Metabolic syndrome with the atypical antipsychotics

Combined sulforaphane and β-sitosterol mitigate olanzapine-induced metabolic disorders in rats: Insights on FOXO, PI3K/AKT, JAK/STAT3, and MAPK signaling pathways

One of the best antipsychotics for treating schizophrenia and bipolar disorders is olanzapine (OLA). However, its use is restricted owing to unfavorable adverse effects as liver damage, dyslipidemia, and weight gain. The primary objective of the present investigation was to examine the signaling mechanisms that underlie the metabolic disruption generated by OLA. Besides, the potential protective effect of sulforaphane (SFN) and β-sitosterol (βSS) against obesity and metabolic toxicity induced by OLA were inspected as well. A total of five groups of male Wistar rats were established, including the control, OLA, SFN+OLA, βSS+OLA, and the combination + OLA groups. Hepatic histopathology, biochemical analyses, ultimate body weights, liver function, oxidative stress, and pro-inflammatory cytokines were evaluated. In addition to the relative expression of FOXO, the signaling pathways for PI3K/AKT, JAK/STAT3, and MAPK were assessed as well. All biochemical and hepatic histopathological abnormalities caused by OLA were alleviated by SFN and/or βSS. A substantial decrease in systolic blood pressure (SBP), proinflammatory cytokines, serum lipid profile parameters, hepatic MDA, TBIL, AST, and ALT were reduced through SFN or/and βSS. To sum up, the detrimental effects of OLA are mediated by alterations in the Akt/FOXO3a/ATG12, Ras/SOS2/Raf-1/MEK/ERK1/2, and Smad3,4/TGF-β signaling pathways. The administration of SFN and/or βSS has the potential to mitigate the metabolic deficit, biochemical imbalances, hepatic histological abnormalities, and the overall unfavorable consequences induced by OLA by modulating the abovementioned signaling pathways.

The Lived Experience of Informal Caregivers of People Who Have Severe Mental Illness and Coexisting Long-Term Conditions: A Qualitative Study

BACKGROUND

People with severe mental illness (SMI) experience higher rates and poorer outcomes of physical long-term conditions (LTCs). The management of SMI and LTCs is highly complex and many people with SMI rely on informal carers for support, which may lead to high levels of caregiver burden, and caregiver burnout. Caregiver burnout can result in poor health outcomes for informal carers and a reduction in the quality of care they are able to provide. Therefore, it is important to understand the caring experience to identify and address factors that contribute to burden and burnout.

METHODS

This paper reports a secondary qualitative analysis of semistructured interviews and focus groups conducted with informal carers of people who have coexisting SMI and LTCs. We recruited 12 informal carers in England between December 2018 and April 2019. The transcripts were coded and analysed thematically.

RESULTS

We identified two overarching themes and five subthemes. The themes included 'Fighting on all fronts: Mounting strain between demands and resources', which described the challenge of providing care in the context of coexisting SMI and LTCs, and 'Safekeeping: The necessity of chronic hypervigilance', which captured how informal carers' roles were defined by managing high-risk situations, leading to hypervigilance and paternalistic approaches to care.

CONCLUSION

The experience of informal carers for people with SMI and coexisting LTCs is marked by limited access to support and the management of significant risk, which could contribute to high caregiver burden. Further primary research is needed to understand how the experiences of the caregiver role for people with SMI and LTCs influence caregiver burden.

PATIENT OR PUBLIC CONTRIBUTION

Our PPI panel DIAMONDS Voice provided guidance on this study from conception, design and development of interview guides and recruitment materials to final write-up. DIAMONDS Voice consists of service users and carers who have experience of SMI and LTCs. Three carer members reviewed the final manuscript, and two are credited as authors.

The prevalence of vitamin D deficiency and associated factors in first-episode psychosis

AIM

Vitamin D deficiency is prevalent in people with established psychotic disorders, but less is known about vitamin D levels in people with first-episode psychosis (FEP). This study aimed to determine the prevalence of vitamin D deficiency in people with FEP and identify the factors associated with vitamin D status.

METHODS

This was a prospective cohort study nested within a randomized controlled trial, which included 37 young people with an FEP with minimal antipsychotic medication exposure.

RESULTS

Twenty-four percent of participants were vitamin D deficient, and a further 30% were vitamin D insufficient. There was no association between vitamin D and demographic factors or clinical symptoms (positive, negative, general psychopathology and depressive symptoms) or cognition and functioning. However, vitamin D levels were associated with season of sampling.

CONCLUSIONS

Considering the longer-term adverse effects associated with vitamin D deficiency, it is warranted to ensure this clinical population receives supplementation if indicated.

Retina as a potential biomarker in schizophrenia spectrum disorders: a systematic review and meta-analysis of optical coherence tomography and electroretinography

INTRODUCTION

Abnormal findings on optical coherence tomography (OCT) and electroretinography (ERG) have been reported in participants with schizophrenia spectrum disorders (SSDs). This study aims to reveal the pooled standard mean difference (SMD) in retinal parameters on OCT and ERG among participants with SSDs and healthy controls and their association with demographic characteristics, clinical symptoms, smoking, diabetes mellitus, and hypertension.

METHODS

Using PubMed, Scopus, Web of Science, and PSYNDEX, we searched the literature from inception to March 31, 2023, using specific search terms. This study was registered with PROSPERO (CRD4202235795) and conducted according to PRISMA 2020.

RESULTS

We included 65 studies in the systematic review and 44 in the meta-analysis. Participants with SSDs showed thinning of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer- inner plexiform cell layer, and retinal thickness in all other segments of the macula. A meta-analysis of studies that excluded SSD participants with diabetes and hypertension showed no change in results, except for pRNFL inferior and nasal thickness. Furthermore, a significant difference was found in the pooled SMD of pRNFL temporal thickness between the left and right eyes. Meta-regression analysis revealed an association between retinal thinning and duration of illness, positive and negative symptoms. In OCT angiography, no differences were found in the foveal avascular zone and superficial layer foveal vessel density between SSD participants and controls. In flash ERG, the meta-analysis showed reduced amplitude of both a- and b-waves under photopic and scotopic conditions in SSD participants. Furthermore, the latency of photopic a-wave was significantly shorter in SSD participants in comparison with HCs.

DISCUSSION

Considering the prior report of retinal thinning in unaffected first-degree relatives and the results of the meta-analysis, the findings suggest that retinal changes in SSDs have both trait and state aspects. Future longitudinal multimodal retinal imaging studies are needed to clarify the pathophysiological mechanisms of these changes and to clarify their utility in individual patient monitoring efforts.

Knowledge and dispensing practice of community pharmacists towards antipsychotic medicines in a Nigerian metropolitan city - a cross-sectional study

BACKGROUND

Antipsychotic drugs are prescription-only-medications which require valid prescriptions before it can be obtained from a pharmacy. On the other hand, community pharmacists in developing countries have sometimes been implicated in over-the-counter dispensing of prescription-only-medications.

OBJECTIVE

This study investigated the accessibility of antipsychotic drugs without prescriptions from community pharmacies, and the factors responsible for the over-the-counter dispensing of antipsychotics by community pharmacists.

METHODS

An exploratory cross-sectional mixed method survey design using pretested structured questionnaires among 119 community pharmacists, simulated patients in 119 community pharmacies, and one-on-one in-depth interview among eleven (11) community pharmacist-owners/superintendent pharmacists were utilized for data collection. The knowledge of the pharmacists on antipsychotics including classification, side effects, and dispensing practices were explored. Qualitative data was analyzed with thematic analysis, while quantitative data was analyzed using descriptive statistics.

RESULTS

Majority of the community pharmacists (87.4%) showed good knowledge of antipsychotics as it relates to the different classes and the side effects peculiar to each class. Antipsychotic medications were dispensed by 85 (71.4%) of community pharmacists without a prescription. One-on-one in-depth interview sessions with community pharmacist owners/superintendent pharmacists demonstrated that community pharmacists are knowledgeable about antipsychotics and their side effects. Reasons given for dispensing this class of drugs without prescription included emergencies, and knowledge of the person as being on the drugs long-term. About 4% pharmacists were adamant on dispensing only with prescription.

CONCLUSION

Community pharmacists in Ibadan metropolis readily dispense antipsychotics without valid prescriptions despite having an optimal knowledge about the negative implications of doing so. This could be due to weak legislation and regulation of drug laws. There is a need for more stringent regulations as well as adequate sensitization about the negative effects of inappropriate dispensing of prescription-only-medications.

Biopsychosocial Variables in Male Schizophrenic Patients: A Comprehensive Comparison with Healthy Controls

OBJECTIVE

this study aims to comprehensively compare neuropsychological, psychopathological, anthropometric, biochemical, pharmacological, and lifestyle variables between 27 male schizophrenic patients (SZ group) and 30 age- and sex-matched healthy male controls (HC group).

METHODS

participants underwent a battery of neuropsychological tests including the Trail Making Test (TMT), Stroop Color-Word Interference Test, and Verbal Fluency Test. Psychopathological symptoms in the SZ group were evaluated using the Positive and Negative Syndrome Scale (PANSS). Anthropometric measurements such as body weight, height, BMI, and waist circumference were taken. Biochemical markers measured included fasting glucose, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and fasting insulin. Lifestyle factors were assessed through a questionnaire for the study of views and eating habits of people aged 16 to 65.

RESULTS

the HC group outperformed the SZ group in the TMT_A test and the Stroop test, but no significant differences were observed in the TMT_B test or in phonemic fluency tests. No correlation was found between age and PANSS scores within the SZ group. Anthropometrically, the SZ group had higher body weight, waist circumference, and BMI, with no difference in height. Biochemically, the HC group had higher HDL cholesterol levels but lower insulin and insulin resistance indices. Pharmacological assessment showed a more significant impact on body weight among SZ patients taking second-generation antipsychotics. Lifestyle factors such as diet and screen time were comparable between groups, but the SZ group reported longer sleep duration and lower leisure time activity.

CONCLUSIONS

our study highlights distinct neuropsychological, pharmacological, anthropometric, and biochemical differences between male schizophrenic patients and healthy controls. The results underscore the complexity of schizophrenia and point toward the need for a multi-faceted approach to its management and understanding.

High prevalence of metabolic diseases, liver steatosis and fibrosis among Chinese psychiatric patients

BACKGROUND

We aimed to investigate the differences of metabolic disorders between the general population and psychiatric patients, with an emphasis on the prevalence and influencing factors of liver fibrosis in psychiatric patients.

METHODS

A total of 734 psychiatric patients and 734 general population matched for age, sex, and BMI were enrolled from Shanghai, China. All participants underwent blood pressure, glucose, lipid profile measurements, and anthropometric parameters including body weight, height and waist circumference. FibroScan examinations were also performed on psychiatric patients. Liver steatosis and fibrosis were diagnosed by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) by professional staff.

RESULTS

Compared with the general population, psychiatric patients revealed significantly higher burden of metabolic disorders. The overall prevalence of liver steatosis (CAP ≥ 233 dB/m) and fibrosis (LSM ≥ 7.0 kPa) was 48.7% and 15.5% in psychiatric patients. Psychiatric patients with liver steatosis or fibrosis showed worse metabolic profile. Meanwhile, the prevalence of liver fibrosis was also significantly higher in patients with overweight, central obesity, diabetes, hypertension, metabolic syndrome, and liver steatosis. In logistic regression analyses, age, BMI and visceral adiposity index were independent risk factors for liver fibrosis in psychiatric patients. Additionally, antipsychotic medication was suggested to be associated with an increased risk of liver fibrosis in psychiatric patients with liver steatosis.

CONCLUSIONS

Prevalence of liver steatosis and fibrosis is high in Chinese psychiatric patients. Those with antipsychotic polypharmacy and obesity are at high risk, and may benefit from early liver assessment in preventing fibrosis progression.

Efficacy and safety profiles of mood stabilizers and antipsychotics for bipolar depression: a systematic review

The whole picture of psychotropics for bipolar depression (BPD) remains unclear. This review compares the differences in efficacy and safety profiles among common psychotropics for BPD. MEDLINE, EMBASE, and PsycINFO were searched for proper studies. The changes in the depressive rating scale, remission/response rates, nervous system adverse events (NSAEs), gastrointestinal adverse events (GIAEs), metabolic parameters, and prolactin were compared between medication and placebo or among medications with the Cohen's d or number needed to treat/harm. The search provided 10 psychotropics for comparison. Atypical antipsychotics (AAPs) were superior to lithium and lamotrigine at alleviating acute depressive symptoms. Lithium was more likely to induce dry mouth and nausea. Cariprazine and aripiprazole seemed to be associated with an increased risk of akathisia and upper GIAEs. Lurasidone was associated with an increased risk of developing akathisia and hyperprolactinemia. Olanzapine, olanzapine-fluoxetine combination (OFC), and quetiapine were associated with an increased risk of NSAEs, metabolic risk, dry mouth, and constipation. Cariprazine, lurasidone, OFC, or quetiapine was optimal monotherapy for BPD. Further studies are needed to assess the efficacy and safety of lamotrigine for treating BPD. Adverse events varied widely across different drug types due to variations in psychopharmacological mechanisms, dosages, titration, and ethnicities.

The association between Compulsory Community Treatment Order status and mortality in New Zealand

BACKGROUND

Compulsory Community Treatment Orders (CTOs) enable psychiatric medication without the need for consent. Careful scrutiny of outcomes including mortality is required to ensure compulsory treatment is evidence-based and ethical.

AIMS

To report mortality for patients placed on CTOs and analyse data according to CTO status, mortality cause and diagnosis.

METHOD

Data for all patients placed under CTOs between 1 January 2009 and 31 December 2018 was provided by the Ministry of Health, New Zealand. Data included diagnostic and demographic information, dates of CTOs, and any dates and causes of death. Deaths were categorised into suicides, accidents and assaults, and medical causes. Mortality data are reported according to CTO status and diagnosis.

RESULTS

A total of 14 726 patients were placed on CTOs over the study period, during which there were 1328 deaths. The mortality rate was 2.97 on and 2.31 off CTOs (rate ratio 1.29, 95% CI 1.14-1.45; P < 0.01). The mortality rate for accidents and assaults was 0.44 on and 0.25 off CTOs (rate ratio 1.73, 95% CI 1.23-2.42; P < 0.01). The mortality rate for medical causes was 2.33 on and 1.90 off CTOs (rate ratio 1.22, 95% CI 1.07-1.40; P < 0.01). The suicide rate was 0.20 on and 0.15 off of CTOs (rate ratio 1.33, 95% CI 0.81-2.12; P = 0.22).

CONCLUSIONS

Increased care and medication provided during compulsory treatment does not the modify the course of illness sufficiently to reduce mortality during CTOs. Higher mortality rates during CTO periods compared with non-CTO periods may reflect greater unwellness during CTOs.

Roles of Pancreatic Islet Catecholamine Neurotransmitters in Glycemic Control and in Antipsychotic Drug-Induced Dysglycemia

Catecholamine neurotransmitters dopamine (DA) and norepinephrine (NE) are essential for a myriad of functions throughout the central nervous system, including metabolic regulation. These molecules are also present in the pancreas, and their study may shed light on the effects of peripheral neurotransmission on glycemic control. Though sympathetic innervation to islets provides NE that signals at local α-cell and β-cell adrenergic receptors to modify hormone secretion, α-cells and β-cells also synthesize catecholamines locally. We propose a model where α-cells and β-cells take up catecholamine precursors in response to postprandial availability, preferentially synthesizing DA. The newly synthesized DA signals in an autocrine/paracrine manner to regulate insulin and glucagon secretion and maintain glycemic control. This enables islets to couple local catecholamine signaling to changes in nutritional state. We also contend that the DA receptors expressed by α-cells and β-cells are targeted by antipsychotic drugs (APDs)-some of the most widely prescribed medications today. Blockade of local DA signaling contributes significantly to APD-induced dysglycemia, a major contributor to treatment discontinuation and development of diabetes. Thus, elucidating the peripheral actions of catecholamines will provide new insights into the regulation of metabolic pathways and may lead to novel, more effective strategies to tune metabolism and treat diabetes.

Technology-enabled collaborative care for youth with early psychosis: Results of a feasibility study to improve physical health behaviours

AIM

Psychotic disorders are associated with excess morbidity and premature mortality. Contributing factors include tobacco smoking, low physical activity, and poor nutrition. This study tested a Technology-Enabled Collaborative Care model to improve health behaviours among youth with early psychosis.

METHODS

A feasibility study among youth (ages 16-29) with early psychosis in Ontario, Canada. Participants were randomized to either a health coach supervised by a virtual care team (high intensity, n = 29), or self-directed learning (low intensity, n = 23) for 12 weeks. The primary outcome was participant engagement, defined as self-perceived benefit of changing health behaviours. Secondary outcomes were measures of health behaviours and programme-use metrics.

RESULTS

Engagement was higher for high intensity participants for physical activity (adjusted group difference in change at 24 weeks = 3.4, CI95% = 1.9-4.9, p < .001) and nutrition (adjusted difference = 2.9, CI95% = 1.2-4.6, p = .001). No change was observed in health behaviours. Sixty two percent of participants completed 6 or more of the 12 weekly remote individualized health coaching sessions. Nine (39%) low intensity and 12 (41%) high intensity participants completed the final follow-up.

CONCLUSIONS

Personalized health coaching for youth with psychosis is feasible and may have sustained benefits. However, retention with this population for 12 weeks is challenging.

Multicenter Analysis of Cardiometabolic-related Diagnoses in Transgender and Gender-Diverse Youth: A PEDSnet Study

CONTEXT

Studies on cardiometabolic health in transgender and gender-diverse youth (TGDY) are limited to small cohorts.

OBJECTIVE

This work aimed to determine the odds of cardiometabolic-related diagnoses in TGDY compared to matched controls in a cross-sectional analysis, using a large, multisite database (PEDSnet).

METHODS

Electronic health record data (2009-2019) were used to determine odds of cardiometabolic-related outcomes based on diagnosis, anthropometric, and laboratory data using logistic regression among TGDY youth vs controls. The association of gender-affirming hormone therapy (GAHT) with these outcomes was examined separately among TGDY. TGDY (n = 4172) were extracted from 6 PEDSnet sites and propensity-score matched on 8 variables to controls (n = 16 648). Main outcomes measures included odds of having cardiometabolic-related diagnoses among TGDY compared to matched controls, and among TGDY prescribed GAHT compared to those not prescribed GAHT.

RESULTS

In adjusted analyses, TGDY had higher odds of overweight/obesity (1.2; 95% CI, 1.1-1.3) than controls. TGDY with a testosterone prescription alone or in combination with a gonadotropin-releasing hormone agonist (GnRHa) had higher odds of dyslipidemia (1.7; 95% CI, 1.3-2.3 and 3.7; 95% CI, 2.1-6.7, respectively) and liver dysfunction (1.5; 95% CI, 1.1-1.9 and 2.5; 95% CI, 1.4-4.3) than TGDY not prescribed GAHT. TGDY with a testosterone prescription alone had higher odds of overweight/obesity (1.8; 95% CI, 1.5-2.1) and hypertension (1.6 95% CI, 1.2-2.2) than those not prescribed testosterone. Estradiol and GnRHa alone were not associated with greater odds of cardiometabolic-related diagnoses.

CONCLUSION

TGDY have increased odds of overweight/obesity compared to matched controls. Screening and tailored weight management, sensitive to the needs of TGDY, are needed.

Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and Antipsychotics

Major bleeding risks associated with non-vitamin K oral anticoagulants (NOACs) used with and without concurrent antipsychotics in patients with non-valvular atrial fibrillation (AF) were assessed. A total of 98,863 patients with non-valvular AF receiving at least one NOAC prescription from Taiwan’s National Health Insurance database were enrolled. Major bleeding was defined as a primary diagnosis of intracranial or gastrointestinal hemorrhage or bleeding at other sites. The adjusted incidence rate difference (AIRD) per 1,000 person-years and adjusted rate ratio of major bleeding were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score. A total of 8,037 major bleeding events occurred during 705,521 person-quarters with NOAC prescriptions. Antipsychotics were used in 26.35% of NOAC-exposed patients. Compared to using NOAC alone, co-medication of either typical (AIRD: 79.18, 95% confidence interval [CI]: 70.63–87.72) or atypical (AIRD: 40.5, 95% CI: 33.64–47.35) antipsychotic with NOAC had a significant increase in the adjusted incidence rate per 1,000 person-years of major bleeding. The concomitant use of a NOAC with chlorpromazine (AIRD: 103.87, 95% CI: 51.22–156.52), haloperidol (AIRD: 149.52, 95% CI: 125.03–174.00), prochlorperazine (AIRD: 90.43, 95% CI: 78.55–102.32), quetiapine (AIRD: 44.6, 95% CI: 37.11–52.09), or risperidone (AIRD: 41.55, 95% CI: 22.86–60.24) (All p < 0.01) showed a higher adjusted incidence rate of major bleeding than using NOACs alone. The concomitant use of typical (chlorpromazine, haloperidol, or prochlorperazine) or atypical (quetiapine or risperidone) antipsychotic with NOACs was associated with a significantly increased risk of major bleeding.

Technology-enabled collaborative care for youth with early psychosis: A protocol for a feasibility study to improve physical health behaviours

AIM

Individuals with psychotic disorders have poorer health outcomes and die earlier due to cardiovascular diseases when compared to healthy populations. Contributing factors include low levels of physical activity, poor nutrition and tobacco smoking. Currently, patients navigate a fragmented health-care system to seek physical and mental health services, often without access to evidence-based health promotion interventions, especially in non-academic settings or rural areas, increasing client barriers at the individual and provider level. To address these gaps, we wish to test the feasibility and impact of a Technology-Enabled Collaborative Care for Youth (TECC-Y) model to improve healthy behaviours among youth with early psychosis. The model addresses geographical barriers and maldistribution of physical and mental health care.

METHODS

A randomized controlled trial, including youth (ages of 16-29) with early psychosis (diagnosed in the past 5 years) residing in Ontario, Canada. Our primary outcome is client engagement. Secondary outcomes include smoking status, physical health and nutrition. Participants are randomly assigned to either a health coach supervised by a virtual care team, or a self-directed learning group (e-platform with psychoeducational materials). Assessments are conducted at baseline, 6, 12 and 24 weeks.

RESULTS

This paper presents the protocol of the study. Recruitment commenced in August 2018. This study was registered on 16 July 2018 on clinicaltrials.gov (Registry ID: NCT03610087).

CONCLUSIONS

TECC-Y will determine if a technology-based collaborative care model engages youth with early psychosis, and whether this will be associated with changes in smoking, physical health and nutrition.

Metabolic syndrome among people with mental illness in sub Saharan Africa: Female gender as a factor. A Systematic review and meta-analysis

Background

The prevalence of metabolic syndrome among psychiatric patients in developing nations is mounting alarmingly and it is a reason for decreased life expectancy and quality of life of people with mental illness. Although great discrepant epidemiological studies have been carried out in Sub Saharan African countries, there has no systematic review and meta-analysis conducted. Therefore, summarized evidence has a paramount importance for policy makers and health planning. This study aims to estimate the prevalence of metabolic syndrome and to examine the effect of gender on metabolic syndrome among people with mental illness in sub Saharan Africa.

Method

Systematic literature search was performed using PubMed, CINAHL, Web of science, Global health electronic databases. In addition, gray literatures were retrieved from Google and Google scholar. Two authors independently extracted all the necessary data using a format prepared in Microsoft Excel. Data analysis was done using STATA Version 14 (software). The heterogeneity of the studies was assessed using I²test.Random-effects model was used to estimate pooled prevalence of MetS and its odds ratio. Publication bias was checked using Funnel plot and Egger's test.

Result

1306 studies were reviewed and nine studies fulfilling the inclusion criteria were selected for the meta-analysis. The meta-analysis of nine studies that included 1896 participants found a prevalence rate of metabolic syndrome which was performed based on assessment criteria; JIS criteria prevalence 21.11% (95% CI: 17.93–24.29), IDF criteria 23.77% (95% CI: 15.41–32.12) and NCEP ATP-III criteria 21.63% (95% CI: 16.30–26.96). Female gender (AOR = 3.00; 95% CI: 1.98–4.55) was found to have a significant association with metabolic syndrome.

Conclusion

The prevalence of metabolic syndrome among people with mental illness in sub Saharan Africa is high in various assessment criteria. The likelihood is significantly increased in females than males. Metabolic syndrome increases by three folds among females with mental illness as compared to their counterparts.

•

Prevalence of metabolic syndrome among psychiatric patients in developing nations is increasing alarmingly.

•

This study revealed the prevalence of metabolic syndrome and the effect of gender on metabolic syndrome.

•

The prevalence of metabolic syndrome among people with mental illness in sub Saharan Africa is high.

•

The Likelihood of Metabolic syndrome increases by three folds among females with mental illness as compared to males.

Changes in peripheral blood compounds following psychopharmacological treatment in drug-naïve first-episode patients with either schizophrenia or major depressive disorder: a meta-analysis

BACKGROUND

This meta-analysis on peripheral blood compounds in drug-naïve first-episode patients with either schizophrenia or major depressive disorder (MDD) examined which compounds change following psychopharmacological treatment.

METHODS

The Embase, PubMed and PsycINFO databases were systematically searched for longitudinal studies reporting measurements of blood compounds in drug-naïve first-episode schizophrenia or MDD.

RESULTS

For this random-effects meta-analysis, we retrieved a total of 31 studies comprising 1818 schizophrenia patients, and 14 studies comprising 469 MDD patients. Brain-derived neurotrophic factor (BDNF) increased following treatment in schizophrenia (Hedges' g (g): 0.55; 95% confidence interval (CI) 0.39-0.70; p < 0.001) and MDD (g: 0.51; CI 0.06-0.96; p = 0.027). Interleukin (IL)-6 levels decreased in schizophrenia (g: -0.48; CI -0.85 to -0.11; p = 0.011), and for MDD a trend of decreased IL-6 levels was observed (g: -0.39; CI -0.87 to 0.09; p = 0.115). Tumor necrosis factor alpha (TNFα) also decreased in schizophrenia (g: -0.34; CI -0.68 to -0.01; p = 0.047) and in MDD (g: -1.02; CI -1.79 to -0.25; p = 0.009). Fasting glucose levels increased only in schizophrenia (g: 0.26; CI 0.07-0.44; p = 0.007), but not in MDD. No changes were found for C-reactive protein, IL-1β, IL-2 and IL-4.

CONCLUSIONS

Psychopharmacological treatment has modulating effects on BDNF and TNFα in drug-naïve first-episode patients with either schizophrenia or MDD. These findings support efforts for further research into transdiagnostic preventive strategies and augmentation therapy for those with immune dysfunctions.

Effect of aripiprazole as an adjunct to atypical antipsychotics on weight and metabolic profile: a 12-week open-label trial

BACKGROUND

Atypical antipsychotics are widely prescribed, yet have been associated with weight gain and metabolic syndrome.

AIM

To study the effect of adjunct low-dose aripiprazole on weight and metabolic parameters of subjects on atypical antipsychotics (olanzapine, clozapine or risperidone).

METHODS

The study was carried out as an open-label trial with a fixed dose of 5 mg aripiprazole added to the patient's current antipsychotic for 12 weeks. The primary outcome measure was mean change in weight, while secondary outcome measures included change in waist circumference; fasting blood glucose; HbA1c; triglycerides; total, HDL and LDL cholesterol levels; functioning; and neurocognition.

RESULTS

For the overall study (n = 55), there was no significant effect of adjunct aripiprazole on the weight of the subjects. However, the clozapine group achieved significant weight loss (p = 0.002) and also had significant improvements in total cholesterol (p < 0.001), HDL (p = 0.016), LDL (p = 0.044) and triglyceride levels (p = 0.038). The olanzapine group had significant improvement in triglycerides (p = 0.001), and other metabolic parameters for this group showed improvement trends, but did not reach statistical significance. The risperidone group did not show any significant improvement in weight or metabolic parameters.

CONCLUSIONS

The study adds support to the adjunctive use of aripiprazole to clozapine for weight loss and improvement in metabolic profile, and for reduction in cardiometabolic risk for patients on olanzapine.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT02949752.

Factors Related to the Length of Stay for Patients With Schizophrenia: A Retrospective Study

BACKGROUND

The length of stay (LOS) of patients with schizophrenia has been a wide concern of researchers. Reasonable management of the LOS to achieve a balance between quality of treatment and efficient medical source allocation has become a significant issue in clinical work in psychiatry. Figuring out the factors related to the LOS of schizophrenia patients can help optimize its management by the hospital.

METHOD

The essential information of patients was obtained from the electronic medical record system. The variables were divided into the following kinds: demographic, clinical, and biochemical. Univariate analysis and multivariate analysis were conducted to find the potential factors related to the LOS of schizophrenia patients. Receiver operating characteristic analyses were conducted to evaluate the accuracy of judging the LOS of the regression model.

RESULT

A total of 1,160 patients with schizophrenia were enrolled in our research. Our results demonstrated that the status of unmarried (single, separated, divorced, or widowed) and the abnormality of thyroid-stimulating hormone (TSH) were risk factors for the longer LOS of schizophrenia patients. The area under the curve was 0.576, which meant that the regression model had a certain predictive value.

CONCLUSION

To our knowledge, this research is the first study to analyze the effect of various factors, including the biochemical index, on the LOS of a single type of mental disorder. Marital status and TSH were proven to be related to the LOS of schizophrenia patients. The results of this study provided reference factors of LOS for clinical psychiatry, which will be helpful to the management of hospitalization and in optimizing the allocation of medical sources.

Case Report: Deutetrabenazine as an Adjunctive Treatment for Stuttering

Childhood-Onset Fluency Disorder (Stuttering) is a neurodevelopmental disorder in which disturbances occur in the normal fluency and time patterning of speech. While the dopamine system has been well-described in its neurophysiology, there currently is no FDA-approved treatment for stuttering. Second-generation antipsychotics, which have been effective in the treatment of schizophrenia and bipolar disorder, act as dopamine D-2 receptor antagonists at the postsynaptic neuron and have been shown to reduce the symptoms of stuttering. However, the D-2 receptor antagonist and partial agonist agents carry the potential for metabolic side effects and can potentially lead to movement disorders. Deutetrabenazine, a VMAT-2 inhibitor indicated to treat hyperkinetic movement disorders, is a potential candidate in the treatment of stuttering, based on its mechanism of action in decreasing dopamine activity while not carrying the risk of metabolic adverse events.

Mood Disorders and Increased Risk of Noncommunicable Disease in Adults With HIV

BACKGROUND

People living with HIV (PLWH) experience high rates of mood disorders (major depression and bipolar affective disorder) which in the general population have been associated with noncommunicable disease (NCD) risk. We examined whether prevalent mood disorders are associated with incident NCDs and multimorbidity (accumulation of ≥2 NCDs) in PLWH.

SETTING

Adult HIV clinic cohort in Nashville, Tennessee, between 1998 and 2015.

METHODS

PLWH with ≥1 year of follow-up in the clinic were assessed for cardiovascular disease, metabolic syndrome (any 3 of hypertension, hyperlipidemia, diabetes, or obesity), chronic kidney and liver disease, non-AIDS-defining cancers, and dementia. Only mood disorders documented during the first year of care were included. Cumulative incidence and adjusted subhazard ratios (aSHRs) were calculated for risk of NCDs and multimorbidity with death as a competing risk. Multivariable Cox models estimated mortality risk after multimorbidity.

RESULTS

Of 4140 adults, 24% had a mood disorder diagnosed in the first year of care, 51% had ≥1 NCD at baseline, and there were 2588 incident NCDs during the study period. Mood disorders were associated with increased risk of first NCD (aSHR = 1.29, 95% confidence interval: 1.06 to 1.57), incident multimorbidity (aSHR ranging from 1.04 to 1.42), and metabolic syndrome (aSHR = 1.29, 95% confidence interval: 1.02 to 1.64). Mood disorders were not conclusively associated with mortality risk after multimorbidity.

CONCLUSIONS

PLWH with mood disorders were at increased risk of incident NCDs and multimorbidity, particularly metabolic syndrome. Focused prevention and treatment of NCDs may reduce the burden of multimorbidity in this high-risk group.

Metabolomics approach revealed robust changes in amino acid and biogenic amine signatures in patients with schizophrenia in the early course of the disease

The primary objective of this study was to evaluate how schizophrenia (SCH) spectrum disorders and applied antipsychotic (AP) treatment affect serum level of amino acids (AAs) and biogenic amines (BAs) in the early course of the disorder. We measured 21 different AAs and 10 BAs in a sample of antipsychotic (AP)-naïve first-episode psychosis (FEP) patients (n = 52) at baseline, after 0.6-year as well as after 5.1-year treatment compared to control subjects (CSs, n = 37). Serum levels of metabolites were determined with AbsoluteIDQ p180 kit using flow injection analysis tandem mass spectrometry and liquid chromatography technique. Elevated level of taurine and reduced level of proline and alpha-aminoadipic acid (alpha-AAA) were established as metabolites with significant change in AP-naïve FEP patients compared to CSs. The following 0.6-year treatment restored these alterations. However, further continuous 5.1-year AP treatment changed the metabolic profile substantially. Significantly elevated levels of asparagine, glutamine, methionine, ornithine and taurine, alongside with decreased levels of aspartate, glutamate and alpha-AAA were observed in the patient group compared to CSs. These biomolecule profile alterations provide further insights into the pathophysiology of SCH spectrum disorders and broaden our understanding of the impact of AP treatment in the early stages of the disease.

Increased Vascular Pathology in Older Veterans With a Purple Heart Commendation or Chronic Post-Traumatic Stress Disorder

The goal of this retrospective cohort study was to determine whether stressors related to military service, determined by a diagnosis of chronic post-traumatic stress disorder (cPTSD) or receiving a Purple Heart (PH), are associated with an increased risk of vascular risk factors and disease, which are of great concern for veterans, who constitute a significant portion of the aging US population. The Veterans Integrated Service Network (VISN) 16 administrative database was searched for individuals 65 years or older between October 1, 1997 to September 30, 1999 who either received a PH but did not have cPTSD (PH+/cPTSD-; n = 1499), had cPTSD without a PH (PH-/cPTSD+; n = 3593), had neither (PH-/cPTSD-; n = 5010), or had both (PH+/cPTSD+; n = 153). In comparison to the control group (PH-/cPTSD-), the PH+/cPTSD- group had increased odds ratios for incidence and prevalence of diabetes mellitus, hypertension, and hyperlipidemia. The PH-/cPTSD+ group had increased odds ratios for prevalence of diabetes mellitus and for the incidence and prevalence of hyperlipidemia. The PH-/cPTSD+ and PH+/cPTSD- groups were associated with ischemic heart disease and cerebrovascular disease, but not independently of the other risk factors. The PH+/cPTSD+ group was associated only with an increase in the incidence and prevalence of hyperlipidemia, though this group's much smaller sample size may limit the reliability of this finding. We conclude that certain physical and psychological stressors related to military service are associated with a greater incidence of several vascular risk factors in veterans aged 65 years or older, which in turn are associated with greater rates of ischemic heart disease and cerebrovascular disease.

Correlation between vaspin and PANSS scores in schizophrenia patients with obesity

OBJECTIVE

Metabolic abnormalities such as diabetes, dyslipidemia, abdominal obesity, metabolic syndrome, and abnormal levels of plasma adipokines have been observed in patients with schizophrenia. This study aimed to investigate the differences and correlations of plasma vaspin levels with metabolic parameters in patients with schizophrenia and to compare with healthy controls.

METHOD

We measured plasma levels of vaspin and metabolic parameters of 100 patients with schizophrenia and 95 healthy controls. Patients with schizophrenia were evaluated with the Positive and Negative Syndrome Scale (PANSS) and The Global Assessment of Functioning.

RESULTS

Mean levels of body mass index, waist circumference, triglyceride, and low-density lipoprotein cholesterol of the patients were statistically higher than those of the healthy controls (p = 0.002, p < 0.001, p = 0.03, and p = 0.002, respectively). Plasma levels of vaspin were 0.96 ± 0.73 ng/ml in patients with schizophrenia and 0.29 ± 0.15 ng/ml in the healthy controls (p < 0.001). Plasma vaspin levels were statistically higher in patients with schizophrenia than healthy controls both in groups with and without metabolic syndrome and obesity (p < 0.001). Plasma vaspin levels showed a positive correlation with triglyceride in patients with schizophrenia (r = 0.26, p = 0.007). There were positive correlations between vaspin and PANSS scores in schizophrenia patients with obesity (PANSS Positive: r = 0.42, p = 0.01; PANSS Negative: r = 0.42, p = 0.01; PANSS General: r = 0.43, p = 0.01; PANSS Total: r = 0.47, p = 0.006).

CONCLUSIONS

Our study showed a significant relationship and positive correlation between vaspin and PANSS scores in schizophrenia patients with obesity. Vaspin may play an important role in the metabolic processes of patients with schizophrenia.

Assessment of lipid response to acute olanzapine administration in healthy adults

BACKGROUND

Atypical antipsychotics (AAP) can induce hypertriglyceridaemia and type 2 diabetes. Weight gain contributes to these effects, but there is evidence that AAP can have acute metabolic effects on glycaemia independent of weight change.

AIMS

We undertook a single-blind crossover study in eight healthy volunteers to assess whether the AAP olanzapine acutely increases triglyceride and free fatty acid in response to a high-fat oral load (50 g fat with no carbohydrate) and whether these effects are attenuated by the dopamine D2 receptor agonist bromocriptine.

METHODS

Participants underwent three treatments in random order: Olanzapine 10 mg plus placebo (OL + PL), Olanzapine 10 mg plus bromocriptine 5 mg (OL + BR) and placebo plus placebo (PL + PL).

RESULTS

Olanzapine increased plasma prolactin, an effect that was reversed by co-administration of the D2 receptor agonist bromocriptine (P = .0002). There were no significant differences in postprandial triglyceride (P = .8), free fatty acid (P = .4) or glucose (P = .8).

CONCLUSION

These results suggest that AAPs likely do not directly increase postprandial lipids but may do so indirectly via changes in body weight and/or glycaemia.

The Predictive Value of Endothelial Inflammatory Markers in the Onset of Schizophrenia

PURPOSE

This study aimed to assess the serum levels of intracellular adhesion molecule (sICAM-1), and vascular cell adhesion molecule (sVCAM-1), in the first psychotic episode schizophrenia (SZ) patients, before and after six months of antipsychotic treatment.

PATIENTS AND METHODS

The study included 50 patients with a first hospitalization for SZ and 50 healthy control subjects that were patient-matched regarding age, gender, body mass index and smoking status. The evaluation included the presence of cardiovascular risk factors, measurements of systolic and diastolic blood pressure, body mass index, smoking status, ankle-brachial index, carotid intima-media thickness, and echocardiography. The Brief Psychiatric Rating Scale (BPRS) score was calculated for the patients. The plasma levels of fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, sICAM-1 and sVCAM-1 were determined at baseline in all subjects and after six months of antipsychotic treatment. Thirty patients (60%) were treated with olanzapine and 20 (40%) with risperidone.

RESULTS

The average age of patients experiencing their first episode of SZ was 29.7±6.6 years, and 23 (46%) were men. The initial sICAM-1 levels of the patients were lower than those of the control group (P<0.0001), and increased after treatment (P=0.02), but remained lower than in the healthy controls (P=0.026). The initial levels of sVCAM-1 levels were higher in the patients (P<0.0001) and decreased after treatment (P<0.0001) to values that were similar to those of the control group (P=0.39). The only independent predictor of a baseline BPRS over 120 was the baseline sVCAM-1 level (P<0.0001). Antipsychotic treatment induced significant decreases in BPRS score (P<0.0001), in systolic (P=0.005) and diastolic (P<0.0001) blood pressure, in HDL-c (P=0.02), as well as significant increases in blood glucose (P<0.01) and LDL-c (P<0.001), with no differences between olanzapine and risperidone.

CONCLUSION

In the patients experiencing an FEP of SZ, the levels of sICAM-1 were lower, while the levels of sVCAM-1 were higher than in the healthy control subjects. The antipsychotics used in the treatment of schizophrenia increased sICAM-1 and decreased sVCAM. The baseline level of sVCAM-1 was an independent predictor of a BPRS score >120 at baseline.

Immunoendocrine Peripheral Effects Induced by Atypical Antipsychotics

Atypical antipsychotics (AAP) or second-generation antipsychotics are the clinical option for schizophrenia treatment during acute psychoses, but they are also indicated for maintenance during lifetime, even though they are being used for other psychiatric conditions in clinical practice such as affective disorders and autism spectrum disorder, among others. These drugs are differentiated from typical antipsychotics based on their clinical profile and are a better choice because they cause fewer side effects regarding extrapyramidal symptoms (EPS). Even though they provide clear therapeutic benefits, AAP induce peripheral effects that trigger phenotypic, functional, and systemic changes outside the Central Nervous System (CNS). Metabolic disease is frequently associated with AAP and significantly impacts the patient's quality of life. However, other peripheral changes of clinical relevance are present during AAP treatment, such as alterations in the immune and endocrine systems as well as the intestinal microbiome. These less studied alterations also have a significant impact in the patient's health status. This manuscript aims to revise the peripheral immunological, endocrine, and intestinal microbiome changes induced by AAP consumption recommended in the clinical guidelines for schizophrenia and other psychiatric disorders.

Psychopharmacologic Treatment of Schizophrenia in Adolescents and Children

An increasing number of antipsychotic medications have demonstrated efficacy in randomized placebo-controlled trials in the treatment of children and adolescents with schizophrenia. This review summarizes and synthesizes relevant antipsychotic medication studies, with particular emphasis on second-generation agents, and discusses other clinical considerations that may influence medication selection. With the exception of clozapine demonstrating superior efficacy in the improvement of psychotic symptoms in treatment-resistant patients, many antipsychotic agents have been shown to be similarly efficacious, including first-generation medications. Consideration of the side-effect profile, which can differ substantially from medication to medication, is essential when choosing treatment options.

Prevalence and Associated Factors of Metabolic Syndrome among Patients with Severe Mental Illness Attending a Tertiary Hospital in Southwest Uganda

Globally, the prevalence of metabolic syndrome (MetS) and its components which are the major cardiovascular disease (CVD) risk factors, is higher among patients with severe mental illness (SMI) compared to the general population. This is mainly due to the deleterious lifestyles characterized by physical inactivity, excessive alcohol consumption, smoking, and unhealthy diets common among patients with SMI as well as due to cardiometabolic effects of psychotropic medications. Despite these conditions being highly prevalent among patients with SMI, little attention is given to these conditions during routine reviews in the mental health clinics in most low-income countries including Uganda. The main objective of this study was to determine the prevalence and associated factors of MetS among patients with SMI at Mbarara Regional Referral Hospital (MRRH), a tertiary hospital in southwestern Uganda. Through a cross-sectional study at the mental health clinic of the hospital, we recruited 304 patients with SMI and evaluated them for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We defined the prevalence of MetS as the proportion of patients meeting the NCEP ATP III criteria. We used logistic regression to evaluate associations between MetS and independent variables. We included a total of 302 (44.37% male, 55.63% female) patients with a diagnosis of SMI in the analysis. The prevalence of MetS was 23.51% (95% CI 18.84–28.71). At multivariable logistic regression, age >40 years and long duration of mental illness (>10 years) were significantly associated with MetS. The prevalence of MetS is high among patients with psychiatric disorders, and thus metabolic screening, especially among the high-risk groups, is critical.

Metabolic profiling identifies TC and LDL as potential serum biomarkers for depressive symptoms in schizophrenia

This study aimed to explore the relationship between serum levels of cardiometabolic biomarkers and depressive symptoms in schizophrenia patients treated with atypical antipsychotics. A total of 210 patients with schizophrenia and 70 healthy controls were recruited in our present study. All patients were rated on the 17-item Hamilton Depression Rating Scale (HAMD-17) to measure depressive symptoms and the Positive and Negative Syndrome Scale (PANSS) for psychopathology. Serum cardiometabolic biomarkers (HDL, LDL, TC, TG, GLU) in all participants were measured. Our results showed that schizophrenia patients had higher levels of serum GLU, TG, TC, LDL and BMI, but lower levels of HDL than controls (all P < 0.05). Compared to patients without depressive symptoms, those with depressive symptoms showed higher PANSS total, general psychopathology, positive and negative symptom scores (all p < 0.05), as well as higher serum levels of LDL (p < 0.001) and TC (p = 0.011). In addition, our correlation analysis showed that serum LDL (P < 0.001) and TC (P = 0.045) levels were positively associated with HAMD total scores in schizophrenia patients after age, sex and education levels were controlled. Our results suggest the appearance of depression in schizophrenia patients may be associated with high levels of metabolic parameters, especially TC and LDL.

Management of Psychosis in Neuropsychiatric Lupus

Manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE) are heterogeneous. Acute psychosis is an uncommon but well-recognized manifestation of NPSLE. With no specific biomarkers to date, the diagnosis of NPSLE relies on clinical acumen for circumstantial evidence and exclusion of important differential diagnoses. The attribution of psychosis to NPSLE is facilitated by the application attribution models. In particular, the American College of Rheumatology nomenclature, Systemic Lupus International Collaborating Clinics attribution models and Italian algorithm for the attribution of psychosis to NPSLE are revisited. The mainstay of treatment for psychosis attributable to NPSLE is immunosuppression and symptomatic control. In refractory cases, immunomodulatory and emerging biological agents may be considered. This article reviews the diagnostic dilemma, pathogenic mechanisms and treatment of psychosis in SLE patients.

Metabolic Syndrome Exacerbates Pulmonary Hypertension due to Left Heart Disease

RATIONALE

Pulmonary hypertension (PH) due to left heart disease (LHD), or group 2 PH, is the most prevalent form of PH worldwide. PH due to LHD is often associated with metabolic syndrome (MetS). In 12% to 13% of cases, patients with PH due to LHD display vascular remodeling of pulmonary arteries (PAs) associated with poor prognosis. Unfortunately, the underlying mechanisms remain unknown; PH-targeted therapies for this group are nonexistent, and the development of a new preclinical model is crucial. Among the numerous pathways dysregulated in MetS, inflammation plays also a critical role in both PH and vascular remodeling.

OBJECTIVE

We hypothesized that MetS and inflammation may trigger the development of vascular remodeling in group 2 PH.

METHODS AND RESULTS

Using supracoronary aortic banding, we induced diastolic dysfunction in rats. Then we induced MetS by a combination of high-fat diet and olanzapine treatment. We used metformin treatment and anti-IL-6 (interleukin-6) antibodies to inhibit the IL-6 pathway. Compared with sham conditions, only supracoronary aortic banding+MetS rats developed precapillary PH, as measured by both echocardiography and right/left heart catheterization. PH in supracoronary aortic banding+MetS was associated with macrophage accumulation and increased IL-6 production in lung. PH was also associated with STAT3 (signal transducer and activator of transcription 3) activation and increased proliferation of PA smooth muscle cells, which contributes to remodeling of distal PA. We reported macrophage accumulation, increased IL-6 levels, and STAT3 activation in the lung of group 2 PH patients. In vitro, IL-6 activates STAT3 and induces human PA smooth muscle cell proliferation. Metformin treatment decreased inflammation, IL-6 levels, STAT3 activation, and human PA smooth muscle cell proliferation. In vivo, in the supracoronary aortic banding+MetS animals, reducing IL-6, either by anti-IL-6 antibody or metformin treatment, reversed pulmonary vascular remodeling and improve PH due to LHD.

CONCLUSIONS

We developed a new preclinical model of group 2 PH by combining MetS with LHD. We showed that MetS exacerbates group 2 PH. We provided evidence for the importance of the IL-6-STAT3 pathway in our experimental model of group 2 PH and human patients.

The relationship between serum adiponectin levels, cardiometabolic indices and metabolic syndrome in schizophrenia

BACKGROUND

Adiponectin is a hormone secreted by adipose tissues that is thought to influence lipid and glucose metabolism, and the development of metabolic derangements, including metabolic syndrome (MetS), in schizophrenia. We aim to determine the serum adiponectin levels in Chinese patients with schizophrenia, and explore the relationship between adiponectin levels and metabolic parameters, including MetS and its components. We hypothesized that serum adiponectin levels are similar in schizophrenia patients and controls, but decreased amongst patients on atypical antipsychotics.

METHODS

81 patients and 81 controls were recruited. Anthropometric parameters and fasted blood samples for metabolic measurements were obtained. Serum adiponectin levels were measured using Bioplex assays.

RESULTS

There was no difference in median adiponectin levels between schizophrenia patients and controls. Those taking typical antipsychotics alone had lower median adiponectin levels than those on mixed typical and atypical antipsychotics. Serum adiponectin level, controlled for age, gender and body mass index, was positively correlated with high-density lipoprotein cholesterol, and negatively correlated with diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels in schizophrenia patients. Patients with MetS had lower median adiponectin levels than those without MetS, and serum adiponectin levels decreased as the number of MetS components increased. After adjusting for variables thought to influence MetS, our logistic regression model did not reveal any significant association between adiponectin levels and MetS in schizophrenia patients.

CONCLUSION

Our findings highlight the need for more studies focusing on serum adiponectin level and its relationship with MetS in schizophrenia, particularly in those taking typical antipsychotics.

Exploring shared genetic bases and causal relationships of schizophrenia and bipolar disorder with 28 cardiovascular and metabolic traits

BACKGROUND

Cardiovascular diseases represent a major health issue in patients with schizophrenia (SCZ) and bipolar disorder (BD), but the exact nature of cardiometabolic (CM) abnormalities involved and the underlying mechanisms remain unclear. Psychiatric medications are known risk factors, but it is unclear whether there is a connection between the disorders (SCZ/BD) themselves and CM abnormalities.

METHODS

Using polygenic risk scores and linkage disequilibrium score regression, we investigated the shared genetic bases of SCZ and BD with 28 CM traits. We performed Mendelian randomization (MR) to elucidate causal relationships between the two groups of disorders. The analysis was based on large-scale meta-analyses of genome-wide association studies. We also identified the potential shared genetic variants and inferred the pathways involved.

RESULTS

We found tentative polygenic associations of SCZ with glucose metabolism abnormalities, adverse adipokine profiles, increased waist-to-hip ratio and visceral adiposity (false discovery rate or FDR&lt;0.05). However, there was an inverse association with body mass index. For BD, we observed several polygenic associations with favorable CM profiles at FDR&lt;0.05. MR analysis showed that SCZ may be causally linked to raised triglyceride and that lower fasting glucose may be linked to BD. We also identified numerous single nucleotide polymorphisms and pathways shared between SCZ/BD with CM traits, some of which are related to inflammation or the immune system.

CONCLUSIONS

Our findings suggest that SCZ patients may be genetically predisposed to several CM abnormalities independent of medication side effects. On the other hand, CM abnormalities in BD may be more likely to be secondary. However, the findings require further validation.

Mitigation of Olanzapine-Induced Weight Gain With Samidorphan, an Opioid Antagonist: A Randomized Double-Blind Phase 2 Study in Patients With Schizophrenia

OBJECTIVE

Preclinical evidence and data from a proof-of-concept study in healthy volunteers suggest that samidorphan, an opioid antagonist, mitigates weight gain associated with olanzapine. This study prospectively compared combination therapy of olanzapine plus either samidorphan or placebo for the treatment of schizophrenia.

METHODS

This was an international, multicenter, randomized phase 2 study of olanzapine plus samidorphan in patients with schizophrenia. The study had a 1-week open-label olanzapine lead-in period followed by a 12-week double-blind treatment phase in which patients were randomly assigned in a 1:1:1:1 ratio to receive olanzapine plus placebo (N=75) or olanzapine plus 5 mg (N=80), 10 mg (N=86), or 20 mg (N=68) of samidorphan. The primary aims were to confirm that the antipsychotic efficacy of olanzapine plus samidorphan was comparable to olanzapine plus placebo, to assess the effect of combining olanzapine with samidorphan on olanzapine-induced weight gain, and to assess the overall safety and tolerability of olanzapine plus samidorphan.

RESULTS

Antipsychotic efficacy, as assessed by total score on the Positive and Negative Syndrome Scale (PANSS), was equivalent across all treatment groups. Treatment with olanzapine plus samidorphan resulted in a statistically significant lower weight gain (37% lower weight gain compared with olanzapine plus placebo). The least square mean percent change from baseline in body weight was 4.1% (2.9 kg) for the olanzapine plus placebo group and 2.6% (1.9 kg) for the olanzapine plus samidorphan group (2.8% [2.1 kg] for the 5 mg group, 2.1% [1.5 kg] for the 10 mg group, and 2.9% [2.2 kg] for the 20 mg group). Adverse events reported at a frequency ≥5% in any of the olanzapine plus samidorphan groups and occurring at a rate ≥2 times greater than in the olanzapine plus placebo group were somnolence, sedation, dizziness, and constipation. Other safety measures were comparable between the olanzapine plus samidorphan groups and the olanzapine plus placebo group.

CONCLUSIONS

The antipsychotic efficacy of olanzapine plus samidorphan was equivalent to that of olanzapine plus placebo, and olanzapine plus samidorphan was associated with clinically meaningful and statistically significant mitigation of weight gain compared with olanzapine plus placebo. Olanzapine plus samidorphan was generally well tolerated, with a safety profile similar to olanzapine plus placebo.

Effects of omega-3 fatty acids on metabolic syndrome in patients with schizophrenia: a 12-week randomized placebo-controlled trial

RATIONALE

Individuals with schizophrenia are at increased risk of developing metabolic syndrome (MetS) due to their lifestyle and antipsychotic treatment. Our previous study showed that patients with both schizophrenia and MetS present an increased expression and production of tumor necrosis factor-alpha (TNF-alpha). Omega-3 fatty acids have a documented role in suppressing TNF-alpha; therefore, we hypothesized that they may be of value in relieving inflammation and improving metabolic disturbance in patients with both schizophrenia and MetS.

OBJECTIVES

This study employed a randomized placebo-controlled trial to investigate the effects of omega-3 fatty acids on MetS in patients with schizophrenia.

METHODS

We recruited 80 patients with both schizophrenia and MetS who received long-term olanzapine monotherapy. The patients were randomly assigned to the OMG-3 group (n = 40) or the placebo group (n = 40).

RESULTS

Patients with both schizophrenia and MetS had significantly higher levels of TNF-alpha than the control subjects (Z = - 4.37, P < 0.01). There was a significant correlation between omega-3 fatty acid treatment and reduced triglyceride (TG) levels (F_{group × time} = 13.42; df = 1, 66; P < 0.01) when the patients completed this study. Along with metabolic improvement, omega-3 fatty acids decreased TNF-alpha levels after 12 weeks of treatment (F_{group × time} = 6.71; df = 1, 66; P = 0.012). We also found that the extent of TNF-alpha decrease was significantly correlated with that of TG decrease (r = 0.38, P = 0.001).

CONCLUSIONS

Our findings provide suggestive evidence that omega-3 fatty acids have beneficial effects on TG metabolism in patients with both schizophrenia and MetS that parallel decreased inflammation levels.

Five Year Outcomes of Tapering Antipsychotic Drug Doses in a Community Mental Health Center

There is evidence that many individuals are on higher doses of antipsychotic drug than is required for optimal functioning yet there are limited guidelines on how to reduce them. This paper reports on 5 year outcomes for sixty-seven individuals who received treatment at a community mental health center and were offered the opportunity to gradually reduce their doses of antipsychotic drug in collaboration with the treating psychiatrist. Over a period of 6 months, the author invited patients who were clinically stable and able to participate in discussions of potential risks and benefits to begin gradual dose reductions. Initially, 40 expressed interest in tapering and 27 declined. The groups did not differ in age, sex, race, or diagnosis. The group who chose to taper began on significantly lower doses. Most patients succeeded at making modest dose reductions. At 5 years, there were no significant differences in the two outcomes measures, rate of hospitalization and employment status. Many patients were able to engage in these discussions which did not result in widespread discontinuation of drug. This is a naturalistic, small study of a topic that warrants further research.

Metabolic syndrome and associated factors among psychiatric patients in Jimma University Specialized Hospital, South West Ethiopia

BACKGROUND

Metabolic syndrome is a multisystem disorder which coined to describe the recognized clustering of metabolic and cardiovascular abnormalities including obesity, hypertension, dyslipidemia, and abnormalities of glucose homeostasis.

OBJECTIVE

To assess the prevalence and associated factors of metabolic syndrome among psychiatric patients in Jimma University Specialized Hospital.

METHODS

This study was conducted at Jimma University Specialized hospital psychiatric ward from May 15 to July 16, 2015. A cross-sectional study design and consecutive sampling technique were used. A single population proportion formula was used to include a total of 360 psychiatric patients. An interview administered structured questionnaire was used to collect socio-demographic and some clinical data. Anthropometric data were collected based on standard guild line for anthropometric measurement. Five milliliter of venous blood was collected from ante-cubital fossa after overnight fasting for 8 h. Semi-automated clinical chemistry analyzer (Temis Linear) was used for biochemical laboratory analysis. Data analysis was performed by using SPSS version-20 software. Binary and multiple logistic regressions were used to identify the association between dependent and independent variables. P value less than 0.05 was taken as statistically significant association.

RESULTS

The prevalence of metabolic syndrome among psychiatric patients was 28.9%. Age greater than 30 years old (AOR: 5.2, CI: 2.3, 11.8, P. value < 0.05); being female (AOR: 7.1, CI: 3.3, 15.2, P. value < 0.05); regularly eating high protein and fat (AOR: 3.3, CI: 1.3, 8.2, P. value < 0.056) were independent determinant variables for high prevalence of metabolic syndrome among diabetic patients in the study area. The other independent variables such as family history of hypertension, chewing chat, Psychotropic drugs, duration of treatment, regularly eating fruits and vegetables had no statistically significant association with metabolic syndrome (P. value > 0.05).

CONCLUSION AND RECOMMENDATION

There was high prevalence of metabolic syndrome among the psychiatric patients. Therefore; close assessment, management and treatment of metabolic syndrome among patients with psychiatry problem is essential.

Exercise as an intervention for first-episode psychosis: a feasibility study

AIM

Exercise can improve psychiatric symptoms, neurocognitive functioning and physical health in schizophrenia. However, the effects in early psychosis have not been explored. This study aimed to assess the feasibility of an exercise intervention for early psychosis and to determine if it was associated with changes in physical and mental health.

METHODS

Thirty-one patients with first-episode psychosis (FEP) were recruited from early intervention services to a 10-week exercise intervention. The intervention group received individualized training programmes, aiming to achieve ≥90 min of moderate-to-vigorous activity each week, using exercise programmes tailored to individual preferences and needs. A comparison FEP sample from the same services (n = 7) received treatment as usual.

RESULTS

Rates of consent and retention in the exercise group were 94% and 81%, respectively. Participants achieved an average of 107 min of moderate-to-vigorous exercise per week. Positive and Negative Syndrome Scale total scores reduced by 13.3 points after 10 weeks of exercise, which was significantly greater than the treatment as usual comparison group (P = 0.010). The greatest differences were observed in negative symptoms, which reduced by 33% in the intervention group (P = 0.013). Significant improvements were also observed in psychosocial functioning and verbal short-term memory. Increases in cardiovascular fitness and processing speed were positively associated with the amounts of exercise achieved by participants.

CONCLUSION

Individualized exercise training could provide a feasible treatment option for improving symptomatic, neurocognitive and metabolic outcomes in FEP.

The Wnt Signaling Pathway Effector TCF7L2 Mediates Olanzapine-Induced Weight Gain and Insulin Resistance

Olanzapine is a widely used atypical antipsychotic medication for treatment of schizophrenia and is often associated with serious metabolic abnormalities including weight gain and impaired glucose tolerance. These metabolic side effects are severe clinical problems but the underpinning mechanism remains poorly understood. Recently, growing evidence suggests that Wnt signaling pathway has a critical role in the pathogenesis of schizophrenia and molecular cascades of antipsychotics action, of which Wnt signaling pathway key effector TCF7L2 is strongly associated with glucose homeostasis. In this study, we aim to explore the characteristics of metabolic disturbance induced by olanzapine and to elucidate the role of TCF7L2 in this process. C57BL/6 mice were subject to olanzapine (4 mg/kg/day), or olanzapine plus metformin (150 mg/kg/day), or saline, respectively, for 8 weeks. Metabolic indices and TCF7L2 expression levels in liver, skeletal muscle, adipose, and pancreatic tissues were closely monitored. Olanzapine challenge induced remarkably increased body weight, fasting insulin, homeostasis model assessment-insulin resistance index, and TCF7L2 protein expression in liver, skeletal muscle, and adipose tissues. Notably, these effects could be effectively ameliorated by metformin. In addition, we found that olanzapine-induced body weight gain and insulin resistance actively influence the expression of TCF7L2 in liver and skeletal muscle, and elevated level of insulin determines the increased expression of TCF7L2 in adipose tissue. Our results demonstrate that TCF7L2 participates in olanzapine-induced metabolic disturbance, which presents a novel mechanism for olanzapine-induced metabolic disturbance and a potential therapeutic target to prevent the associated metabolic side effects.

The prevalence of metabolic syndrome in patients receiving antipsychotics in Qatar: a cross sectional comparative study

BACKGROUND

Metabolic abnormalities are common in patients maintained on antipsychotics. These abnormalities increase the risk of cardiovascular diseases and mortality in this population. The aim of this study is to assess the prevalence of metabolic syndrome (MetS) in subjects maintained on antipsychotics relative to controls in Qatar, and to assess the factors contributing to the development of MetS.

METHODS

A cross sectional design was used to collect data and fasting blood samples from subjects maintained on antipsychotics for at least six months (n = 112) and from a control group (n = 114). The groups were compared in regard to prevalence of MetS, and multiple regression analysis was used to determine the risk factors in each group.

RESULTS

The two groups (antipsychotics vs. control) were similar in regard to age (35.73 ± 10.28 vs. 35.73 ± 8.16 years) and gender ratio. The MetS was higher among the subjects on antipsychotics, but this difference did not reach statistical significance. Blood pressure (BP) was significantly higher in the antipsychotics group and BMI was the major risk factor to develop MetS in this group.

CONCLUSIONS

The prevalence of MetS in both groups is high and mostly attributed to obesity and high BP. Public health interventions are needed to address this major health problem overall. Larger studies are needed to further assess the impact of antipsychotics and mental illness on the development of MetS.

Application of plasma levels of olanzapine and N-desmethyl-olanzapine to monitor metabolic parameters in patients with schizophrenia

Metabolic disturbance is a common side effect of olanzapine (OLZ); however, the relationships between plasma OLZ concentration (C_OLZ) and metabolic disturbance remain unclear. Our previous study revealed that C_OLZ≧22.77ng/mL was a positive predictor of therapeutic efficacy in patients with schizophrenia. This study aimed to investigate the roles of OLZ or N-desmethyl-olanzapine (DMO) in metabolic outcomes among OLZ-treated patients with schizophrenia. The metabolic syndrome (MS) was diagnosed based on the modified the National Cholesterol Education Program Adult Treatment Panel III criteria for Asians. HPLC-ECD analytical system was applied to determine the C_OLZ and DMO concentration (C_DMO). The absolute drug levels and concentration-to-dose ratios (C/D ratios) were tested for their correlations to metabolic parameters. Total 151 fasting blood samples from patients with schizophrenia were collected. DMO C/D ratio negatively correlated with weight, body mass index, waist circumference, and C-peptide level. The receiver operator characteristic analysis determined a threshold C_DMO>5.63ng/mL and DMO C/D ratio>0.35ng/mL/mg were negative predictors of MS. The C_OLZ/C_DMO ratio>6.03 was identified as positive predictor of MS. Combined with previous study result, we proposed that the optimal OLZ treatment should maintain C_OLZ/C_DMO ratio between 3 and 6 to maximize the clinical efficacy and minimize the metabolic side effects. Our findings suggested that therapeutic drug monitoring on OLZ and DMO is a valuable tool to monitor metabolic side effects in OLZ-treated patients with schizophrenia.

Change and dispersion of QT interval during treatment with quetiapine extended release versus aripiprazole in children and adolescents with first-episode psychosis: results from the TEA trial

OBJECTIVE

The aim of this study was to compare the effect of quetiapine extended release (ER) versus aripiprazole on corrected QT interval (QTc) and QT dispersion (QTd) in youths with first-episode psychosis.

METHODS

Youths 12-17 years were randomized to quetiapine ER (daily dose range = 50 to 800 mg) or aripiprazole (daily dose range = 2.5 to 30 mg) in a 12-week double-blinded trial and examined at weeks 0, 4, and 12. Primary outcome was QTc change using Hodges formula (QTcH); secondary outcomes included QTcH > 450 ms, QTcH > 500 ms, QTcH change > 60 ms, QTd, and heart rate (HR).

RESULTS

Among 113 randomized youths, follow-up ECG was available for 93 patients (82.3%) (age = 15.8 ± 1.3 years, males = 34.4%, schizophrenia = 67.7%). Quetiapine ER treatment (n = 47) was associated with a significant increase in QTcH of + 6.8 ± 20.2 ms (p = 0.025), while the change from baseline in patients receiving aripiprazole (n = 46) was non-significant (- 3.4 ± 18.9 ms, p = 0.225). One patient in the quetiapine ER group had a QTcH change of + 62.3 ms. Age, sex, smoking, body mass index, and concomitant medication were not significantly associated with QTcH change, but higher baseline potassium was correlated to higher QTcH change in the quetiapine ER group. The HR increased significantly with quetiapine ER (+ 11.0 ± 14.2 bpm, p < 0.001) but not with aripiprazole (- 0.8 ± 12.0 bpm, p = 0.643). QTd did not significantly change with quetiapine ER or aripiprazole.

CONCLUSION

QTcH and HR increased significantly with quetiapine ER, although changes were small and likely not clinically significant in otherwise healthy patients. QTcH and HR were unchanged with aripiprazole. No significant change in QTd was seen. ClinicalTrials.gov: NCT01119014, EudraCT: 2009-016715-38.

Cardiovascular Risk in Early Psychosis: Relationship with Inflammation and Clinical Features 6 Months after Diagnosis

BACKGROUND

We aimed to investigate the state of cardiovascular risk/protection factors in early psychosis patients.

METHODS

A total 119 subjects were recruited during the first year after their first episode of psychosis. Eighty-five of these subjects were followed during the next 6 months. Cardiovascular risk/protection factors were measured in plasma and co-variated by sociodemographic/clinical characteristics. Multiple linear regression models detected the change of each biological marker from baseline to follow-up in relation to clinical scales, antipsychotic medication, and pro-/antiinflammatory mediators.

RESULTS

Glycosylated hemoglobin is a state biomarker in first episode of psychosis follow-up patients and inversely correlated to the Global Assessment of Functioning scale. We found opposite alterations in the levels of VCAM-1 and E-selectin in first episode of psychosis baseline conditions compared with control that were absent in the first episode of psychosis follow-up group. Adiponectin levels decreased in a continuum in both pathological time points studied. E-Selectin plasma levels were inversely related to total antipsychotic equivalents and adiponectin levels inversely co-related to the Global Assessment of Functioning scale. Finally, adiponectin levels were directly related to antiinflammatory nuclear receptor PPARγ expression in first episode of psychosis baseline conditions and to proinflammatory nuclear factor nuclear factor κB activity in follow-up conditions, respectively.

CONCLUSIONS

Our results support the need for integrating cardiovascular healthcare very early after the first episode of psychosis.

The prevalence, risk factors and clinical correlates of obesity in Chinese patients with schizophrenia

Obesity is a common comorbidity in schizophrenia. Few studies have addressed obesity in Chinese schizophrenia patients. The aims of this current study were to evaluate the prevalence, risk factors and clinical correlates of obesity in Chinese patients with schizophrenia. A total of 206 patients were recruited from a hospital in Beijing. Their clinical and anthropometric data together with plasma glucose and lipid parameters were collected. Positive and Negative Syndrome Scale (PANSS) was rated for all patients. Overall, 43 (20.9%) patients were obese and 67 (32.5%) were overweight. The obese patients had significantly higher glucose levels, triglyceride levels than non-obese patients. Females and patients with type 2 diabetes mellitus had increased risk for obesity. Correlation analysis showed that BMI was associated with sex, education levels, negative symptoms, total PANSS score, triglyceride levels and type 2 diabetes mellitus. Further stepwise regression analysis showed that sex, type 2 diabetes, education level, triglyceride and amount of smoking/day were significant predictors for obesity. Our study showed that the prevalence of obesity in Chinese patients with schizophrenia is higher than that in the general population. Some demographic and clinical variables are risk factors for obesity in schizophrenia.

Is cerebrovascular disease a silent condition in patients with chronic schizophrenia-related disorders?

Patients with chronic schizophrenia-related disorders are at a heightened risk of developing cardiovascular disease. The presence and interpretation of cerebral vascular lesions in neuroimaging tests in these patients represents a common clinical challenge. Nevertheless, the literature on cerebrovascular disease in this population is scarce and contradictory. The aim of this study was to analyse the relationship between schizophrenia-related disorders and cerebrovascular morbidity. A case-control study compared cerebrovascular morbidity in a group of patients with schizophrenia-related disorder versus a group of patients with another severe mental illness. The risk of presenting cerebrovascular morbidity was four times higher and statistically significant in patients with schizophrenia-related disorders compared with controls, paired by age and sex. However, both groups were homogeneous in terms of cardiovascular risk factors. There were significant differences between the two groups only in the time using first-generation antipsychotic drugs and taking two or more antipsychotic medications simultaneously. The relationship between chronic schizophrenia-related disorders and cerebrovascular disease may be beyond the classic cardiovascular risk factors and related to certain medications. This is one of the first studies to focus on the relation among cerebrovascular morbidity, antipsychotic drugs and disorders related to schizophrenia in middle-aged and elderly adults.

Cause of death and potentially avoidable deaths in Australian adults with intellectual disability using retrospective linked data

OBJECTIVES

To investigate mortality and its causes in adults over the age of 20 years with intellectual disability (ID).

DESIGN, SETTING AND PARTICIPANTS

Retrospective population-based standardised mortality of the ID and Comparison cohorts. The ID cohort comprised 42 204 individuals who registered for disability services with ID as a primary or secondary diagnosis from 2005 to 2011 in New South Wales (NSW). The Comparison cohort was obtained from published deaths in NSW from the Australian Bureau of Statistics (ABS) from 2005 to 2011.

MAIN OUTCOME MEASURES

We measured and compared Age Standardised Mortality Rate (ASMR), Comparative Mortality Figure (CMF), years of productive life lost (YPLL) and proportion of deaths with potentially avoidable causes in an ID cohort with an NSW general population cohort.

RESULTS

There were 19 362 adults in the ID cohort which experienced 732 (4%) deaths at a median age of 54 years. Age Standardised Mortality Rates increased with age for both cohorts. Overall comparative mortality figure was 1.3, but was substantially higher for the 20-44 (4.0) and 45-64 (2.3) age groups. YPLL was 137/1000 people in the ID cohort and 49 in the comparison cohort. Cause of death in ID cohort was dominated by respiratory, circulatory, neoplasm and nervous system. After recoding deaths previously attributed to the aetiology of the disability, 38% of deaths in the ID cohort and 17% in the comparison cohort were potentially avoidable.

CONCLUSIONS

Adults with ID experience premature mortality and over-representation of potentially avoidable deaths. A national system of reporting of deaths in adults with ID is required. Inclusion in health policy and services development and in health promotion programmes is urgently required to address premature deaths and health inequalities for adults with ID.