID: PMC4004180 DOI: 10.1016/j.schres.2012.08.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 08/27/2012] [Accepted: 08/29/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Co-morbidity of schizophrenia (SZ) and metabolic problems such as diabetes mellitus (DM) has been suggested by many studies. Nonetheless, it is still debated whether DM affects cognitive dysfunction associated with SZ and how much treatment for DM is beneficial for cognitive functions in SZ. We addressed these questions by re-assessing the cognitive dataset from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study. METHODS We identified 1289 SZ patients in which scores for several cognitive domains of verbal memory, vigilance, processing speed, reasoning, and working memory together with the composite score and metabolic characteristics (body mass index, dyslipidemia, hypertension, and DM) were available at baseline of the trial. We performed multiple linear regression analyses to assess the impact of DM on cognitive performance of SZ patients, controlling for a number of other confounding factors including obesity, hypertension, and dyslipidemia. We also conducted analyses of covariance to compare cognitive performance among SZ patients without DM and diabetic SZ sub-groups based on anti-diabetic drugs they were receiving at baseline of the trial. RESULTS Co-morbid DM with SZ predicted worse overall cognitive performance and lower scores for three cognitive domains (vigilance, processing speed, and reasoning), but none of the other metabolic factors (i.e., obesity, hypertension and dyslipidemia) correlated with cognitive function in SZ. Furthermore, SZ patients with untreated DM showed poorer overall cognitive performance and a significantly lower score in the domain of vigilance compared with SZ patients without DM. CONCLUSION Our data suggest that DM negatively affects the overall cognitive function of SZ patients.
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Affiliation(s)
- Yoichiro Takayanagi
- Department of Mental Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
| | - Nicola G. Cascella
- Neuropsychiatry Program, Sheppard Enoch Pratt Hospital, Baltimore,
MD, United Sates,Correspondence: Nicola G. Cascella M.D., Neuropsychiatry
Program, Sheppard Enoch Pratt Hospital, 6501 N. Charles Street, Towson, Maryland
21204, United Sates,
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins
University School of Medicine, Baltimore, MD 21287, United States
| | - William W. Eaton
- Department of Mental Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
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Hultsjö S, Hjelm K. Community health-care staff's experiences of support to prevent type 2 diabetes among people with psychosis: an interview study with health staff. Int J Ment Health Nurs 2012; 21:480-9. [PMID: 22616560 DOI: 10.1111/j.1447-0349.2012.00820.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the study was to describe mental health staff experiences of giving support to prevent type 2 diabetes mellitus (DM) among people with psychosis in community psychiatry. A qualitative interview study with a purposeful sample of 12 community health staff was conducted. Data were analysed using qualitative content analysis. The results show how staff reported continuously supporting people with psychosis to adapt to healthy lifestyles, but stated that support is not given until after a person becomes overweight or is diagnosed with type 2 DM. Support was described as a never-ending process of motivation facing many reverses. Individually-adapted support given in practical situations was perceived as most successful. Cooperation between health-care organizations was seen as essential, but inadequate. Limitations in income and social network, and easy access to fast food and alcohol, were seen as obstacles to support. The results indicate that community health staff are in a position to make a considerable impact in motivating and supporting healthy lifestyle changes in practical situations in daily life among people with psychosis. This study raises awareness of how community health staff's support can be useful when developing nursing skills and health-care plans for people with psychosis.
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Affiliation(s)
- Sally Hultsjö
- Psychiatric Clinic, County Hospital, Ryhov, Jonkoping, Sweden.
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Predictors of death from natural causes in schizophrenia: 10-year follow-up of a community cohort. Soc Psychiatry Psychiatr Epidemiol 2012; 47:843-7. [PMID: 21559973 DOI: 10.1007/s00127-011-0392-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 04/27/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE People with schizophrenia have increased natural mortality. There is much speculation but little evidence about the reasons behind this. This paper describes a study designed to measure the impact of pre-selected clinical, demographic and lifestyle variables on the natural mortality of a cohort with schizophrenia. METHODS Ten-year Cox proportional hazards regression analysis of a community cohort of 95 people with schizophrenia. RESULTS Death from natural causes was significantly associated with psychosis (HR 2.62, 95% CI 1.13-6.07), age (HR 1.08, 95% CI 1.02-1.13) and cigarette smoking (HR 2.53, 95% CI 1.01-6.34) at outset. There was a trend to association with low dietary unsaturated fat (P = 0.06). CONCLUSIONS Active psychosis appears to predict natural mortality in people with schizophrenia. Mental health services should prioritise the effective treatment of psychosis. Further research is needed to clarify other risk factors and evaluate health promotion interventions.
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Ye W, Ascher-Svanum H, Tanji Y, Flynn JA, Takahashi M, Conley RR. Antipsychotic monotherapy among outpatients with schizophrenia treated with olanzapine or risperidone in Japan: a health care database analysis. Neuropsychiatr Dis Treat 2012; 8:259-66. [PMID: 22745559 PMCID: PMC3385585 DOI: 10.2147/ndt.s25662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Antipsychotic monotherapy is often recommended over antipsychotic polypharmacy because of fewer adverse events, reduced treatment complexity, and lower medication cost. This study compared the rate and the duration of antipsychotic monotherapy following initiation of olanzapine or risperidone in the treatment of outpatients with schizophrenia in Japan. METHODS Outpatients diagnosed with schizophrenia in the Japan Medical Data Center database were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, diagnosis codes. Patients were between 20 and 65 years old, initiated on olanzapine or risperidone therapy between August 2003 and July 2008, and continuously enrolled during the 6 months prior to and the 12 months following the initiation date. Antipsychotic polypharmacy was defined as concurrent use of two or more antipsychotics. The probability of monotherapy during the 12-month follow-up period was assessed using a propensity score-adjusted generalized estimating equation model. Duration of monotherapy was contrasted using a propensity score-adjusted bootstrapping model. RESULTS After applying all inclusion and exclusion criteria, the final analytic sample consisted of 332 olanzapine- and 496 risperidone-treated outpatients. At treatment initiation, 61.5% of the olanzapine-treated patients and 45.6% of the risperidone-treated patients received antipsychotic monotherapy (P < 0.001). After correcting for background differences, monotherapy was more common among olanzapine-treated patients (P = 0.001). In addition, olanzapine was used as monotherapy for a longer duration (P = 0.006). CONCLUSION Consistent with prior global research, this retrospective naturalistic study of schizophrenia outpatients in Japan found that olanzapine is more likely to be used as monotherapy and to be used as monotherapy for a longer duration than risperidone.
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Affiliation(s)
- Wenyu Ye
- Lilly Suzhou Pharmaceutical Co, Ltd, Shanghai, People's Republic of China
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Kusumi I, Ito K, Uemura K, Honda M, Hayashishita T, Miyamoto K, Sawayama H, Kako Y, Tsuchida S, Hashimoto N, Koyama T. Screening for diabetes using monitoring guidance in schizophrenia patients treated with second-generation antipsychotics: a 1-year follow-up study. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1922-6. [PMID: 21807061 DOI: 10.1016/j.pnpbp.2011.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/08/2011] [Accepted: 07/09/2011] [Indexed: 11/26/2022]
Abstract
Second-generation antipsychotics (SGAs) tend to induce weight gain, dyslipidemia and diabetes mellitus. For those reasons, patients treated with SGAs should receive appropriate monitoring to avoid morbidity and mortality associated with cardiovascular disease. We conducted a one-year follow-up study using Japanese blood glucose monitoring guidance in schizophrenia patients treated with SGAs to evaluate the detection capability of the guidance in real clinical settings and to assess the importance of longitudinal monitoring. This retrospective cohort study included schizophrenia patients receiving at least one SGA, who were enrolled during June 2008-January 2009 at multiple sites and who had both baseline data and follow-up monitoring data at month 12. After one-year follow-up, the probable diabetes type (fasting blood glucose is higher than 125 mg/dL, casual blood glucose is higher than 179 mg/dL, or glycosylated hemoglobin (Hb(A1c)) is greater than 6.4%) was detected in 30 (8%) of the patients, and the pre-diabetes type (fasting blood glucose is 110-125 mg/dL, or casual blood glucose is 140-179 mg/dL, or Hb(A1c) is 6.0-6.4%) in 65 (17.4%) out of the total of 374 patients. During the follow-up period, 1.5% of patients had advanced from the normal (fasting blood glucose is less than 110 mg/dL, casual blood glucose is less than 140 mg/dL, or Hb(A1c) is less than 6.0%) to probable diabetes type and 42.4% had progressed from the pre-diabetes to probable diabetes type. Predictive factors for worsening of the diabetic state were a family history of diabetes, and high serum total-cholesterol and triglyceride levels at baseline. Not only cross-sectional baseline screening but also longitudinal follow-up screening is important to detect glucose abnormalities in patients treated with SGAs.
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Affiliation(s)
- Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Kusumi I, Ito K, Honda M, Hayashishita T, Uemura K, Hashimoto N, Murasaki M, Atsumi Y, Kadowaki T, Koyama T. Screening for diabetes using Japanese monitoring guidance in schizophrenia patients treated with second-generation antipsychotics: a cross-sectional study using baseline data. Psychiatry Clin Neurosci 2011; 65:349-55. [PMID: 21545674 DOI: 10.1111/j.1440-1819.2011.02218.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The Japanese blood glucose monitoring guidance for patients receiving second-generation antipsychotics has been newly developed. We aimed to report a cross-sectional study using the baseline data of the Japanese monitoring guidance to find undiagnosed hyperglycemia systematically as a routine clinical practice and to quantify the frequency of glucose abnormalities in schizophrenia patients treated with second-generation antipsychotics. METHODS Data for 537 patients with schizophrenia, who had not been diagnosed as having diabetes prior to baseline screening and started the monitoring between June 2008 and January 2009, were collected from medical records in 25 hospitals. Blood glucose (fasting or casual), hemoglobin(A1c) , serum lipids, height/weight, clinical diabetic symptoms, and family history of diabetes were assessed. Patients were classified into normal, pre-diabetic or probable diabetic type based on their values of blood glucose or hemoglobin(A1c) , and various background characteristics and serum lipid values were compared among the three types. RESULTS Out of 537 patients, 13 (2.4%) met criteria for probable diabetic type, 51 (9.5%) for pre-diabetic type, and 473 (88.1%) for normal type. Individuals categorized as probable diabetic type had a higher body mass index and higher frequency of family history of diabetes mellitus than those with normal type. CONCLUSION Glucose abnormalities were newly detected in 11.9% of schizophrenia patients treated with second-generation antipsychotics by the baseline monitoring. To assess the detective power and usefulness of the guidance, longitudinal investigations are necessary.
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Affiliation(s)
- Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Lee SY, Park MH, Patkar AA, Pae CU. A retrospective comparison of BMI changes and the potential risk factors among schizophrenic inpatients treated with aripiprazole, olanzapine, quetiapine or risperidone. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:490-6. [PMID: 21146575 DOI: 10.1016/j.pnpbp.2010.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/03/2010] [Accepted: 12/03/2010] [Indexed: 11/15/2022]
Abstract
The objective of this study was to evaluate weight gain and its potential risk factors among different second generation antipsychotics (SGAs). The study was conducted for Korean inpatients with schizophrenia in a university hospital in Seoul, between Jan 2000 and Dec 2007. Data were collected by reviewing the medical records of the patients, who were prescribed to one of the SGAs among aripiprazole, olanzapine, quetiapine or risperidone. The changes of weight and body mass index (BMI); risk of clinically significant weight gain (>7% gain to initial weight) and their associations with various clinical characteristics of such patients were analyzed. Five hundred and eighty-eight (588) and 294 subjects treated with one of the four SGAs for a duration of 1 month and 2 months were included, respectively. Olanzapine showed significantly greater weight and BMI increase at month 1 (p=0.028 for weight; p=0.019 for BMI) and month 2 (p=0.032 for weight; p=0.029 for BMI) than others. Females showed greater BMI increase change (0.70±0.91 kg/m(2), p=0.008) and were also more likely to experience clinically significant weight gain (odd ratio=1.846, 95% CI=1.098 to 3.105, p=0.021) at month 1. Younger patients (<45 years old) had significantly greater weight and BMI increase at both months 1 and 2. Younger patients also showed greater risk for clinically significant weight gain at month 2 (odd odd ratio=2.567, 95% CI=1.196 to 5.508, p=0.016). Low baseline BMI (<25 kg/m(2)) was associated with greater weight gain at month 1 (1.92±2.29 kg, p<0.001) and month 2 (4.07±3.56 kg, p<0.001) and BMI increase at month 1 and month 2 (p<0.001 for both). Patients with low baseline BMI showed higher risk of clinically significant weight gain at both months 1 and 2 (p<0.001 for both). Olanzapine was shown to have higher metabolic risk than other SGAs in inpatients with schizophrenia. The individual's own clinical characteristics also exerted influence on weight gain effects of SGAs. Younger patients with lower baseline BMI were under greater risk of antipsychotic-induced weight gain. More studies are required to verify the role of gender on weight gain.
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Affiliation(s)
- Seung-Yup Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
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DE Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011; 10:52-77. [PMID: 21379357 PMCID: PMC3048500 DOI: 10.1002/j.2051-5545.2011.tb00014.x] [Citation(s) in RCA: 1450] [Impact Index Per Article: 111.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.
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Abstract
OBJECTIVE To record risk factors for breast cancer in women with schizophrenia and recommend preventive actions. METHOD A PubMed literature search (from 2005 to 2010) was conducted, using the search terms 'schizophrenia', 'antipsychotics', 'breast cancer' and 'risk factors'. RESULTS Several risk factors of relevance to schizophrenia were identified: obesity, elevated prolactin levels, low participation in mammography screening, high prevalence of diabetes, comparatively low parity, low incidence of breastfeeding, social disadvantage, high levels of smoking and alcohol consumption, low activity levels. CONCLUSION Awareness of breast cancer risk should lead to more accurate risk ascertainment, stronger linkage with primary care, regular monitoring and screening, judicious choice and low dose of antipsychotic treatment, concomitant use of adjunctive cognitive and psychosocial therapies, referral to diet and exercise programmes as well as smoking and drinking cessation programmes, avoidance of hormonal treatment and discussion with patient and family about the pros and cons of preventive measures in high-risk women. Psychiatrists are in a position to reverse many of the identified risk factors.
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Affiliation(s)
- M V Seeman
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
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Banta JE, Belk I, Newton K, Sherzai A. Inpatient charges and mental illness: Findings from the Nationwide Inpatient Sample 1999-2007. CLINICOECONOMICS AND OUTCOMES RESEARCH 2010; 2:149-58. [PMID: 21935325 PMCID: PMC3169970 DOI: 10.2147/ceor.s7560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Indexed: 11/23/2022] Open
Abstract
Inpatient costs related to mental illness are substantial, though declining as a percentage of overall mental health treatment costs. The public sector has become increasingly involved in funding and providing mental health services. Nationwide Inpatient Sample data for the years 1999–2007 were used to: 1) examine Medicare, Medicaid, and private insurance charges related to mental illness hospitalizations, including trends over time; and 2) examine trends in mental comorbidity with physical illness and its effect on charges. There were an estimated 12.4 million mental illness discharges during the 9-year period, with Medicare being the primary payer for 4.3 million discharges, Medicaid for 3.3 million, private insurance for 3.2 million, and 1.6 million for all other payers. Mean inflation-adjusted charges per hospitalization were US$17,528, US$15,651, US$10,539, and US$11,663, respectively. Charges to public sources increased for schizophrenia and dementia-related discharges, with little private/public change noted for mood disorders. Comorbid mood disorders increased dramatically from 1.5 million discharges in 1999 to 3.4 million discharges in 2007. Comorbid illness was noted in 14.0% of the 342 million inpatient discharges during the study period and was associated with increased charges for some medical conditions and decreased charges for other medical conditions.
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