Atypical Antipsychotic Drugs, Schizophrenia, and Metabolic Syndrome in Non–Euro-American Societies

ADVERSE EFFECTS ASSOCIATED with ANTIPSYCHOTIC USE in OLDER ADULTS

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 antipsychotic 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. Cardiovascular risks, particularly stroke, with antipsychotic 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 antipsychotics, prompting the need for additional real-world studies to inform clinical practice. Conflicting evidence on diabetes mellitus and acute kidney injury necessitates ongoing studies and further research in older adults.

Olanzapine-induced weight gain and lipid dysfunction in mice between different gender

As one of the most common antipsychotics, olanzapine may cause metabolic-related adverse effects, but it is still unknown how olanzapine alters lipid metabolism. In this study, we found that olanzapine-treated mice showed varying degrees of dyslipidemia, which was particularly pronounced in female mice. Based on ultra-performance liquid chromatography-quadrupole time-of-flight-MS (UPLC-Q-TOF-MS) technology and lipid metabolomics, we mapped the changes in lipid metabolism in olanzapine-treated mice and then compared the changes in lipid metabolism between male and female mice. There were 98 metabolic differentiators between the olanzapine-treated and control groups in females and 79 in males. These metabolites were glycerolipids, glycerophospholipids, fatty amides, and sphingolipids, which are involved in glycerolipid metabolism, glycerophospholipid metabolism, and fatty acid metabolism. These results suggest that olanzapine-induced changes in the levels of lipid metabolites are closely associated with disturbances in lipid metabolic pathways, which may underlie lipemia. This lipidome profiling study not only visualizes changes in lipid metabolism in liver tissue but also provides a foundation for understanding the regulatory pathways and mechanisms involved in olanzapine-induced lipid metabolism disorders. Furthermore, this study demonstrates differences in lipid metabolism between males and females, providing a reference for clinical treatment regimen selection.

The Role of ElastPQ in Assessing Liver Stiffness for Non-Alcoholic Fatty Liver Disease in Patients Treated with Atypical Antipsychotic Drugs

Objective

To evaluate the role of elastography point quantification (ElastPQ) for the quantitative assessment of stiffness in the fatty liver disease in mental disorder patients and to provide a noninvasive detection method for non-alcoholic fatty liver (NAFLD) caused by atypical antipsychotics drugs (AAPDs).

Methods

A total number of 168 mental disorder patients treated with AAPDs and 58 healthy volunteers were enrolled in this study. All the subjects underwent ultrasound and ElastPQ tests. The basic data of the patients were analyzed.

Results

BMI, liver function, and the value of ElastPQ were considerably higher in the patient group than that in the healthy volunteers. The values of liver stiffness obtained by ElastPQ were increased gradually from 3.48(3.14-3.81) kPa in the normal liver to 8.15(6.44-9.88) in the severe fatty liver. The receiver operating characteristic (ROC) for the diagnosis of fatty liver with ElastPQ were 0.85, 0.79, 0.80, and 0.87 for the diagnosis of normal, mild, moderate, and severe steatosis, respectively, with a sensitive/specificity of 79%/76.4%, 85.7%/78.3%, 86.2%/73%, and 81.3%/82.1%, correspondingly. Moreover, ElastPQ in the olanzapine group was higher than those in the risperidone and aripiprazole groups (5.11(3.83-5.61) kPa vs 4.35(3.63-4.98) kPa, P < 0.05; 5.11(3.83-5.61) kPa vs 4.79(4.18-5.24) kPa, P < 0.05). After one-year treatment, the value of ElastPQ was 4.43(3.85-5.22) kPa, but it was 5.81(5.09-7.33) kPa in patients treated for more than three years. This value increased with treatment prolongation (P < 0.05).

Conclusion

ElastPQ is a real-time, quantitative method for assessing the stiffness of NAFLD. The liver stiffness value could be varied in the different stages of fatty liver. Olanzapine has a considerable influence on liver stiffness. The long-term use of AAPDs can increase the stiffness value of fatty liver.

Influence of antipsychotic medications on hyperlipidemia risk in patients with schizophrenia: evidence from a population-based cohort study and in vitro hepatic lipid homeostasis gene expression

Introduction

Schizophrenia increases the risk of mortality and cardiovascular disease (CVD) risk. However, the correlation between antipsychotics (APs) and CVD remains controversial. Hyperlipidemia is a significant risk factor for CVD.

Methods

We conducted a nationwide population-based retrospective cohort study to investigate the effects of APs on the risk of hyperlipidemia and lipid homeostasis gene expression. We used data from the Longitudinal Health Insurance Database of Taiwan on new-onset schizophrenia patients and a comparison cohort without schizophrenia. We used a Cox proportional hazards regression model to analyze the differences in hyperlipidemia development between the two cohorts. Furthermore, we examined the effects of APs on the hepatic expression of lipid homeostasis-related genes.

Results

After adjusting for potential interrelated confounding factors, the case group (N = 4,533) was found to have a higher hyperlipidemia risk than the control cohort (N = 4,533) [adjusted hazard ratio (aHR), 1.30, p < 0.001]. Patients with schizophrenia without APs had a significantly higher risk of hyperlipidemia (aHR, 2.16; p < 0.001). However, patients receiving APs had a significantly lower risk of hyperlipidemia than patients not receiving APs (all aHR ≤ 0.42, p < 0.001). First-generation antipsychotics (FGAs) induce the expression of hepatic lipid catabolism genes in an in vitro model.

Discussion

Patients with schizophrenia had a higher risk of hyperlipidemia than controls; however, compared with non-treated patients, AP users had a lower risk of hyperlipidemia. Early diagnosis and management of hyperlipidemia may help prevent CVD.

Metabolic syndrome in patients with schizophrenia: Why should we care

Metabolic syndrome (MS) is a serious disease in patients with schizophrenia; it is necessary to evaluate the characteristics and influencing factors of MS to provide reliable evidence for the management of schizophrenia. Patients with schizophrenia treated in our hospital from January 1, 2018, to March 31, 2021, were selected. The characteristics and treatment details of MS and no-MS patients were evaluated. Pearson correlation analyses were applied for analyzing MS and related characteristics. Logistic regression analyses were conducted to evaluate the risk factors of MS in patients with schizophrenia. A total of 465 patients with schizophrenia were included, the incidence of MS in patients with schizophrenia was 18.06%. Pearson correlation analyses had found that age (r = 0.621), waist circumference (r = 0.744), body mass index (r = 0.691), diabetes (r = 0.598), course of disease (r = 0.504), triglyceride (r = 0.532), high-density lipoprotein cholesterol (r = -0.518), low-density lipoprotein cholesterol (r = 0.447), and total cholesterol (r = 0.523) were correlated with MS (all P < .05). Logistic regression analyses showed that age ≥55 years (odds ratio [OR]: 2.012, 95% confidence interval [CI]: 1.425-3.196), waist circumference ≥80 cm (OR: 1.944, 95% CI: 1.081-3.172), body mass index ≥24.5 kg/m2 (OR: 2.451, 95% CI: 1.825-3.108), diabetes (OR: 2.301, 95% CI: 1.944-2.881), course of disease ≥15 years (OR: 1.804, 95% CI: 1.236-2.845), triglyceride ≥1.5 mmol/L (OR: 2.032, 95% CI: 1.614-3.079), high-density lipoprotein cholesterol ≤0.8 mmol/L (OR: 1.226, 95% CI: 1.102-1.845), low-density lipoprotein cholesterol ≥2 mmol/L (OR: 1.759, 95% CI: 1.236-1.987), and total cholesterol ≥4.5 mmol/L (OR: 1.664, 95% CI: 1.422-1.852) were the risk factors of MS in patients with schizophrenia (all P < .05). MS is very common in patients with schizophrenia, which may be associated with many possible risk factors, and early interventions and nursing care targeted at those influencing factors are needed to improve the prognosis of schizophrenia.

Metabolic risk factors of cognitive impairment in young women with major psychiatric disorder

BACKGROUND

Cognitive performance improves clinical outcomes of patients with major psychiatric disorder (MPD), but is impaired by hyperglycemia. Psychotropic agents often induce metabolism syndrome (MetS). The identification of modifiable metabolic risk factors of cognitive impairment may enable targeted improvements of patient care.

OBJECTIVE

To investigate the relationship between MetS and cognitive impairment in young women with MPD, and to explore risk factors.

METHODS

We retrospectively studied women of 18-34 years of age receiving psychotropic medications for first-onset schizophrenia (SCH), bipolar disorder (BP), or major depressive disorder (MDD). Data were obtained at four time points: presentation but before psychotropic medication; 4-8 and 8-12 weeks of psychotropic therapy; and enrollment. MATRICS Consensus Cognitive Battery, (MCCB)-based Global Deficit Scores were used to assess cognitive impairment. Multiple logistic analysis was used to calculate risk factors. Multivariate models were used to investigate factors associated with cognitive impairment.

RESULTS

We evaluated 2,864 participants. Cognitive impairment was observed in 61.94% of study participants, and was most prevalent among patients with BP (69.38%). HbA1c within the 8-12 week-treatment interval was the most significant risk factor and highest in BP. Factors in SCH included pre-treatment waist circumference and elevated triglycerides during the 8-12 weeks treatment interval. Cumulative dosages of antipsychotics, antidepressants, and valproate were associated with cognitive impairment in all MPD subgroups, although lithium demonstrated a protect effect (all P < 0.001).

CONCLUSIONS

Cognitive impairment was associated with elevated HbA1c and cumulative medication dosages. Pre-treatment waist circumference and triglyceride level at 8-12 weeks were risk factors in SCH. Monitoring these indices may inform treatment revisions to improve clinical outcomes.

Discontinuation and remission rates and social functioning in patients with schizophrenia receiving second-generation antipsychotics: 52-week evaluation of JUMPs, a randomized, open-label study

AIM

Globally, evidence from short-term studies is insufficient for the guidelines to uniformly recommend a particular antipsychotic(s) for the maintenance treatment of schizophrenia. Therefore, long-term comprehensive evaluation of antipsychotics is required from a social rehabilitation perspective, especially for drugs that have not yet been studied. The Japan Useful Medication Program for Schizophrenia (JUMPs) is a large-scale, long-term naturalistic study to present pivotal 52-week data on the continuity of second-generation antipsychotics (SGA: aripiprazole, blonanserin, and paliperidone).

METHODS

JUMPs was an open-label, three-arm, randomized, parallel-group, 52-week study. Enrolled patients had schizophrenia, were ≥20 years old, and required antipsychotic treatment or switched from previous therapy. The primary endpoint was treatment discontinuation rate over 52 weeks. Secondary outcomes included remission rate, social functioning, and quality-of-life scores [Personal and Social Performance Scale (PSP) and EuroQol-5 dimensions], and safety.

RESULTS

In total, 251 patients received aripiprazole (n = 82), blonanserin (n = 85), or paliperidone (n = 84). The discontinuation rate (P = 0.9771) and remission rates (P > 0.05) over 52 weeks did not differ significantly between the three treatment groups. The discontinuation rates were 68.3%, 68.2%, and 65.5% in the aripiprazole, blonanserin, and paliperidone groups, respectively. Significant improvements (all P < 0.05) from baseline in PSP scores were observed at start of monotherapy, week 26, and week 52 in the overall cohort and blonanserin group and at week 26 in the aripiprazole group. The adverse event profile favored blonanserin.

CONCLUSION

All three SGAs evaluated in this study showed similar treatment discontinuation rates in patients with chronic schizophrenia in Japan.

Abnormalities in Glucose Blood Level during Antipsychotic Treatment in Schizophrenia Patients

Background: Schizophrenia is one of the mental disorder with many problematic issues, in both psychologically and socially. This disease requires provision of long-term antipsychotic therapy, hence could rise other potential health problems. Antipsychotic treatment can cause serious glucometabolic side-effects, including type 2 diabetes and hyperglycemic emergency. Recent attention has also been focused on antipsychotic-induced hyperglycemic emergencies experienced by new users of typical and atypical antipsychotic. Patients treated with atypical APDs have ~10 times higher risk in developing hyperglycaemic emergencies. In our pre-eliminary study, hyperglycemia condition in new patients occurs in four  in seven patients who received typical and atypical antipsychotics. This condition is often overlooked and is not routinely evaluated. Moreover, it can develop into diabetes and increase the risk of morbidity and mortality in schizophrenia patients. In this study, we would like to determine the acute effects of metabolic (hyperglycemia) in patients treated with antipsychotic (Risperidone and Haloperidol) Measurement of blood sugar levels was performed in groups treated with haloperidol (N = 15) and treated with risperidone (N = 15). Plasma samples were taken at the beginning of treatment, in week IV, and in week VIII. The measurement of glucose levels was performed after meal and in early morning before breakfast (fasting blood glucose level 8 hours). Results: The blood sugar level after meals was significantly higher in the Risperidone group compared to the Haloperidol group  (p <0.001) after IV and VIII weeks. Meanwhile, the fasting blood sugar level was significantly higher in the Risperidone group compared to the Haloperidol group after VIII weeks of treatment ( p <0.001). Conclusions: Both antipsychotics can cause an increase in blood sugar levels. Treatment with Risperidone significantly increased the blood sugar levels compared to treatment with haloperidol. Measurement of blood sugar level is needed to monitor the metabolic effect of antipsychotic, especially in patients treated with Risperidone. It is necessary to have dietary regulation and physical activities to prevent undesired metabolic side effects.

Adjuvant Pitolisant in a Case With Early-Onset Schizophrenia

OBJECTIVES

Early-onset schizophrenia is notorious for poor prognostication and treatment refractoriness. Child/adolescent psychiatric population, by virtue of age, is at a heightened risk for cardiometabolic risk of atypical antipsychotics. Available pharmacological options are, sorely, too limited to mitigate this risk.

METHODS

The authors are reporting here on an adolescent case with early-onset schizophrenia who has favorably responded to olanzapine but with problematic weight gain that failed a trial of add-on metformin. A trial of add-on pitolisant was pursued.

RESULTS

Adjunctive pitolisant has successfully helped with the weight issue. Strikingly, there were parallel improvements in both cognitive and negative domains as well.

CONCLUSIONS

Add-on pitolisant can be a safe and effective strategy to address antipsychotic-induced metabolic syndrome. Gains might also span negative/cognitive domains. This might open new treatment venues for such complicated clinical scenarios that await replication in larger rigorous studies.

Unveiling the Metabolic Profile of First-Episode Drug-Naïve Schizophrenia Patients: Baseline Characteristics of a Longitudinal Study Among Han Chinese

Objective: Metabolic and other medical conditions are frequently comorbid with schizophrenia. As they might be the side-effects of antipsychotic treatment, studying first-episode drug-naïve schizophrenia (FDSZ) provides a unique opportunity to investigate a direct pathogenic link between metabolic changes and schizophrenia. Here, we presented the methods and baseline unique metabolic profile of FDSZ patients without medical comorbidities unveiling subthreshold indices of metabolic disturbances. Method: Drug-naïve individuals diagnosed with schizophrenia but without any previous medical conditions were invited to participate in the study. Participants were submitted to structured psychiatric and cognitive assessments, laboratory and neuroimaging tests. Subjects will be followed after antipsychotic treatment at 6, 24 and 48 weeks. Results: During an 8-month-period, out of 103 patients presenting with first episode psychosis, 67 subjects (43.3% men, 56.7% women) were enrolled in the study. They had a mean ± SD age of 32.1 ± 8.7 years, with a mean BMI of 21.1 kg/m² and 11.3 ± 3.6 years of schooling. Less than 1/3 reported a family history of mental illness. Upon laboratory assessment, 10.4%, 7.5%, and 11.9% of patients were identified with hyperhomocysteinemia, hypertriglyceridemia and hyperprolactinemia, respectively, with percentages of women relatively higher than men except for hypertriglyceridemia. Conclusions: First episode schizophrenia patients, especially women, present subclinical metabolic abnormalities, independent of antipsychotic treatment.

Glucose disturbances, cognitive deficits and white matter abnormalities in first-episode drug-naive schizophrenia

Disturbance of glucose metabolism may be implicated in cognitive deficits of schizophrenia in its early phases. Many studies have reported the important role of widespread disruption of white matter (WM) connectivity in pathogenesis, cognitive deficit and psychopathology of schizophrenia. However, no study has investigated their inter-relationships in drug-naive first episode (DNFE) patients with schizophrenia. Glucose metabolism parameters including fasting glucose, insulin and homeostasis model of assessment-insulin resistance (HOMA-IR) index, cognitive performance on the MATRICS Consensus Cognitive Battery (MCCB) and the voxel-wised WM fractional anisotropy (FA) values were examined using DTI in 39 DNFE schizophrenia and 31 control subjects. The Positive and Negative Syndrome Scale was utilized for clinical symptoms. The patients showed significantly greater fasting plasma levels of glucose and insulin and HOMA-IR, and poorer cognitive scores, together with widespread reduced FA values in five brain areas, including left and right corpus callosum, superior longitudinal fasciculus, posterior thalamic radiation, and corona radiata (all p < 0.05). Association analysis showed that glucose level was positively associated with Digital Sequence Test and Continuous Performance Test, but negatively with FA values in posterior thalamic radiation and left corpus callosum in patients (all p < 0.05). Furthermore, multiple regression analysis revealed that the interactions of glucose × FA in left corpus callosum, longitudinal fasciculus and corona radiata were independent contributors to the Brief Visuospatial Memory Test (BVMT) of MCCB, while the interaction of glucose × FA in left corpus callosum, or in longitudinal fasciculus was associated with MCCB mazes and Trail Making A Test, respectively. Therefore, abnormal glucose metabolism, cognitive impairment and widespread disruption of WM structure occur in an early course of schizophrenia onset. An interaction between glucose metabolism abnormality and the WM dysconnectivity may lead to cognitive impairment.

Plasma soluble P-selectin correlates with triglycerides and nitrite in overweight/obese patients with schizophrenia

Background:

Soluble P-selectin (sP-selectin) is associated with risk factors for cardiovascular disease (CVD) but this association has not been evaluated in patients with schizophrenia. This study primarily evaluated the association of sP-selectin with plasma lipids and nitrite (NO₂−) respectively in overweight/obese adults with schizophrenia.

Methods:

One-hundred and six patients with schizophrenia (mean age 32.9 years; 71.60% male) were recruited from a psychiatric hospital. Participants completed a structured interview and provided a fasting blood sample. Body mass index (BMI) was used to divide the sample into normal weight and overweight/obese groups. Pearson’s and partial correlation coefficients (controlling for age, sex, race, education, and inflammation) were calculated to examine the association of sP-selectin with plasma lipids, and NO₂− in the overweight/obese patients (primary analysis), as well as in the normal weight patients and the total sample (exploratory analyses).

Results:

After controlling for potential confounders, sP-selectin positively correlated with triglycerides (r = 0.38, p = 0.01) and NO₂− (r = 0.40, p < 0.01) in the overweight/obese group only.

Conclusions:

Future longitudinal studies should evaluate the utility of sP-selectin as a biomarker of CVD in overweight/obese adults with schizophrenia (for example, by relating sP-selectin to incidence of cardiovascular events).

Review of Early Intervention Programmes in Psychosis: Implementation Proposal for Peru

A delay in receiving an antipsychotic treatment is associated with unfavourable clinical and functional outcomes in patients with a first episode of psychosis. In recent years, early psychosis intervention programmes have been implemented that seek the early detection and treatment of patients who begin to describe psychotic symptoms. These programmes have shown to be more effective than standard care in improving the symptoms of the disorder and recovering the patient's functionality, in turn proving to be more cost-effective. The benefits of these programmes have led to their implementation in high-income countries. However, implementation in medium- and low-income countries has been slower. Peru, a Latin American country with an upper middle income, is undergoing a mental health reform that prioritises health care based on the prevention, treatment and psychosocial recovery of patients from a comprehensive and community approach. The present manuscript describes the characteristics and structure of the pioneering and more developed programmes for early psychosis intervention, and discusses the benefits and challenges of implementing an early psychosis intervention programme in Peru in the current context of mental health reform.

Polycystic Ovary Syndrome and Psychotic Disorder

Polycystic ovary syndrome (PCOS), a disease that usually emerges during adolescence, is characterized by hormonal imbalance and ovarian dysfunction. The prevalence can vary between 5.6 to 21.3% in women and 6% in adolescent girls. This discrepancy is related to the population studied and the diagnostic criteria used. The underlying pathophysiology of PCOS is not fully understood, but it can lead to a number of co-morbidities, including hypertension, diabetes, dyslipidemia, and also, mental health disorders. Clinical and preclinical data indicate neuroendocrine involvement with dysfunction in gamma-Aminobutyric acid (GABA) signaling and neuronal androgen receptors that might reduce hypothalamic sensitivity and lead to an impairment of estradiol and progesterone feedback. Based on these assumptions, the aims of this paper are to review the association of PCOS and psychotic disorders in order to address the burden of women comorbid for both conditions.

Cortisol and DHEAS Related to Metabolic Syndrome in Patients with Schizophrenia

BACKGROUND

Both dehydroepiandrosterone (DHEAS) and cortisol are secreted by the adrenal glands and may modulate metabolic syndrome (MetS), which often affects the health of patients with schizophrenia. The relationship between the serum levels of these hormones and MetS has not been established.

PURPOSE

In this pilot study, we investigated the serum levels in schizophrenia patients with and without MetS and compared them with those in healthy volunteers.

PATIENTS AND METHODS

After obtaining informed consent, 110 patients with acute paranoid schizophrenia were recruited directly after admission to the Mental Health Research Institute. The control group consisted of 51 persons reported on questioning to be mentally and somatically healthy. Blood samples to prepare serum were drawn after an 8-h overnight fast during one of the first days of admission. Serum cortisol and DHEAS concentrations were quantified by enzyme-linked immunosorbent assay.

RESULTS

A total of 42 patients had MetS and 68 patients were without MetS. The cortisol blood level was significantly (p = 0.012) higher in schizophrenia patients without MetS in comparison to healthy controls, while patients with schizophrenia and a MetS have significantly (p = 0.014) lower DHEAS levels than healthy volunteers. These differences could, however, exclusively be attributed to female participants. Analysis of covariance adjusted for gender and age demonstrated a significant relationship between age and DHEAS levels (F = 9.512, р = 0.003).

CONCLUSION

Lower DHEAS serum levels in relationship to MetS become evident in women, but not in men, and have age differences as a confounding factor.

Associations among antipsychotics, metabolism-related diseases, and cataracts in patients with schizophrenia: A retrospective cohort study

BACKGROUND

Long-term cataract risks associated with first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs), and their associations with metabolism-related diseases are not yet elucidated.

METHODS

Using Taiwan National Health Insurance data, we conducted a propensity score matched population-based cohort study consisting of 10,014 patients with newly diagnosed schizophrenia from 2005 to 2009 and followed them until the end of 2013. A Cox hazard model with metabolism-related diseases as time-dependent covariates was adapted to estimate the hazard ratio (HR) of cataracts between SGAs and FGAs groups.

RESULTS

During the 8-year follow-up, patients receiving SGAs were associated with a higher risk of cataract than those receiving FGAs with an adjusted HR of 1.59 (95% confidence interval [CI] = 1.06-2.36). Patients receiving high-metabolic-risk SGAs (clozapine and olanzapine) showed the highest risk of cataracts among SGAs when compared with those receiving FGAs (aHR = 2.57, 95% CI: 1.35-4.88). SGAs demonstrated a stronger contribution in the risk of cataract in patients without diabetes mellitus (DM) and hyperlipidemia than in those developed these diseases. Patients who developed DM or hyperlipidemia after receiving antipsychotics had an approximately 2.5-fold increased cataract risk over those who did not develop these diseases.

CONCLUSIONS

Regardless of the condition of metabolic-related diseases, SGAs were independently associated with an increased risk of cataract. DM and hyperlipidemia developed after antipsychotics contributed to the risk of cataract risk.

Apolipoprotein serum levels related to metabolic syndrome in patients with schizophrenia

BACKGROUND

Schizophrenia is associated with a lowered life expectancy due to cardiovascular disease. This is, at least in part, related to an increased vulnerability to the development of metabolic syndrome (MetS) in patients with schizophrenia. The dysregulation of apolipoproteins (Apos) may also play a role in the pathogenesis of schizophrenia via their effect on cerebral cholesterol processing.

AIM

The aim of this study was to investigate serum Apos A1, C3, E, A2 and C2 concentration in schizophrenia patients with or without MetS in comparison to healthy donors.

METHODS

After obtaining informed consent, 53 patients with a diagnosis of paranoid schizophrenia according to ICD-10 criteria (F20) were included. Patients were divided into two groups with (N = 26) and without (N = 27) MetS according to the criteria of the International Diabetes Federation. The control group included 20 mentally and physically healthy subjects. Serum Apos A1, A2, C2, C3 and E were measured using xMAP technology (Luminex).

RESULTS

Serum ApoA1 was significantly decreased in patients with schizophrenia compared to healthy subjects (p = 0.002); ApoA2 was lower in patients without MetS in comparison to patients with MetS (p = 0.017) and the levels of ApoC3 and ApoC2 were increased in patients with schizophrenia with MetS in comparison with the control group and also with patients without MetS. No other significant differences were established concerning the other assayed apolipoproteins.

CONCLUSIONS

In line with literature data the results of our study suggest that while disturbances in ApoA1 level may play a role in the pathogenesis of schizophrenia, ApoA2, ApoC2, ApoC3 and ApoE may be primarily related to metabolic imbalance.

Atypical antipsychotics-induced metabolic syndrome and nonalcoholic fatty liver disease: a critical review

The atypical antipsychotics (AAPs) have been used as first-line drugs in psychiatric practice for a wide range of psychotic disorders, including schizophrenia and bipolar mania. While effectively exerting therapeutic effects on positive and negative symptoms, as well as cognitive impairments in schizophrenia patients, these drugs are less likely to induce extrapyramidal symptoms compared to typical antipsychotics. However, the increasing application of them has raised questions on their tolerability and adverse effects over the endocrine, metabolic, and cardiovascular axes. Specifically, AAPs are associated to different extents, with weight gain, metabolic syndrome (MetS), and nonalcoholic fatty liver disease (NAFLD). This article summarized clinical evidence showing the metabolic side effects of AAPs in patients with schizophrenia, and experimental evidence of AAPs-induced metabolic side effects observed in animals and cell culture studies. In addition, it discussed potential mechanisms involved in the APPs-induced MetS and NAFLD.

Second generation antipsychotic-induced mitochondrial alterations: Implications for increased risk of metabolic syndrome in patients with schizophrenia

Metabolic syndrome (MetS) is seen more frequently in persons with schizophrenia than in the general population, and these metabolic abnormalities are further aggravated by second generation antipsychotic (SGA) drugs. Although the underlying mechanisms responsible for the increased prevalence of MetS among patients under SGA treatment are not well understood, alterations in mitochondria function have been implicated. We performed a comprehensive evaluation of the role of mitochondrial dysfunction in the pathophysiology of drug-induced MetS in schizophrenia. We found a downregulation in genes encoding subunits of the electron transport chain complexes (ETC), enzyme activity, and mitochondrial dynamics in peripheral blood cells from patients at high-risk for MetS. Additionally, we evaluated several markers of energy metabolism in lymphoblastoid cell lines from patients with schizophrenia and controls following exposure to antipsychotics. We found that the high-risk drugs clozapine and olanzapine induced a general down-regulation of genes involved in the ETC, as well as decreased activities of the corresponding enzymes, ATP levels and a significant decrease in all the functional parameters of mitochondrial oxygen consumption in cells from patients and controls. We also observed that the medium-risk SGA quetiapine decreased oxygen consumption and respiratory control ratio in controls and patients. Additionally, clozapine and olanzapine induced a downregulation of Drp1 and Mfn2 both in terms of mRNA and protein levels. Together, these data suggest that an intrinsic defect in multiple components of oxidative metabolism may contribute to the increased prevalence of MetS in patients under treatment with SGAs known to cause risk for MetS.

The association between rehabilitation programs and metabolic syndrome in chronic inpatients with schizophrenia

The correlation between different rehabilitation programs and the prevalence of metabolic syndrome in people with schizophrenia is unclear. We tested the association in chronic inpatients with schizophrenia of a psychiatric hospital in Taiwan. Patients with schizophrenia and age from 20 to 65 years old were included. The criteria of metabolic syndrome were according to the adapted Adult Treatment Protocol for Asians. According to different types of rehabilitations, patients were divided into work group, occupational therapy group and daily activities group. A total of 359 chronic inpatients with schizophrenia were recruited. Participants had a mean age of 45.9 years and the prevalence of metabolic syndrome was 37.3%. There was a significantly higher prevalence of metabolic syndrome in the work group than in the daily activity group (adjusted odds ratio (aOR) = 1.91, 95% CI = 1.019-3.564, p < 0.05) after adjusted related confounders. Other factors associated with higher prevalence of metabolic syndrome included old age, female gender, low psychotic symptoms severity and clozapine user. This study identified a high prevalence of metabolic syndrome in chronic inpatients with schizophrenia especially in patients with good occupational function. Further investigation of the relationship between the occupational function and metabolic syndrome is necessary for chronic inpatients with schizophrenia.

Molecular Mechanisms of Antipsychotic Drug-Induced Diabetes

Antipsychotic drugs (APDs) are widely prescribed to control various mental disorders. As mental disorders are chronic diseases, these drugs are often used over a life-time. However, APDs can cause serious glucometabolic side-effects including type 2 diabetes and hyperglycaemic emergency, leading to medication non-compliance. At present, there is no effective approach to overcome these side-effects. Understanding the mechanisms for APD-induced diabetes should be helpful in prevention and treatment of these side-effects of APDs and thus improve the clinical outcomes of APDs. In this review, the potential mechanisms for APD-induced diabetes are summarized so that novel approaches can be considered to relieve APD-induced diabetes. APD-induced diabetes could be mediated by multiple mechanisms: (1) APDs can inhibit the insulin signaling pathway in the target cells such as muscle cells, hepatocytes and adipocytes to cause insulin resistance; (2) APD-induced obesity can result in high levels of free fatty acids (FFA) and inflammation, which can also cause insulin resistance. (3) APDs can cause direct damage to β-cells, leading to dysfunction and apoptosis of β-cells. A recent theory considers that both β-cell damage and insulin resistance are necessary factors for the development of diabetes. In high-fat diet-induced diabetes, the compensatory ability of β-cells is gradually damaged, while APDs cause direct β-cell damage, accounting for the severe form of APD-induced diabetes. Based on these mechanisms, effective prevention of APD-induced diabetes may need an integrated approach to combat various effects of APDs on multiple pathways.

Overexpression of Insig-2 inhibits atypical antipsychotic-induced adipogenic differentiation and lipid biosynthesis in adipose-derived stem cells

Atypical antipsychotics (AAPs) are considered to possess superior efficacy for treating both the positive and negative symptoms of schizophrenia; however, AAP use often causes excessive weight gain and metabolic abnormalities. Recently, several reports have demonstrated that AAPs activate sterol regulatory element-binding protein (SREBP). SREBP, SREBP cleavage-activating protein (SCAP) and insulin-induced gene (Insig) regulate downstream cholesterol and fatty acid biosynthesis. In this study, we explored the effects of clozapine, olanzapine and risperidone on SREBP signaling and downstream lipid biosynthesis genes in the early events of adipogenic differentiation in adipose-derived stem cells (ASCs). After the induction of adipogenic differentiation for 2 days, all AAPs, notably clozapine treatment for 3 and 7 days, enhanced the expression of SREBP-1 and its downstream lipid biosynthesis genes without dexamethasone and insulin supplementation. Simultaneously, protein level of SREBP-1 was significantly enhanced via inhibition of Insig-2 expression. By contrast, SREBP-1 activation was suppressed when Insig-2 expression was upregulated by transfection with Insig-2 plasmid DNA. In summary, our results indicate that AAP treatment, notably clozapine treatment, induces early-stage lipid biosynthesis in ASCs. Such abnormal lipogenesis can be reversed when Insig-2 expression was increased, suggesting that Insig/SCAP/SREBP signaling may be a therapeutic target for AAP-induced weight gain and metabolic abnormalities.

Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review

Since the discovery of chlorpromazine (CPZ) in 1952, first-generation antipsychotics (FGAs) have revolutionized psychiatric care in terms of facilitating discharge from hospital and enabling large numbers of patients with severe mental illness (SMI) to be treated in the community. Second-generation antipsychotics (SGAs) ushered in a progressive shift from the paternalistic management of SMI symptoms to a patient-centered approach, which emphasized targets important to patients - psychosocial functioning, quality of life, and recovery. These drugs are no longer limited to specific Diagnostic and Statistical Manual of Mental Disorders (DSM) categories. Evidence indicates that SGAs show an improved safety and tolerability profile compared with FGAs. The incidence of treatment-emergent extrapyramidal side effects is lower, and there is less impairment of cognitive function and treatment-related negative symptoms. However, treatment with SGAs has been associated with a wide range of untoward effects, among which treatment-emergent weight gain and metabolic abnormalities are of notable concern. The present clinical review aims to summarize the safety and tolerability profile of selected FGAs and SGAs and to link treatment-related adverse effects to the pharmacodynamic profile of each drug. Evidence, predominantly derived from systematic reviews, meta-analyses, and clinical trials of the drugs amisulpride, aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, ziprasidone, CPZ, haloperidol, loxapine, and perphenazine, is summarized. In addition, the safety and tolerability profiles of antipsychotics are discussed in the context of the "behavioral toxicity" conceptual framework, which considers the longitudinal course and the clinical and therapeutic consequences of treatment-emergent side effects. In SMI, SGAs with safer metabolic profiles should ideally be prescribed first. However, alongside with safety, efficacy should also be considered on a patient-tailored basis.

Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care

BACKGROUND

Metabolic syndrome (MetS) and cardiovascular risk are highly prevalent among individuals with schizophrenia. This study aimed to determine the cardiometabolic profile and the associated risk factors in a group of institutionalized patients with schizophrenia or schizoaffective disorder receiving prolonged hospital care in the only tertiary psychiatric institution in Singapore.

METHODS

Patients residing in long stay wards who were hospitalized for a minimum period of 1year were recruited. Fasting blood sample was collected to obtain levels of blood glucose, total cholesterol, high-density lipoprotein (HDL) and triglycerides. Waist circumference, blood pressure, height and weight were also measured. The prevalence of MetS and the 10-year cardiovascular risk were determined.

RESULTS

This inpatient group had a mean age of 56.1years and an average length of hospitalization of 8.8years. The prevalence of MetS in this group was 51.9% and 26.9% based on the AHA/NHLBI and modified NCEP ATP III criteria respectively. Those in the high risk BMI category and those who had pre-existing diabetes had higher odds of MetS. Their 10-year cardiovascular risk was estimated at 12.8%, indicating intermediate risk based on the Framingham risk function.

CONCLUSION

Despite the low smoking rate in this group of inpatients, their cardiovascular risk appeared to be relatively high possibly due to old age and age-related conditions such as hypertension and low HDL. While literature has found the use of atypical antipsychotic medications to increase the risk of MetS, we did not find any significant association. Additionally, the duration of hospitalization did not affect the rate of MetS in our sample.

Omega – 3 fatty acids in schizophrenia – part I: importance in the pathophysiology of schizophrenia

Despite the increasing offer of antipsychotic drugs, the effectiveness of pharmacotherapy in schizophrenia is still unsatisfactory. Drug resistance, lack of complete remission and the increasing risk of metabolic complications are the reasons why the new forms of therapy in schizophrenia among which unsaturated essential fatty acids omega 3 (EFAs ω-3) affecting the proper functioning of nervous system, are mentioned, are being looked for.

Fatty acids represent 50-60% of the dry weight of the brain and diet is one of the factors that influence the value of each of the fat fractions in the neuron membranes. Patients with schizophrenia tend to have irregular nutritional status concerning essential fatty acids ω-3, which might result from metabolic disorders or irregular consumption of fatty acids.

Apart from being a review of the literature on this subject, this very paper characterizes essential fatty acids ω-3, their metabolism, the most important sources in the diet and the opinions of experts in the field about the recommended intake. It pays attention to the role of essential fatty acids in both the structure and functioning of the central nervous system is, as well as their role in the pathophysiology of schizophrenia, with particular emphasis on the membrane concept by David Horrobin. The assessment of the errors in consumption and metabolism of essential fatty acids are described as well.

The evidence was found both in epidemiological and modeling studies. It supports the participation of EFAs in etiopathogenesis and pathophysiology of schizophrenia. Further research is needed, both observational and interventional, as to the role of essential fatty acids ω-3 in the functioning of the CNS as well as the development and course of schizophrenia.

Improving Metabolic Syndrome Screening on Patients on Second Generation Antipsychotic Medication

AIM

This quality improvement project aims at stressing the importance of screening for metabolic syndrome (MS) on patients with serious mental illness (SMI) managed with second generation antipsychotic (SGA) medication.

METHOD

One hundred charts of patients who were on SGA (n=100) were randomly selected from more than 1000 charts for the purpose of this project with (n=50) charts for pre-intervention and (n=50) charts for post intervention. A chi-square test of independence was calculated comparing the frequency of labs and vital done in pre-intervention and post-intervention period.

RESULTS

A significant interaction was found [χ²(2)=32.67, p<.001] indicating that providers were more likely to order labs in postintervention (62%) than in pre-intervention (22%). No significant relationship was found for vital signs [χ²(1)=.542, p>.05]. The use of the screening and monitoring tool showed that gaps exist in the screening for MS among patients on SGA.

IMPLICATION TO PRACTICE

Advanced health nurse practitioners are well placed to take the lead in screening, monitoring, and implementing the necessary measures to address MS among patients with serious mental illness.

Impaired glucose tolerance in first-episode drug-naïve patients with schizophrenia: relationships with clinical phenotypes and cognitive deficits

BACKGROUND

Schizophrenia patients have a higher prevalence of type 2 diabetes mellitus with impaired glucose tolerance (IGT) than normals. We examined the relationship between IGT and clinical phenotypes or cognitive deficits in first-episode, drug-naïve (FEDN) Han Chinese patients with schizophrenia.

METHOD

A total of 175 in-patients were compared with 31 healthy controls on anthropometric measures and fasting plasma levels of glucose, insulin and lipids. They were also compared using a 75 g oral glucose tolerance test and the homeostasis model assessment of insulin resistance (HOMA-IR). Neurocognitive functioning was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Patient psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS).

RESULTS

Of the patients, 24.5% had IGT compared with none of the controls, and they also had significantly higher levels of fasting blood glucose and 2-h glucose after an oral glucose load, and were more insulin resistant. Compared with those patients with normal glucose tolerance, the IGT patients were older, had a later age of onset, higher waist or hip circumference and body mass index, higher levels of low-density lipoprotein and triglycerides and higher insulin resistance. Furthermore, IGT patients had higher PANSS total and negative symptom subscale scores, but no greater cognitive impairment except on the emotional intelligence index of the MCCB.

CONCLUSIONS

IGT occurs with greater frequency in FEDN schizophrenia, and shows association with demographic and anthropometric parameters, as well as with clinical symptoms but minimally with cognitive impairment during the early course of the disorder.

Second-generation antipsychotics and adiponectin levels in schizophrenia: A comparative meta-analysis

People with schizophrenia treated with second-generation antipsychotics (SGAs) have lower plasma adiponectin levels, as compared with general population, that may lead to metabolic abnormalities. However, the contribution of different SGAs on adiponectin dysregulation is still unclear. The objective of this systematic review and meta-analysis was to estimate differences in adiponectin levels among people with schizophrenia treated with different SGAs. We systematically searched for observational studies published up to March 2015 in main electronic databases. Different SGAs were included if data on adiponectin were available from at least three different samples involving as a minimum five participants per treatment arm. Standardized mean differences with relevant 95% confidence intervals were generated. I(2) was used to test heterogeneity among studies. Eight studies were included with data suitable for carrying out four different comparisons: Clozapine vs. Olanzapine (including n=877 individuals with schizophrenia); Clozapine vs. Risperidone (n=660); Olanzapine vs. Risperidone (n=738); Quetiapine vs. Risperidone (n=186). There were no differences on adiponectin levels between people taking Clozapine and those taking Olanzapine (p=0.86), but high heterogeneity was detected (I(2)=82%). Both individuals taking Clozapine (p<0.001; I(2)=0%) and those taking Olanzapine (p=0.02; I(2)=9%), but not subjects treated with Quetiapine (p=0.47; I(2)=0%), had adiponectin levels significantly lower than people taking Risperidone. Our findings are consistent with previous evidence showing greater metabolic abnormalities attributable to Clozapine and Olanzapine, as compared with other SGAs. Although mechanisms whereby both these SGAs influence adiponectin remain unexplained, its reduction might mediate relevant abnormalities. Prospective evaluations of long-term effects of different SGAs on adiponectin are needed.

Are the safety profiles of antipsychotic drugs used in dementia the same? An updated review of observational studies

With an increase in the global prevalence of dementia, there is also an increase in behavioural and psychological symptoms of dementia (BPSD) for which antipsychotic drugs are often used. Despite several safety warnings on antipsychotic use in dementia, there is little evidence to support the efficacy of antipsychotics in individual BPSD symptoms or to evaluate the drug safety profile by individual antipsychotic drug. There is emerging but scarce evidence that suggests an inter-drug variability between antipsychotic safety outcomes in BPSD. The objective of this review was to examine the existing literature on antipsychotic drug use in dementia patients; in particular to see whether inter-drug differences regarding antipsychotic safety were reported. A literature search was conducted for observational studies published in the English language from 2004 to 2014 that reported the risk of all-cause mortality, cerebrovascular events, pneumonia and other outcomes such as hip/femur fracture, deep vein thrombosis (DVT) and hyperglycaemia. Six of 16 mortality studies (38%), 7 of 28 stroke studies (25%), 1 of 6 pneumonia (17%) studies and 2 of 6 fracture studies (33%) investigated inter-drug safety outcomes in elderly patients/dementia patients, while to our knowledge, there are no studies investigating the inter-drug variation of deep-vein thrombosis and hyperglycaemia risk. The results of the observational studies provide mixed results on the safety of antipsychotics in BPSD but it is clear that there are differences between the safety profiles of antipsychotic drugs. Robust evidence of such inter-drug variability could significantly improve patient safety as antipsychotics become more targeted to clinical risk factors.

Diabetes mellitus onset in geriatric patients: does long-term atypical antipsychotic exposure increase risk?

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.

Is abnormal non-high-density lipoprotein cholesterol a gender-specific predictor for metabolic syndrome in patients with schizophrenia taking second-generation antipsychotics?

Evidence supports an association between metabolic syndrome (MetS) and schizophrenia. However, specific risk factors for MetS and gender differences in patients with schizophrenia taking second-generation antipsychotics (SGAs) have not been well explored. A cross-sectional cohort of 329 Han Chinese patients was recruited in a psychiatric hospital in central Taiwan. Using the definitions of the International Diabetes Federation for Chinese, the prevalence of MetS was 23.7% (men: 25.7%; women: 21.2%). Logistic regression analyses showed that patients with a BMI ≥ 24 and an abnormal non-high-density lipoprotein cholesterol (non-HDL-C) were significantly (p < 0.001) more likely to develop MetS. A BMI ≥ 24 was a significant risk factor in men (OR: 6.092, p < 0.001) and women (OR: 5.886, p < 0.001). An abnormal non-HDL-C was a significant specific risk factor for men with MetS (OR: 4.127, p < 0.001), but not for women. This study supports a greater prevalence of MetS in patients with schizophrenia taking SGAs than in the general population. Abnormal BMI and non-HDL-C were significantly associated with developing MetS, and an abnormal non-HDL-C was a specific risk factor for men. Future development of specific interventions and regular monitoring for MetS is imperative for early identification and prevention.

Weight gain and antipsychotics: a drug safety review

INTRODUCTION

Second-generation antipsychotics (SGAs) are widely used in several psychiatric disease entities and exert to a different extent a risk for antipsychotic-induced weight gain (AIWG). As AIWG is associated with an increase in metabolic syndrome or cardiovascular events, knowledge of these risks is crucial for further monitoring and the initiation of counteractive measures.

AREAS COVERED

We searched PubMed and Web of Sciences for randomized-controlled trials and naturalistic observational studies published between 2010 and 2014 with sample sizes exceeding 100, including all marketed SGAs apart from zotepine, and providing data on weight increase. We also summarized relevant systematic reviews and meta-analyses of head-to-head comparisons.

EXPERT OPINION

Recently published data still support the hierarchical ranking of SGAs already proposed in previous reviews ranking clozapine and olanzapine as having the highest risk, followed by amisulpride, asenapine, iloperidone, paliperidone, quetiapine, risperidone and sertindole in the middle, and aripiprazole, lurasidone and ziprasidone with the lowest risk. Number needed to harm varied considerably in our meta-analysis. Younger patients and patients with a lower baseline body mass index are most vulnerable. The greatest amount of weight gain occurs within the first weeks of treatment. AIWG occurs in all diagnostic groups and is also common in treatment with first-generation antipsychotics; therefore, awareness of this adverse event is essential for anyone prescribing antipsychotics.

Psychiatrists’ approach to vascular risk assessment in Latin America

AIM: To explore the way in which Latin American psychiatrists approach the screening of vascular risk factors in patients receiving antipsychotic medication.

METHODS: This was a descriptive, cross sectional study that surveyed Latin-American physicians to evaluate differences between groups divided in three main sections. The first section included demographic and professional data. The second section asked about the available medical resources: weighing scales, sphygmomanometer and measuring tape. Finally, the third section aimed at looking into the attitudes towards cardiovascular prevention. The latter was also divided into two subsections. In the first one, the questions were about weight, blood pressure and waist perimeter. In the second subsection the questions asked about the proportion of patients: (1) that suffered from overweight and/or obesity; (2) whose lipids and glycemia were controlled by the physician; (3) that were questioned by, and received information from the physician about smoking; and (4) that received recommendations from the physician to engage in regular physical activity. The participants were physicians, users of the medical website Intramed. The visitors were recruited by a banner that invited them to voluntarily access an online self-reported structured questionnaire with multiple options.

RESULTS: We surveyed 1185 general physicians and 792 psychiatrists. Regarding basic medical resources, a significantly higher proportion of general physicians claimed to have weighing scales (χ² = 404.9; P < 0.001), sphygmomanometers (χ² = 419.3; P < 0.001), and measuring tapes (χ² = 336.5; P < 0.001). While general physicians measured overweight and metabolic indexes in the general population in a higher proportion than in patients treated with antipsychotics (Z = -11.91; P < 0.001), psychiatrists claimed to measure them in patients medicated with antipsychotics in a higher proportion than in the general population (Z = -3.26; P < 0.001). Also general physicians tended to evaluate smoking habits in the general population more than psychiatrists (Z = -7.02; P < 0.001), but psychiatrists evaluated smoking habits in patients medicated with antipsychotics more than general physicians did (Z = -2.25; P = 0.024). General physicians showed a significantly higher tendency to control blood pressure (χ² = 334.987; P < 0.001), weight (χ² = 435.636; P < 0.001) and waist perimeter (χ² = 96.52; P < 0.001) themselves and they did so in all patients. General physicians suggested physical activity to all patients more frequently (Z = -2.23; P = 0.026), but psychiatrists recommended physical activity to patients medicated with antipsychotics more frequently (Z = -7.53; P < 0.001).

CONCLUSION: Psychiatrists usually check vascular risk factors in their patients, especially in those taking antipsychotics. General practitioners check them routinely without paying special attention to this population.