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Denis Völker JS, Micluția IV, Vinași RC. Investigating Cannabidiol's potential as a supplementary treatment for schizophrenia: A narrative review. Eur J Pharmacol 2024; 979:176821. [PMID: 39068976 DOI: 10.1016/j.ejphar.2024.176821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
Schizophrenia presents a complex mental health challenge, often inadequately addressed by existing antipsychotic treatments, leading to persistent symptoms and adverse effects. Hence, developing alternative therapeutic approaches is crucial. Cannabidiol (CBD), a nonpsychoactive compound in Cannabis sativa, has been extensively explored for its therapeutic potential in treating psychiatric disorders, including schizophrenia. CBD exhibits antipsychotic, anxiolytic, and neuroprotective effects. However, distinguishing the individual effects of CBD and THC remains challenging. Therefore, this review aims to critically analyze the potential role of CBD as an adjunctive therapy in schizophrenia treatment. The therapeutic action of CBD may involve activating the 5-hydroxytryptamine 1A receptors and suppressing the G-protein-coupled receptor 55, thereby affecting various neurotransmitter systems. Additionally, the anti-inflammatory and antioxidative effects of CBD may contribute to alleviating neuroinflammation linked to schizophrenia. Compared to typical antipsychotics, CBD demonstrates a lower incidence of side effects and it exhibited favorable tolerability in clinical trials. A 2012 clinical trial demonstrated the efficacy of CBD in reducing both positive and negative symptoms of schizophrenia, presenting a safer profile than that of traditional antipsychotics. However, further research is needed to fully establish the safety and efficacy of CBD as an adjunctive treatment. Future research directions encompass exploring detailed antipsychotic mechanisms, long-term safety profiles, interactions with current antipsychotics, optimal dosing, and patient-specific factors such as genetic predispositions. Despite these research needs, the potential of CBD to enhance the quality of life and symptom management positions it as a promising candidate for innovative schizophrenia treatment approaches.
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Affiliation(s)
- Jes Sebastian Denis Völker
- Department of Clinical Psychiatry Spitalul Clinic Judeţean de Urgenţă Cluj (Cluj County Emergency Clinical Hospital), Cluj-Napoca, Romania.
| | - Ioana Valentina Micluția
- Department of Clinical Psychiatry Spitalul Clinic Judeţean de Urgenţă Cluj (Cluj County Emergency Clinical Hospital), Cluj-Napoca, Romania.
| | - Ramona-Cristina Vinași
- Department of Clinical Neurosciences (DCN) Spitalul Clinic Judeţean de Urgenţă Cluj (Cluj County Emergency Clinical Hospital), Cluj-Napoca, Romania.
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Toimela J, Halt A, Kerkelä M, Kampman O, Suvisaari J, Kieseppä T, Lähteenvuo M, Tiihonen J, Ahola-Olli A, Veijola J, Holm M. Association of obesity to reaction time and visual memory in schizophrenia. Schizophr Res Cogn 2024; 37:100316. [PMID: 38764744 PMCID: PMC11101897 DOI: 10.1016/j.scog.2024.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
Background Both overweight and cognitive deficits are common among people with schizophrenia (SZ) and schizoaffective disorder. The results in earlier studies have been inconsistent on whether overweight is associated with cognitive deficits in psychotic disorders. Aims Our aim in this study was to detect possible associations between obesity and cognitive deficits among study participants with SZ and schizoaffective disorder. Methods The study sample included 5382 participants with a clinical diagnosis of SZ or schizoaffective disorder selected from the Finnish SUPER study. Obesity was measured both with body-mass index and waist circumference. The cognitive performance was evaluated with two tests from the Cambridge automated neuropsychological test battery: Reaction time was evaluated with the 5-choice serial reaction time task. Visual memory was evaluated with the paired associative learning test. The final analysis included a total sample of 4498 participants applicable for the analysis of the reaction time and 3967 participants for the analysis of the visual memory. Results Obesity measured with body-mass index was associated with better performance in reaction time task among both female and male participants. Among male participants, overweight was associated with better performance in the visual memory test. The waist circumference was not associated with cognitive measures. Conclusions The results suggest that obesity in people with SZ or schizoaffective disorder might not be associated with cognitive deficits but instead with better cognitive performance. The results were opposite from earlier literature on the general population. More research is required to better understand whether the results might be partly caused by the differences in the etiology of obesity between the general population and people with SZ.
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Affiliation(s)
- J.S. Toimela
- Research Unit of Clinical Medicine, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland
| | - A.H. Halt
- Research Unit of Clinical Medicine, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, FI-90220 Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M. Kerkelä
- Research Unit of Clinical Medicine, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland
| | - O. Kampman
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå SE-90187, Sweden
- University of Turku, Faculty of Medicine, Department of Clinical Medicine (Psychiatry), Turku, Finland
- The Wellbeing Services Country of Ostrobothnia, Department of Psychiatry, Vaasa, Finland
- The Pirkanmaa Wellbeing Services Country, Department of Psychiatry, Tampere, Finland
| | - J. Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland
| | - T. Kieseppä
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland
- University of Helsinki, Helsinki University Hospital, Psychiatry, FI-00029 Helsinki, Finland
| | - M. Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, FI-70240 Kuopio, Finland
| | - J. Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, FI-70240 Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, SE-17177 Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, SE-11364 Stockholm, Sweden
| | - A. Ahola-Olli
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FI-00014 Helsinki, Finland
- Department of Internal Medicine, Satasairaala Hospital, Pori, Finland
| | - J. Veijola
- Research Unit of Clinical Medicine, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, FI-90220 Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M. Holm
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland
| | - The SUPER researchers listed in the Acknowledgements
- Research Unit of Clinical Medicine, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, FI-90220 Oulu, Finland
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland
- University of Helsinki, Helsinki University Hospital, Psychiatry, FI-00029 Helsinki, Finland
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, FI-70240 Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, SE-17177 Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, SE-11364 Stockholm, Sweden
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FI-00014 Helsinki, Finland
- Department of Internal Medicine, Satasairaala Hospital, Pori, Finland
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå SE-90187, Sweden
- University of Turku, Faculty of Medicine, Department of Clinical Medicine (Psychiatry), Turku, Finland
- The Wellbeing Services Country of Ostrobothnia, Department of Psychiatry, Vaasa, Finland
- The Pirkanmaa Wellbeing Services Country, Department of Psychiatry, Tampere, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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González F, Montoya O, Rosenbaum S. Exercise and Schizophrenia. Curr Top Behav Neurosci 2024. [PMID: 39120811 DOI: 10.1007/7854_2024_505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Schizophrenia is a complex mental disorder that affects millions of people worldwide and has a profound impact on various aspects of life, including physical activity. The relationship between schizophrenia and physical activity is an area of growing interest in medical and health research from a physical, mental, and psychosocial health perspective. Physical activity and structured exercise have been identified as promising interventions to improve physical and psychological health outcomes of people living with schizophrenia. This chapter provides a brief overview that explores various aspects of the relationship between physical activity, exercise, and schizophrenia. The impact of schizophrenia on human movement is discussed, along with an overview of physical activity and cardiorespiratory fitness levels in adults with schizophrenia. Additionally, the influence of exercise interventions on physical and psychological outcomes will be discussed, along with current physical activity recommendations for those living with schizophrenia.
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Affiliation(s)
| | - Olga Montoya
- Escuela Colombiana de Rehabilitación, Bogotá, Colombia
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia.
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El-Shoura EAM, Abdelzaher LA, Mahmoud NI, Farghaly OA, Sabry M, Girgis Shahataa M, Salem EA, Saad HM, Elhussieny O, Kozman MR, Atwa AM. Combined sulforaphane and β-sitosterol mitigate olanzapine-induced metabolic disorders in rats: Insights on FOXO, PI3K/AKT, JAK/STAT3, and MAPK signaling pathways. Int Immunopharmacol 2024; 140:112904. [PMID: 39116489 DOI: 10.1016/j.intimp.2024.112904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/27/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024]
Abstract
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.
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Affiliation(s)
- Ehab A M El-Shoura
- Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt.
| | - Lobna A Abdelzaher
- Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nesreen I Mahmoud
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Nahda University, Beni-Suef, Egypt
| | - Omar A Farghaly
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Egypt
| | - Mostafa Sabry
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Egypt
| | - Mary Girgis Shahataa
- Department of Pharmacology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Esraa A Salem
- Department of Medical Physiology, Faculty of Medicine, Menoufia University, Shebeen ElKom, 32511, Egypt
| | - Hebatallah M Saad
- Department of Pathology, Faculty of Veterinary Medicine, Matrouh University, Marsa Matruh 51744, Egypt
| | - Omnya Elhussieny
- Department of Histology and Cytology, Faculty of Veterinary Medicine, Matrouh University, Marsa Matruh 51744, Egypt
| | - Magy R Kozman
- Clinical Pharmacy Department, Faculty of Pharmacy, Misr University for Science and Technology, Giza 12563, Egypt
| | - Ahmed M Atwa
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Egyptian Russian of Egypt University, Cairo, Egypt
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Ishii H, Yamada H, Sato R, Hayashi W, Nakamura D, Sugita S, Tazaki T, Takashio O, Inamoto A, Iwanami A. Obesity-associated factors in psychiatric outpatients: A multicenter questionnaire survey. Neuropsychopharmacol Rep 2024. [PMID: 39010283 DOI: 10.1002/npr2.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
The prevalence of obesity is increasing worldwide, resulting in various health issues such as hypertension, dyslipidemia, diabetes mellitus, heart disease, and a lower life expectancy. Importantly, several psychiatric disorders and the use of psychotropic medications have been linked to obesity, and the possible risk factors need further investigation. This study examined the prevalence of obesity and its associated factors using a self-administered questionnaire. Participants were recruited from three outpatient clinics and individuals who met one or more of the ICD-10 F0-F9, G4 diagnoses were included. In total, 1384 participants completed the questionnaire about their lifestyle. Statistical analysis compared the demographic and clinical characteristics of the individuals who were obese (Body Mass Index: BMI ≥25) and those who were non-obese (BMI <25). The results revealed that the factors associated with obesity in psychiatric outpatients were being male, prolonged treatment duration, eating out frequently, and use of both second- and first-generation antipsychotics. The study emphasized the importance of closely monitoring BMI in individuals with multiple obesity-related factors.
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Affiliation(s)
- Hiroki Ishii
- Department of Psychiatry, Graduate School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, East Hospital, Showa University Hospital, Shinagawa-ku, Tokyo, Japan
| | - Hiroki Yamada
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan
- Shinrin Koen Mental Clinic, Namekawa-cho, Hiki-gun, Saitama, Japan
| | - Ryotaro Sato
- Department of Psychiatry, Graduate School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, East Hospital, Showa University Hospital, Shinagawa-ku, Tokyo, Japan
| | - Wakaho Hayashi
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Dan Nakamura
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
| | - Shutaro Sugita
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
| | - Taro Tazaki
- Department of Psychiatry, Graduate School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
| | - Osamu Takashio
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, East Hospital, Showa University Hospital, Shinagawa-ku, Tokyo, Japan
| | - Atsuko Inamoto
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan
| | - Akira Iwanami
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
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Sass MR, Christensen AMB, Christensen ML, Gruber E, Nerdrum H, Pedersen LM, Resch M, Jørgensen TH, Ekstrøm CT, Nielsen J, Vilsbøll T, Fink-Jensen A. Liraglutide 3.0 mg once daily for the treatment of overweight and obesity in patients hospitalised at a forensic psychiatric department: A 26-week open-label feasibility study. Acta Psychiatr Scand 2024; 150:35-47. [PMID: 38631670 DOI: 10.1111/acps.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/23/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Overweight and obesity constitute a major concern among patients treated at forensic psychiatric departments. The present clinical feasibility study aimed at investigating the extent to which glucagon-like peptide 1 receptor agonist (GLP-1RA) treatment with once-daily liraglutide 3.0 mg could be a feasible pharmacological treatment of these conditions in patients with schizophrenia spectrum disorders hospitalised in forensic psychiatry. METHODS The 26-week, open-label feasibility study included participants aged 18-65 years diagnosed with a severe mental illness and hospitalised at a forensic psychiatric department. At the time of inclusion, all participants fulfilled the indication for using liraglutide as a treatment for overweight and obesity. Participants' baseline examinations were followed by a 26-week treatment period with liraglutide injection once daily according to a fixed uptitration schedule of liraglutide, with a target dose of 3.0 mg. Each participant attended seven visits to evaluate the efficacy and adverse events. The primary endpoint was the number of "completers", with adherence defined as >80% injections obtained in the period, weeks 12-26. Determining whether liraglutide is a feasible treatment was pre-defined to a minimum of 75% completers. RESULTS Twenty-four participants were included in the study. Sex, male = 19 (79.2%). Mean age: 42.3 [25th and 75th percentiles: 39.1; 48.4] years; body mass index (BMI): 35.7 [31.7; 37.5] kg/m2; glycated haemoglobin (HbA1c): 37 [35; 39] mmol/mol. Eleven out of 24 participants (46%) completed the study. For the completers, the median net body weight loss after 26 weeks of participation was -11.4 kg [-15.4; -5.9]. The net difference in HbA1C and BMI was -2.0 mmol/mol [-4; -1] and -3.6 kg/m2 [-4.7; -1.8], respectively. The weight change and reduction in HbA1c and BMI were all statistically significant from baseline. CONCLUSION The study did not confirm our hypothesis that liraglutide is a feasible treatment for a minimum of 75% of the patients initiating treatment with liraglutide while hospitalised in a forensic psychiatric department. The high dropout rate may be due to the non-naturalistic setting of the clinical trial. For the proportion of patients compliant with the medication, liraglutide 3.0 mg was an efficient treatment for overweight.
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Affiliation(s)
- Marie Reeberg Sass
- Psychiatric Centre Copenhagen, Mental Health Services in the Capitol Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | | | - Margit Lykke Christensen
- Psychiatric Centre Sct. Hans, Forensic Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | - Ema Gruber
- Psychiatric Centre Sct. Hans, Forensic Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | - Helle Nerdrum
- Psychiatric Centre Sct. Hans, Forensic Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | - Lone Marianne Pedersen
- Psychiatric Centre Sct. Hans, Forensic Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | - Maximilian Resch
- Psychiatric Centre Glostrup, Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | | | - Claus T Ekstrøm
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jimmi Nielsen
- Psychiatric Centre Glostrup, Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Anders Fink-Jensen
- Psychiatric Centre Copenhagen, Mental Health Services in the Capitol Region of Denmark, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Orhan A, Nguyen C, Chan A, Herrstedt J. Pharmacokinetics, pharmacodynamics, safety, and tolerability of dopamine-receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting. Expert Opin Drug Metab Toxicol 2024; 20:473-489. [PMID: 38878283 DOI: 10.1080/17425255.2024.2367593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Dopamine (D)2,3-receptor antagonists (RAs) were the first antiemetics used in the prophylaxis of chemotherapy-induced nausea and vomiting (CINV). AREAS COVERED Eight D2,3-RAs, amisulpride, domperidone, droperidol, haloperidol, metoclopramide, metopimazine, olanzapine and prochlorperazine are reviewed focusing on pharmacokinetics, pharmacodynamics, antiemetic effect and side effects. EXPERT OPINION Since the introduction of D2,3-RAs, antiemetics such as corticosteroids, 5-hydroxytryptamine (5-HT)3-RAs and neurokinin (NK)1-RAs have been developed. The classical D2,3-RAs are recommended in the prophylaxis of CINV from low emetic risk chemotherapy, but not as a fixed component of an antiemetic regimen for moderately or highly (HEC) emetic risk chemotherapy. D2,3-RAs are also used in patients with breakthrough nausea and vomiting. It should be emphasized, that most of these drugs are not selective for dopamine receptors.The multi-receptor targeting agent, olanzapine, is recommended in the prophylaxis of HEC-induced CINV as part of a four-drug antiemetic regimen, including a 5-HT3-RA, dexamethasone and a NK1-RA. Olanzapine is the most effective agent to prevent chemotherapy-induced nausea.Side effects differ among various D2,3-RAs. Metopimazine and domperidone possess a low risk of extrapyramidal side effects. Domperidone and metoclopramide are prokinetics, whereas metopimazine delays gastric emptying and haloperidol does not influence gastric motility. Many D2,3-RAs increase the risk of prolonged QTc interval; other side effects include sedation and orthostatic hypotension.
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Affiliation(s)
- Adile Orhan
- Department of Clinical Oncology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Carolyn Nguyen
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, USA
| | - Alexandre Chan
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, USA
| | - Jørn Herrstedt
- Department of Clinical Oncology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Chen X, Gao P, Qi Y, Li Z, Huang H, Shi Y, Wang L, Cui D, Qi D. High circulating MIF levels indicate the association with atypical antipsychotic-induced adverse metabolic effects. Transl Psychiatry 2024; 14:210. [PMID: 38802393 PMCID: PMC11130196 DOI: 10.1038/s41398-024-02934-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
Atypical antipsychotics (AAPs) are primary medications for schizophrenia (SZ). However, their use is frequently associated with the development of adverse metabolic effects, and the mechanisms behind these negative effects remain inadequately elucidated. To investigate the role of macrophage migration inhibitory factor (MIF) in regulating antipsychotic-induced metabolic abnormalities, between 2017 and 2020, a cross-sectional study was conducted, involving 142 healthy individuals and 388 SZ patients undergoing treatment with either typical antipsychotic (TAP) or AAP medications. Symptoms of SZ patients were evaluated using the Positive and Negative Syndrome Scale (PANSS), and measurements of metabolic indices and plasma MIF levels were performed on all individuals. A significant increase in plasma MIF levels was observed in groups receiving five major AAP monotherapies in comparison to healthy controls (all p < 0.0001). There was no such increase shown in the group receiving TAP treatment (p > 0.05). Elevated plasma MIF levels displayed a notable correlation with insulin resistance (β = 0.024, p = 0.020), as well as with the levels of triglycerides (β = 0.019, p = 0.001) and total cholesterol (β = 0.012, p = 0.038) in the groups receiving AAPs. However, while the TAP group also displayed certain metabolic dysfunction compared to healthy controls, no significant association was evident with plasma MIF levels (all p > 0.05). In conclusion, plasma MIF levels exhibit a distinctive correlation with metabolic abnormalities triggered by AAPs. Hence, there is potential for further development of MIF as a distinctive marker for monitoring adverse metabolic effects induced by AAPs in clinical settings.
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Affiliation(s)
- Xi Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Pingyi Gao
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Yadan Qi
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Zezhi Li
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Hongna Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yuan Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Lijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Dake Qi
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Dodd K, Legget KT, Cornier MA, Novick AM, McHugo M, Berman BD, Lawful BP, Tregellas JR. Relationship between functional connectivity and weight-gain risk of antipsychotics in schizophrenia. Schizophr Res 2024; 267:173-181. [PMID: 38552340 PMCID: PMC11332974 DOI: 10.1016/j.schres.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/19/2024] [Accepted: 03/18/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The mechanisms by which antipsychotic medications (APs) contribute to obesity in schizophrenia are not well understood. Because AP effects on functional brain connectivity may contribute to weight effects, the current study investigated how AP-associated weight-gain risk relates to functional connectivity in schizophrenia. METHODS Fifty-five individuals with schizophrenia (final N = 54) were divided into groups based on previously reported AP weight-gain risk (no APs/low risk [N = 19]; moderate risk [N = 17]; high risk [N = 18]). Resting-state functional magnetic resonance imaging (fMRI) was completed after an overnight fast ("fasted") and post-meal ("fed"). Correlations between AP weight-gain risk and functional connectivity were assessed at the whole-brain level and in reward- and eating-related brain regions (anterior insula, caudate, nucleus accumbens). RESULTS When fasted, greater AP weight-gain risk was associated with increased connectivity between thalamus and sensorimotor cortex (pFDR = 0.021). When fed, greater AP weight-gain risk was associated with increased connectivity between left caudate and left precentral/postcentral gyri (pFDR = 0.048) and between right caudate and multiple regions, including the left precentral/postcentral gyri (pFDR = 0.001), intracalcarine/precuneal/cuneal cortices (pFDR < 0.001), and fusiform gyrus (pFDR = 0.008). When fed, greater AP weight-gain risk was also associated with decreased connectivity between right anterior insula and ventromedial prefrontal cortex (pFDR = 0.002). CONCLUSIONS APs with higher weight-gain risk were associated with greater connectivity between reward-related regions and sensorimotor regions when fasted, perhaps relating to motor anticipation for consumption. Higher weight-gain risk APs were also associated with increased connectivity between reward, salience, and visual regions when fed, potentially reflecting greater desire for consumption following satiety.
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Affiliation(s)
- Keith Dodd
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Anschutz Health Sciences Building, 1890 N Revere Ct, Aurora, CO 80045, USA; Department of Bioengineering, University of Colorado Denver, 12705 E Montview Blvd Suite 100, Aurora, CO 80045, USA
| | - Kristina T Legget
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Anschutz Health Sciences Building, 1890 N Revere Ct, Aurora, CO 80045, USA; Research Service, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO 80045, USA
| | - Marc-Andre Cornier
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Clinical Sciences Building, CSB 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Anschutz Health Sciences Building, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Maureen McHugo
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Anschutz Health Sciences Building, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, 1101 E Marshall Street, Richmond, VA 23298, USA
| | - Benjamin P Lawful
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Anschutz Health Sciences Building, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Jason R Tregellas
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Anschutz Health Sciences Building, 1890 N Revere Ct, Aurora, CO 80045, USA; Research Service, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO 80045, USA.
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10
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Tolu‐Akinnawo OZ, Awoyemi T, Guzman RB, Naveed A. Olanzapine-induced cardiomyopathy: A mimicker of obesity cardiomyopathy? Clin Cardiol 2024; 47:e24278. [PMID: 38767024 PMCID: PMC11103636 DOI: 10.1002/clc.24278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Olanzapine, an atypical antipsychotic medication, has gained prominence in the treatment of schizophrenia and related psychotic disorders due to its effectiveness and perceived safety profile. However, emerging evidence suggests a potential link between olanzapine use and adverse cardiovascular effects, including cardiomyopathy. This narrative review explores the mechanisms, clinical implications, and management strategies associated with olanzapine-induced cardiomyopathy. A comprehensive review of the literature was conducted to investigate the relationship between olanzapine and cardiomyopathy. The search included epidemiological studies, clinical case reports, and mechanistic research focusing on the pathophysiology of olanzapine-induced cardiomyopathy. The review also examined treatment strategies for managing this potential complication. Olanzapine-induced cardiomyopathy is hypothesized to be associated with metabolic disturbances and receptor antagonism. The metabolic effects of olanzapine, such as weight gain, insulin resistance, and dyslipidemia, share similarities with obesity-related cardiomyopathy. Additionally, olanzapine's antagonism of certain receptors may contribute to cardiovascular stress. The review highlighted that patients with new-onset heart failure and significant weight gain while on olanzapine should be closely monitored for signs of cardiomyopathy. Early detection and prompt withdrawal of olanzapine, along with initiation of goal-directed medical therapy, are crucial for mitigating this potentially life-threatening condition. The relationship between olanzapine and cardiomyopathy is complex and not yet fully understood. However, the potential for significant cardiovascular risk necessitates vigilance among healthcare providers. Early identification and management of olanzapine-induced cardiomyopathy can improve patient outcomes. Further research is needed to elucidate the precise mechanisms behind this adverse effect and to develop optimized treatment strategies for patients requiring antipsychotic therapy.
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11
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Fehsel K, Bouvier ML, Capobianco L, Lunetti P, Klein B, Oldiges M, Majora M, Löffler S. Neuroreceptor Inhibition by Clozapine Triggers Mitohormesis and Metabolic Reprogramming in Human Blood Cells. Cells 2024; 13:762. [PMID: 38727298 PMCID: PMC11083702 DOI: 10.3390/cells13090762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
The antipsychotic drug clozapine demonstrates superior efficacy in treatment-resistant schizophrenia, but its intracellular mode of action is not completely understood. Here, we analysed the effects of clozapine (2.5-20 µM) on metabolic fluxes, cell respiration, and intracellular ATP in human HL60 cells. Some results were confirmed in leukocytes of clozapine-treated patients. Neuroreceptor inhibition under clozapine reduced Akt activation with decreased glucose uptake, thereby inducing ER stress and the unfolded protein response (UPR). Metabolic profiling by liquid-chromatography/mass-spectrometry revealed downregulation of glycolysis and the pentose phosphate pathway, thereby saving glucose to keep the electron transport chain working. Mitochondrial respiration was dampened by upregulation of the F0F1-ATPase inhibitory factor 1 (IF1) leading to 30-40% lower oxygen consumption in HL60 cells. Blocking IF1 expression by cotreatment with epigallocatechin-3-gallate (EGCG) increased apoptosis of HL60 cells. Upregulation of the mitochondrial citrate carrier shifted excess citrate to the cytosol for use in lipogenesis and for storage as triacylglycerol in lipid droplets (LDs). Accordingly, clozapine-treated HL60 cells and leukocytes from clozapine-treated patients contain more LDs than untreated cells. Since mitochondrial disturbances are described in the pathophysiology of schizophrenia, clozapine-induced mitohormesis is an excellent way to escape energy deficits and improve cell survival.
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Affiliation(s)
- Karin Fehsel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Bergische Landstrasse 2, 40629 Duesseldorf, Germany;
| | - Marie-Luise Bouvier
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Bergische Landstrasse 2, 40629 Duesseldorf, Germany;
| | - Loredana Capobianco
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy; (L.C.); (P.L.)
| | - Paola Lunetti
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy; (L.C.); (P.L.)
| | - Bianca Klein
- Institute of Bio- and Geosciences, IBG-1: Biotechnology, Forschungszentrum Jülich, Leo-Brandt-Straße, 52428 Jülich, Germany; (B.K.); (M.O.)
| | - Marko Oldiges
- Institute of Bio- and Geosciences, IBG-1: Biotechnology, Forschungszentrum Jülich, Leo-Brandt-Straße, 52428 Jülich, Germany; (B.K.); (M.O.)
| | - Marc Majora
- Leibniz Research Institute for Environmental Medicine (IUF), Auf’m Hennekamp 50, 40225 Düsseldorf, Germany;
| | - Stefan Löffler
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Sana Klinikum Offenbach, Teaching Hospital of Goethe University, Starkenburgring 66, 63069 Offenbach, Germany;
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12
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Lungu PF, Lungu CM, Ciobica A, Balmus IM, Vitalaru R, Mavroudis I, Dobrin R, Cimpeanu M, Gurzu IL. The Effect of Antipsychotics on Cognition in Schizophrenia-A Current Narrative Review. Brain Sci 2024; 14:359. [PMID: 38672011 PMCID: PMC11047912 DOI: 10.3390/brainsci14040359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
The majority of schizophrenia-affected individuals display deficiencies in multiple cognitive domains such as attention, working memory, long-term memory, and learning, deficiencies that are stable throughout the disease. The purpose of this narrative review was to examine the effect of antipsychotics on several cognitive domains affected by schizophrenia. Methods: We searched MEDLINE, Elsevier, Scopus, and DOAJ databases for randomized controlled trials and other studies investigating the effects of typical and atypical antipsychotics on cognition in patients with schizophrenia in studies conducted in the last decade. Results: The majority of studies included in this review showed that antipsychotics (especially SGAs) have positive effects on both cognition and general psychopathology of schizophrenia. We mention that treatment with antipsychotic substances represents an ongoing effort of the researchers, who are constantly searching for the best approach to meet the mental health needs of schizophrenia patients. Conclusions: Even with those positive results, it should be noted that more studies are needed in order to fully observe the various effects of certain antipsychotic substances on cognition.
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Affiliation(s)
- Petru Fabian Lungu
- Faculty of Biology, Biology Department, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania; (P.F.L.); (M.C.)
| | - Corina Miruna Lungu
- Faculty of Psychology and Educational Sciences, Psychology Department, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania
| | - Alin Ciobica
- Faculty of Biology, Biology Department, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania; (P.F.L.); (M.C.)
- Center of Biomedical Research, Romanian Academy, Iasi Branch, Teodor Codrescu 2, 700481 Iasi, Romania
- Academy of Romanian Scientists, 3 Ilfov, 050044 Bucharest, Romania
- Preclinical Department, Apollonia University, Strada Păcurari 11, 700511 Iasi, Romania
| | - Ioana Miruna Balmus
- Institute of Interdisciplinary Research, Department of Exact Sciences and Natural Sciences, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania;
- CENEMED Platform for Interdisciplinary Research, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16th Universitatii Street, 700115 Iasi, Romania
| | - Raluca Vitalaru
- Institute of Psychiatry “Socola”, Iasi Str. Bucium 36, 700282 Iasi, Romania (R.D.)
| | - Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK
| | - Romeo Dobrin
- Institute of Psychiatry “Socola”, Iasi Str. Bucium 36, 700282 Iasi, Romania (R.D.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Mirela Cimpeanu
- Faculty of Biology, Biology Department, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania; (P.F.L.); (M.C.)
| | - Irina Luciana Gurzu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
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13
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Orandi BJ, Lofton H, Montgomery RA, Segev DL. Antiobesity pharmacotherapy to facilitate living kidney donation. Am J Transplant 2024; 24:328-337. [PMID: 38072121 DOI: 10.1016/j.ajt.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
Obesity is a chronic, relapsing disease that increases the risks of living kidney donation; at the same time, transplant centers have liberalized body mass index constraints for donors. With the increasing number of antiobesity medications available, the treatment of obesity with antiobesity medications may increase the pool of potential donors and enhance donor safety. Antiobesity medications are intended for long-term use given the chronic nature of obesity. Cessation of treatment can be expected to lead to weight regain and increase the risk of comorbidity rebound/development. In addition, antiobesity medications are meant to be used in conjunction with-rather than in replacement of-diet and physical activity optimization. Antiobesity medication management includes selecting medications that may ameliorate any coexisting medical conditions, avoiding those that are contraindicated in such conditions, and being sensitive to any out-of-pocket expenses that may be incurred by the potential donor. A number of questions remain regarding who will and should shoulder the costs of long-term obesity treatment for donors. In addition, future studies are needed to quantify the degree of weight loss and duration of weight loss maintenance needed to normalize the risk of adverse kidney outcomes relative to comparable nondonors and lower-weight donors.
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Affiliation(s)
- Babak J Orandi
- New York University Department of Surgery, New York, New York, USA; New York University Department of Medicine, New York, New York, USA.
| | - Holly Lofton
- New York University Department of Medicine, New York, New York, USA
| | | | - Dorry L Segev
- New York University Department of Surgery, New York, New York, USA; New York University Department of Population Health, New York, New York, USA
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14
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Satomi E, Kobayashi T, Ishikawa A, Arakawa S, Ishiki H, Amano K, Sakiyama N, Ariyoshi K, Kihara K, Oyamada S, Mizushima A. Investigating the efficacy and safety of olanzapine prophylaxis for opioid-induced nausea and vomiting (JORTC-PAL20): a study protocol for an open-label, single-arm exploratory study. BMJ Open 2024; 14:e076575. [PMID: 38417963 PMCID: PMC10900404 DOI: 10.1136/bmjopen-2023-076575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION In opioid therapy for cancer pain, opioid-induced nausea and vomiting (OINV) occur in 20%-40% of patients during initial opioid treatment or increasing opioid doses. OINV result in failure to achieve pain relief due to poor opioid adherence. Therefore, antiemetics are used to prevent OINV, but their efficacy and safety in this context have not yet been fully elucidated. Olanzapine is a promising antiemetic for the prophylaxis of chemotherapy-induced nausea and vomiting. METHODS AND ANALYSIS This single-arm, single-centre exploratory study will evaluate the prophylactic antiemetic efficacy and safety of 5 mg olanzapine in patients with cancer pain who are withholding initial regular opioid therapy. Thirty-five patients will be enrolled. The primary endpoint is the proportion of patients achieving complete control (CC) of OINV during 5 days of opioid treatment. CC was defined as the absence of emetic episodes, no need for rescue medication to treat nausea, and minimal or no nausea (3 or less on an 11-point categorical scale). Secondary endpoints include the complete response, defined as no emetic episodes and no use of rescue medication during the overall assessment period, the time from opioid initiation to first emetic episode, the time from opioid initiation to first rescue antiemetic administration, and adverse events graded by Patient-Reported Outcome (PRO) Common Terminology Criteria for Adverse Events (CTCAE) version 1.0 and CTCAE version 5.0. ETHICS AND DISSEMINATION This study protocol was approved by National Cancer Center Hospital Certified Review Board. The results will be used as preliminary data to conduct a validation study. TRIAL REGISTRATION NUMBER Japan Registry of Clinical Trials (jRCT) jRCTs031220008.
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Affiliation(s)
- Eriko Satomi
- Palliative Medicine, National Cancer Center Japan, Tokyo, Japan
- Palliative Medicine, Juntendo University School of Medicine, Graduate School of Medicine, Tokyo, Japan
| | | | - Ayaka Ishikawa
- Palliative Medicine, National Cancer Center Japan, Tokyo, Japan
| | - Sayaka Arakawa
- Palliative Medicine, National Cancer Center Japan, Tokyo, Japan
| | - Hiroto Ishiki
- Palliative Medicine, National Cancer Center Japan, Tokyo, Japan
| | - Koji Amano
- Palliative Medicine, Osaka University, Oaska, Japan
| | | | - Keisuke Ariyoshi
- Data Center, Japanese Organisation for Research and Treatment of Cancer, Tokyo, Japan
| | - Kota Kihara
- Secretary, Japanese Organisation for Research and Treatment of Cancer, Tokyo, Japan
| | - Shunsuke Oyamada
- Biostatictics, Japanese Organisation for Research and Treatment of Cancer, Tokyo, Japan
| | - Akio Mizushima
- Palliative Medicine, Juntendo University School of Medicine, Graduate School of Medicine, Tokyo, Japan
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15
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Mascarenhas C, Sousa ACA, Rato L. Effects of Pharmaceutical Substances with Obesogenic Activity on Male Reproductive Health. Int J Mol Sci 2024; 25:2324. [PMID: 38397000 PMCID: PMC10889417 DOI: 10.3390/ijms25042324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/28/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Obesogens have been identified as a significant factor associated with increasing obesity rates, particularly in developed countries. Substances with obesogenic traits are prevalent in consumer products, including certain pharmaceuticals. Specific classes of pharmaceuticals have been recognized for their ability to induce weight gain, often accompanied by hormonal alterations that can adversely impact male fertility. Indeed, research has supplied evidence underscoring the crucial role of obesogens and therapeutic agents in the normal functioning of the male reproductive system. Notably, sperm count and various semen parameters have been closely linked to a range of environmental and nutritional factors, including chemicals and pharmacological agents exhibiting obesogenic properties. This review aimed to explore studies focused on analyzing male fertility parameters, delving into the intricacies of sperm quality, and elucidating the direct and adverse effects that pharmacological agents may have on these aspects.
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Affiliation(s)
- Caio Mascarenhas
- School of Health, Polytechnic Institute of Guarda, 6300-035 Guarda, Portugal;
| | - Ana C. A. Sousa
- Department of Biology, School of Science and Technology, University of Évora, 7006-554 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-671 Évora, Portugal
| | - Luís Rato
- School of Health, Polytechnic Institute of Guarda, 6300-035 Guarda, Portugal;
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal
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16
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Kang D, Song C, Peng X, Yu G, Yang Y, Chen C, Long Y, Shao P, Wu R. The effect of continuous theta burst stimulation on antipsychotic-induced weight gain in first-episode drug-naive individuals with schizophrenia: a double-blind, randomized, sham-controlled feasibility trial. Transl Psychiatry 2024; 14:61. [PMID: 38272892 PMCID: PMC10810827 DOI: 10.1038/s41398-024-02770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
Antipsychotic intake may induce weight gain in drug-naive individuals with schizophrenia, leading to poor compliance in clinical management. However, there is still a lack of effective approaches to treat or prevent this side-effect. Therefore, we conducted this pilot study to investigate the effect of continuous theta burst stimulation (cTBS), a non-invasive magnetic stimulation technique, on preventing olanzapine-induced weight gain. Thirty-nine first-episode drug-naive individuals with schizophrenia were randomly assigned to receive either the active or sham cTBS intervention for 25 sessions (5 times per day for 5 consecutive days). The primary outcomes were changes in body weight and body mass index (BMI). Secondary outcomes included psychiatric symptoms, eating behavior scales, behavior tasks, and metabolic measures. For the result, the body weight and BMI increased significantly in the sham group but not in the active group, with a significant group effect. The active group exhibited a selective increase in the cognitive restraint domain in the Three-Factor Eating Questionnaire (TFEQ-CR) and a decrease in stop-signal reaction time compared to the sham group. The effect of cTBS on body weight was mediated by TFEQ-CR. Our findings demonstrated the feasibility that cTBS intervention could be a potential method for preventing olanzapine-induced weight gain in drug-naive first-episode schizophrenia patients through enhancing cognitive restraint to food. Trial registration: clinical trial registered with clinicaltrials.gov (NCT05086133).
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Affiliation(s)
- Dongyu Kang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Chuhan Song
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Xingjie Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Guo Yu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Ye Yang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Chuwei Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Yujun Long
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Ping Shao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China.
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China.
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Heald A, Daly C, Warner-Levy JJ, Williams R, Meehan C, Livingston M, Pillinger T, Hussain L, Firth J. Weight change following diagnosis with psychosis: a retrospective cohort study in Greater Manchester, UK. Ann Gen Psychiatry 2024; 23:1. [PMID: 38172807 PMCID: PMC10763024 DOI: 10.1186/s12991-023-00485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Weight gain in the months/years after diagnosis/treatment of severe enduring mental illness (SMI) is a major predictor of future diabetes, dysmetabolic profile and increased risk of cardiometabolic diseases. There is limited data on the longer-term profile of weight change in people with a history of SMI and how this may differ between individuals. We here report a retrospective study on weight change over the 5 years following an SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community, with particular focus on comparing non-affective psychosis (NAP) vs affective psychosis (AP) diagnoses. METHODS We undertook an anonymised search in the Greater Manchester Care Record (GMCR). We reviewed the health records of anyone who had been diagnosed for the first time with first episode psychosis, schizophrenia, schizoaffective disorder, delusional disorder (non-affective psychosis = NAP) or affective psychosis (AP). We analysed body mass index (BMI) change in the 5-year period following the first prescription of antipsychotic medication. All individuals had taken an antipsychotic agent for at least 3 months. The 5-year follow-up point was anywhere between 2003 and 2023. RESULTS We identified 9125 people with the diagnoses above. NAP (n = 5618; 37.3% female) mean age 49.9 years; AP (n = 4131; 60.5% female) mean age 48.7 years. 27.0% of NAP were of non-White ethnicity vs 17.8% of AP individuals. A higher proportion of people diagnosed with NAP were in the highest quintile of social disadvantage 52.4% vs 39.5% for AP. There were no significant differences in baseline BMI profile. In a subsample with HbA1c data (n = 2103), mean HbA1c was higher in NAP at baseline (40.4 mmol/mol in NAP vs 36.7 mmol/mol for AP). At 5-year follow-up, there was similarity in both the overall % of individuals in the obese ≥ 30 kg/m2 category (39.8% NAP vs 39.7% AP), and % progressing from a normal healthy BMI transitioned to obese/overweight BMI (53.6% of NAP vs 55.6% with AP). 43.7% of those NAP with normal BMI remained at a healthy BMI vs 42.7% with AP. At 5-year follow-up for NAP, 83.1% of those with BMI ≥ 30 kg/m2 stayed in this category vs 81.5% of AP. CONCLUSION The results of this real-world longitudinal cohort study suggest that the changes in BMI with treatment of non-affective psychosis vs bipolar disorder are not significantly different, while 43% maintain a healthy weight in the first 5 years following antipsychotic prescription.
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Affiliation(s)
- Adrian Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester, UK.
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, M6 8HD, UK.
| | - Chris Daly
- Greater Manchester Mental Health, Prestwich Hospital, Greater Manchester, UK
| | | | - Richard Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Cheyenne Meehan
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, M6 8HD, UK
| | | | | | - Lamiece Hussain
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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McIntyre RS, Kwan ATH, Rosenblat JD, Teopiz KM, Mansur RB. Psychotropic Drug-Related Weight Gain and Its Treatment. Am J Psychiatry 2024; 181:26-38. [PMID: 38161305 DOI: 10.1176/appi.ajp.20230922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Psychotropic drug-related weight gain (PDWG) is a common occurrence and is highly associated with non-initiation, discontinuation, and dissatisfaction with psychiatric drugs. Moreover, PDWG intersects with the elevated risk for obesity and associated morbidity that has been amply reported in the psychiatric population. Evidence indicates that differential liability for PDWG exists for antipsychotics, antidepressants, and anticonvulsants. During the past two decades, agents within these classes have become available with significantly lower or no liability for PDWG and as such should be prioritized. Although lithium is associated with weight gain, the overall extent of weight gain is significantly lower than previously estimated. The benefit of lifestyle and behavioral modification for obesity and/or PDWG in psychiatric populations is established, with effectiveness similar to that in the general population. Metformin is the most studied pharmacological treatment in the prevention and treatment of PDWG, and promising data are emerging for glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide, exenatide, semaglutide). Most pharmacologic antidotes for PDWG are supported with low-confidence data (e.g., topiramate, histamine-2 receptor antagonists). Future vistas for pharmacologic treatment for PDWG include large, adequately controlled studies with GLP-1 receptor agonists and possibly GLP-1/glucose-dependent insulinotropic polypeptide co-agonists (e.g., tirzepatide) as well as specific dietary modifications.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Angela T H Kwan
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Joshua D Rosenblat
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Kayla M Teopiz
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Rodrigo B Mansur
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
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Gudzune KA, Jerome GJ, Dalcin AT, Gao R, Mace E, Fink T, Minahan E, Yuan C, Xie A, Goldsholl S, Gennusa JV, Daumit GL. Scaling a behavioral weight-loss intervention for individuals with serious mental illness using the enhanced replicating effective programs framework: A preconditions phase proof-of-concept study. Obes Sci Pract 2023; 9:618-630. [PMID: 38090682 PMCID: PMC10712421 DOI: 10.1002/osp4.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/01/2023] [Accepted: 06/16/2023] [Indexed: 02/01/2024] Open
Abstract
Background Given the obesity's high prevalence among individuals with serious mental illness (SMI), translating weight-loss interventions with demonstrated effectiveness is needed. This study describes the initial translation phase of such an intervention using the Enhanced Replicating Effective Programs (REP) Framework for delivery by mental health program staff. Methods The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (Achieving Healthy Lifestyles in Psychiatric Rehabilitation) trial intervention was preliminarily adapted to create the ACHIEVE-Dissemination (ACHIEVE-D) curriculum. A treatment-only study was conducted to rapidly evaluate the curriculum using a mixed-methods approach including surveys and focus groups. A study coach delivered an abbreviated curriculum to individuals with SMI from a single psychiatric program. Among all participants with SMI (n = 17), outcomes were attendance and satisfaction; 14 participated in a focus group. The program staff observed curriculum delivery and participated in a focus group (n = 3). Results Overall, 23 group sessions were delivered. Median attendance was 78.6% across participants with SMI; 92.9% would recommend ACHIEVE-D to others. The staff found the curriculum acceptable, particularly its structured nature, inclusion of weight management and exercise, and integrated goal setting and tracking. These improvements recommended by participants and/or staff were to assess participant readiness-to-change prior to enrollment, change the frequency of weigh-ins, and train staff coaches on anticipated challenges (e.g., exercise engagement, weight fluctuations). Conclusions During this first REP phase, individuals with SMI and program staff were satisfied with ACHIEVE-D. Additional refinements will aid future implementation and improve participant experience.
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Affiliation(s)
- Kimberly A. Gudzune
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionBaltimoreMarylandUSA
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Gerald J. Jerome
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of KinesiologyTowson UniversityTowsonMarylandUSA
| | - Arlene T. Dalcin
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionBaltimoreMarylandUSA
| | - Ruiyi Gao
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Elizabeth Mace
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Tyler Fink
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Eva Minahan
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Christina Yuan
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Armstrong Institute for Patient Safety and QualityJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Anping Xie
- Armstrong Institute for Patient Safety and QualityJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Stacy Goldsholl
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Joseph V. Gennusa
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Gail L. Daumit
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionBaltimoreMarylandUSA
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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20
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Stogios N, Humber B, Agarwal SM, Hahn M. Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Curr Psychiatry Rep 2023; 25:707-721. [PMID: 37755655 DOI: 10.1007/s11920-023-01458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Weight gain is a disconcerting issue experienced by patients treated with antipsychotics (APs). This review summarizes current knowledge on the prevalence, etiology, and risk factors for antipsychotic-induced weight gain (AIWG), and evidence for interventions, including special considerations. RECENT FINDINGS Predisposing risk factors for AIWG include lack of prior AP exposure, sex, and age. AP dose and duration of exposure are additional treatment-related factors that may contribute to this issue. Among current approaches to target AIWG, metformin has the most evidence to support its use, and this is increasingly reflected in clinical guidelines. While lifestyle approaches are recommended, cost-effectiveness and scalability represent limitations. More research is needed to identify newer treatment options and inform clinical recommendations for AIWG. Concerns around scope of practice in psychiatry to address AIWG and related comorbidities will require enhanced training opportunities and interdisciplinary collaborations, as well as updated position statements/practice guidelines emphasizing prevention.
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Affiliation(s)
- Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Bailey Humber
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada.
- Department of Pharmacology, University of Toronto, Toronto, Canada.
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Fernández-Abascal B, Suárez-Pinilla M, Cobo-Corrales C, Crespo-Facorro B, Suárez-Pinilla P. Lifestyle intervention based on exercise and behavioural counselling and its effect on physical and psychological health in outpatients with schizophrenia spectrum disorders. An exploratory, pragmatic randomized clinical trial. Schizophr Res 2023; 261:256-268. [PMID: 37857138 DOI: 10.1016/j.schres.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/04/2023] [Accepted: 09/24/2023] [Indexed: 10/21/2023]
Abstract
Patients with Schizophrenia Spectrum Disorders (SSD) often lead unhealthy lifestyles. This pragmatic trial evaluated the effectiveness of a lifestyle intervention, consisting of a 12-week aerobic exercise program and behavioural counselling, in SSD outpatients with metabolic syndrome (MetS). It also aimed to assess persistence of potential effects in a 24-month long-term follow-up. Effectiveness was measured in terms of a wide range of outcomes involving physical and psychological health, quality of life, physical activity and changes in motivation to exercise within the context of the self-determination theory. Our primary outcome was waist circumference change. Thirty-three out of 48 participants completed the study. No differences between groups were found in terms of BMI change or other metabolic parameters. However, the active group (AG) showed improvement regarding waist circumference, negative symptomatology and identified motivation to exercise during the study and follow-up. The AG exhibited changes toward a more active pattern of activity after intervention. Moreover, belonging to the AG was a significant predictor for achieving any degree of clinical improvement after 24-month follow-up. Combined interventions of exercise and behavioural counselling in SSD patients with MetS should be considered as an essential part of the integral treatment in the context of mental health services.
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Affiliation(s)
- Blanca Fernández-Abascal
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, University of Cantabria Medical School, Santander 39011, Spain
| | - Marta Suárez-Pinilla
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, UPM, Madrid 28223, Spain
| | | | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío - IBiS, Sevilla 41013, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Paula Suárez-Pinilla
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, University of Cantabria Medical School, Santander 39011, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid 28029, Spain.
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22
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Ebert T, Hamuda N, City-Elifaz E, Kobo O, Roguin A. Trends in CV mortality among patients with known mental and behavioral disorders in the US between 1999 and 2020. Front Psychiatry 2023; 14:1255323. [PMID: 38025453 PMCID: PMC10646424 DOI: 10.3389/fpsyt.2023.1255323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Patients with mental disorders are at increased risk of cardiovascular events. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental and behavioral co-morbidities in the US. Methods We performed a retrospective, observational study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death dataset. We determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental and behavioral disorders, from 1999 to 2020, stratified by mental and behavioral disorders subtype [ICD10 codes F], age, gender, race, and place of residence. Results Among more than 18.7 million cardiovascular deaths in the United States (US), 13.5% [2.53 million] were patients with a concomitant mental and behavioral disorder. During the study period, among patients with mental and behavioral disorders, the age-adjusted mortality rate increased by 113.9% Vs a 44.8% decline in patients with no mental disorder (both p<0.05). In patients with mental and behavioral disorders, the age-adjusted mortality rate increased more significantly among patients whose mental and behavioral disorder was secondary to substance abuse (+532.6%, p<0.05) than among those with organic mental disorders, such as dementia or delirium (+6.2%, P- nonsignificant). Male patients (+163.6%) and residents of more rural areas (+128-162%) experienced a more prominent increase in age-adjusted cardiovascular mortality. Discussion While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders.
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Affiliation(s)
- Tanya Ebert
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Psychiatry, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nashed Hamuda
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Efrat City-Elifaz
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Psychiatry, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Kobo
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ariel Roguin
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
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Heald AH, Stedman M, Daly C, Warner-Levy JJ, Livingston M, Hussain L, Anderson S. First episode psychosis and weight gain a longitudinal perspective in Cheshire UK: a comparison between individuals with nonaffective versus affective psychosis. Cardiovasc Endocrinol Metab 2023; 12:e0286. [PMID: 37361477 PMCID: PMC10289689 DOI: 10.1097/xce.0000000000000286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
Early weight gain following initiation of antipsychotic treatment predicts longer-term weight gain, with attendant long-term consequences including premature cardiovascular events/death. An important question is whether there is a difference in weight change over time between people with affective versus nonaffective psychosis. Here we describe the results of a real-world analysis of the BMI change in the months postdiagnosis with affective versus nonaffective psychosis. Methods We undertook an anonymised search across one Primary Care Network in Cheshire, UK with a total population of 32 301 individuals. We reviewed the health records of anyone who had been diagnosed over a 10-year period between June 2012 and June 2022 for the first time with first episode nonaffective psychosis versus psychosis associated with depression or bipolar affective disorder (affective psychosis). Results The overall % change in BMI was +8% in nonaffective psychosis individuals and +4% in those with a diagnosis of affective psychosis - however, the distribution was markedly skewed for nonaffective psychosis patients. Using caseness as >30% increase in BMI; affective = 4% cases and nonaffective = 13% cases, there was a three-fold difference in terms of increase in BMI. In regression analysis, the r2 linking the initial BMI to % change in BMI was 0.13 for nonaffective psychosis and 0.14 for affective psychosis. Conclusion The differences observed here in the distribution of weight change over time between individuals with affective versus nonaffective psychosis may relate to underlying constitutional differences. The phenotypic and genetic factors underlying this difference remain to be defined.
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Affiliation(s)
- Adrian H. Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford
| | | | - Chris Daly
- Greater Manchester Mental Health, Prestwich Hospital, Greater Manchester
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24
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Vochoskova K, McWhinney SR, Fialova M, Kolenic M, Spaniel F, Svancer P, Boron P, Okaji Y, Trancik P, Hajek T. Weight and metabolic changes in early psychosis-association with daily quantification of medication exposure during the first hospitalization. Acta Psychiatr Scand 2023; 148:265-276. [PMID: 37528692 DOI: 10.1111/acps.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/30/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The most common causes of death in schizophrenia are cardiovascular disorders, which are closely related to metabolic syndrome/obesity. To better understand the development of metabolic alterations early in the course of illness, we quantified daily medication exposure in the first days of the first hospitalization for psychosis and related it to changes in weight and metabolic markers. STUDY DESIGN We recruited participants with first episode psychosis (FEP, N = 173) during their first psychiatric hospitalization and compared them to controls (N = 204). We prospectively collected weight, body mass index, metabolic markers, and exact daily medication exposure at admission and during hospitalization. STUDY RESULTS Individuals with FEP gained on average 0.97 ± 2.26 BMI points or 3.46 ± 7.81 kg of weight after an average of 44.6 days of their first inpatient treatment. Greater antipsychotic exposure was associated with greater BMI increase, but only in people with normal/low baseline BMI. Additional predictors of weight gain included type of medication and duration of treatment. Medication exposure was not directly related to metabolic markers, but higher BMI was associated with higher TGC, TSH, and lower HDL. Following inpatient treatment, participants with FEP had significantly higher BMI, TGC, prolactin, and lower fT4, HDL than controls. CONCLUSION During their first admission, people with FEP, especially those with normal/low baseline BMI, showed a rapid and clinically significant weight increase, which was associated with exposure to antipsychotics, and with metabolic changes consistent with metabolic syndrome. These findings emphasize weight monitoring in FEP and suggest a greater need for caution when prescribing metabolically problematic antipsychotics to people with lower BMI.
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Affiliation(s)
- Kristyna Vochoskova
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Marketa Fialova
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marian Kolenic
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Patrik Svancer
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petra Boron
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Yurai Okaji
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Pavel Trancik
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Tomas Hajek
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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Sepúlveda-Lizcano L, Arenas-Villamizar VV, Jaimes-Duarte EB, García-Pacheco H, Paredes CS, Bermúdez V, Rivera-Porras D. Metabolic Adverse Effects of Psychotropic Drug Therapy: A Systematic Review. Eur J Investig Health Psychol Educ 2023; 13:1505-1520. [PMID: 37623307 PMCID: PMC10453914 DOI: 10.3390/ejihpe13080110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
This review aimed to investigate the metabolic alterations associated with psychopharmacological treatment of neuropsychiatric disorders, which can significantly impact patients' physical health and overall quality of life. The study utilized the PRISMA methodology and included cross-sectional, retrospective studies, and randomized clinical trials from reputable databases like SCOPUS, CLARIVATE, SCIENCE DIRECT, and PUBMED. Out of the 64 selected studies, various psychotropic drug classes were analyzed, including antidepressants, anticonvulsants, and antipsychotics. Among the antidepressants, such as amitriptyline, Imipramine, and clomipramine, weight gain, constipation, and cardiovascular effects were the most commonly reported metabolic adverse effects. SSRI antidepressants like Fluoxetine, Sertraline, Citalopram, Escitalopram, and Paroxetine exhibited a high prevalence of gastrointestinal and cardiac alterations. Regarding anticonvulsants, valproic acid and Fosphenytoin were associated with adverse reactions such as weight gain and disturbances in appetite and sleep patterns. As for antipsychotics, drugs like Clozapine, Olanzapine, and Risperidone were linked to weight gain, diabetes, and deterioration of the lipid profile. The findings of this review emphasize the importance of continuous monitoring for adverse effects, particularly considering that the metabolic changes caused by psychopharmacological medications may vary depending on the age of the patients. Future research should focus on conducting field studies to further expand knowledge on the metabolic effects of other commonly prescribed psychotropic drugs. Overall, the study highlights the significance of understanding and managing metabolic alterations induced by psychopharmacological treatment to enhance patient care and well-being.
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Affiliation(s)
| | | | | | - Henry García-Pacheco
- Facultad de Medicina, Departamento de Cirugía, Universidad del Zulia, Hospital General del Sur «Dr. Pedro Iturbe», Maracaibo 4002, Venezuela
- Facultad de Medicina, Escuela de Medicina, Cátedra de Fisiología, Universidad del Zulia, Maracaibo 4002, Venezuela
| | - Carlos Silva Paredes
- Facultad de Medicina, Escuela de Medicina, Cátedra de Fisiología, Universidad del Zulia, Maracaibo 4002, Venezuela
- Unidad de Cirugía para Obesidad y Metabolismo (UCOM), Maracaibo 4002, Venezuela
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080001, Colombia
| | - Diego Rivera-Porras
- Facultad de Ciencias Jurídicas y Sociales, Universidad Simón Bolívar, Cúcuta 540001, Colombia
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Rindler GA, Gries A, Freidl W. Associations between overweight, obesity, and mental health: a retrospective study among European adults aged 50. Front Public Health 2023; 11:1206283. [PMID: 37533526 PMCID: PMC10390701 DOI: 10.3389/fpubh.2023.1206283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Background The comorbidities associated with overweight and obesity have been well researched and scientifically proven while their relationship to mental health is still not verified. Methods This study is aimed at investigating reciprocal associations between obesity and mental health, and is intended to further analyze possible long-term effects using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). In order to do that, waves 4 and 8, conducted in 2010 and 2019/20 of this survey, were analyzed in a cross-lagged panel approach including 16,184 adult Europeans (50+) using multiple linear regression analysis focusing on the Body Mass Index (BMI), depression status and quality of life (QoL). Results Findings yield significant cross-lagged effects in one direction regarding BMI predicting QoL and depression state, whereas depression state and QoL do not significantly predict BMI. Findings include people living with obesity, overweight, and underweight showing significantly decreased levels of QoL as well as increased depression scores compared to people of normal weight over a lag time of 10 years, where people living with obesity indicate the strongest effect. Conclusions However, results do not confirm reciprocal associations in the long term. Hence, there is a strong need to carry out further research on this issue.
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Affiliation(s)
| | - Anna Gries
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University, Graz, Austria
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Genetic association of the rs17782313 polymorphism with antipsychotic-induced weight gain. Psychopharmacology (Berl) 2023; 240:899-908. [PMID: 36757449 PMCID: PMC10006246 DOI: 10.1007/s00213-023-06331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
RATIONALE Weight gain is a frequent side effect of treatment with SGAs (second-generation antipsychotics) and a leading cause for nonadherence. Several candidate genes have been identified that could influence the amount of AIWG (antipsychotic-induced weight gain). The polymorphism rs17782313 near the MC4R (human melanocortin 4 receptor gene) was strongly associated with obesity in a large scale GWAS (genome wide association study), yet previous studies investigating its impact on AIWG did not lead to a definite conclusion regarding its effect. In particular, they were all relatively short and had a naturalistic design. OBJECTIVE We therefore examined the influence of the rs17782313 polymorphism on SGA-related weight gain. METHODS Participants of a multicenter randomized, controlled, double-blind study comparing two treatment strategies in individuals with schizophrenia or schizoaffective disorder were genotyped using a rapid-cycle polymerase chain reaction. Up to 252 individuals completed the first 2 weeks (phase I), 212 the entire 8 weeks (hence 'completers'). Patients received either amisulpride or olanzapine or both consecutively. Thirty-seven had their first episode. Weight gain occurring in different genotypes was statistically compared and confounding factors were adjusted by stepwise multiple linear regression. A correction for multiple testing was included. RESULTS Within 212 'completers', carriers of the C allele had a higher absolute weight gain than those homozygous for the T allele (2.6 kg vs. 1.2 kg), though this observation was not significant (P = 0.063). In the amisulpride subpopulation, this association appeared stronger and reached significance (2.5 kg vs. 0.7 kg, P = 0.043), though failed to remain significant after correction for multiple testing. A stepwise multiple linear regression showed a significant association in both the whole study population (P < 0.001) and the amisulpride subpopulation (P < 0.001). CONCLUSION Our results indicate that the rs17782313 polymorphism might influence antipsychotic-induced weight gain and therefore confirm some of the earlier conclusions.
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H. Heald A, Shakespeare M, Phillipson A, Cade J, Netter P, Higgs S. Does food responsiveness change in people with first-episode psychosis over a period of 3 months after commencing antipsychotics? Preliminary results. Cardiovasc Endocrinol Metab 2023; 12:e0274. [PMID: 36582666 PMCID: PMC9750537 DOI: 10.1097/xce.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Adrian H. Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester
| | - Mark Shakespeare
- Rotherham, Doncaster and South Humber (RDASH) NHS Foundation Trust
| | | | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds
| | - Petra Netter
- Department of Psychology, University of Giessen, Germany
| | - Suzanne Higgs
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, UK
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Vranic M, Ahmed F, Hetty S, Sarsenbayeva A, Ferreira V, Fanni G, Valverde ÁM, Eriksson JW, Pereira MJ. Effects of the second-generation antipsychotic drugs aripiprazole and olanzapine on human adipocyte differentiation. Mol Cell Endocrinol 2023; 561:111828. [PMID: 36526026 DOI: 10.1016/j.mce.2022.111828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
Second-generation antipsychotics (SGAs), used as the cornerstone treatment for schizophrenia and other mental disorders, can cause adverse metabolic effects (e.g. obesity and type 2 diabetes). We investigated the effects of SGAs on adipocyte differentiation and metabolism. The presence of therapeutic concentrations of aripiprazole (ARI) or its active metabolite dehydroaripiprazole (DARI) during human adipocyte differentiation impaired adipocyte glucose uptake while the expression of gene markers of fatty acid oxidation were increased. Additionally, the use of a supra-therapeutic concentration of ARI inhibited adipocyte differentiation. Furthermore, olanzapine (OLA), a highly obesogenic SGA, directly increased leptin gene expression but did not affect adipocyte differentiation and metabolism. These molecular insights are novel, and suggest that ARI, but not OLA, may directly act via alterations in adipocyte differentiation and potentially by causing a switch from glucose to lipid utilization in human adipocytes. Additionally, SGAs may effect crosstalk with other organs, such as the brain, to exert their adverse metabolic effects.
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Affiliation(s)
- Milica Vranic
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Sweden
| | - Fozia Ahmed
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Sweden
| | - Susanne Hetty
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Sweden
| | - Assel Sarsenbayeva
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Sweden
| | - Vitor Ferreira
- IIBm Alberto Sols (CSIC-UAM), Madrid, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Spain
| | - Giovanni Fanni
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Sweden
| | - Ángela M Valverde
- IIBm Alberto Sols (CSIC-UAM), Madrid, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Spain
| | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Sweden
| | - Maria J Pereira
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Sweden.
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Sass MR, Danielsen AA, Köhler-Forsberg O, Storgaard H, Knop FK, Nielsen MØ, Sjödin AM, Mors O, Correll CU, Ekstrøm C, Vinberg M, Nielsen J, Vilsbøll T, Fink-Jensen A. Effect of the GLP-1 receptor agonist semaglutide on metabolic disturbances in clozapine-treated or olanzapine-treated patients with a schizophrenia spectrum disorder: study protocol of a placebo-controlled, randomised clinical trial (SemaPsychiatry). BMJ Open 2023; 13:e068652. [PMID: 36720576 PMCID: PMC9890830 DOI: 10.1136/bmjopen-2022-068652] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Clozapine and olanzapine are some of the most effective antipsychotics, but both are associated with weight gain and relevant metabolic disturbances, including pre-diabetes and diabetes. Non-pharmacological/behavioural interventions have had limited effects counteracting these adverse effects. Semaglutide, a glucagon-like peptide 1 receptor agonist, is approved for the treatment of type 2 diabetes and obesity. We will investigate the long-term effects of add-on treatment with semaglutide once a week versus placebo once a week on the metabolic status in pre-diabetic (glycated haemoglobin A1c (HbA1c) 35-47 mmol/mol (5.4%-6.4%) and diabetic (HbA1c 48-57 mmol/mol (6.5%-7.4%)) patients diagnosed with a schizophrenia spectrum disorder who initiated clozapine or olanzapine treatment within the last 60 months. METHODS AND ANALYSIS This is a 26-week, double-blinded, randomised, placebo-controlled trial. Altogether, 104 patients diagnosed with a schizophrenia spectrum disorder, aged 18-65 years, with pre-diabetes or diabetes will be randomised to injections of 1.0 mg semaglutide once a week or placebo for 26 weeks. The primary endpoint is change from baseline in HbA1c. Secondary endpoints include changes in body weight, hip and waist circumference and plasma levels of insulin, glucagon, glucose, and C-peptide, insulin sensitivity, beta cell function, hepatic function, fibrosis-4 score, lipid profile, incretin hormones, bone markers, body composition, bone density, proteomic analyses and oxidative stress markers. Together with alcohol, tobacco and drug use, potential effects on the reward value of a sweet-fat stimulus, psychopathology, level of activity and quality of life will also be assessed. ETHICS AND DISSEMINATION This study is approved by the Danish Medicines Agency and the regional scientific ethics committee of the Capital Region of Denmark (committee C, #H-20019008) and will be carried out in accordance with International Council for Harmonisation Good Clinical Practice guidelines and the Helsinki Declaration. The results will be disseminated through peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04892199.
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Affiliation(s)
- Marie Reeberg Sass
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Aalkjær Danielsen
- Psychiatry, Psychosis Research Unit, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Köhler-Forsberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Psychiatry, Psychosis Research Unit, Aarhus Universitetshospital Skejby, Aarhus, Denmark
| | - Heidi Storgaard
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Mette Ødegaard Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Glostrup, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Glostrup, Denmark
| | - Anders Mikael Sjödin
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- Psychiatry, Psychosis Research Unit, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claus Ekstrøm
- Department of Biostatistics, University of Copenhagen Department of Public Health, Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center North Zeeland, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Hillerød, Denmark
| | - Jimmi Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Glostrup, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Glostrup, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anders Fink-Jensen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Makary S, Abd El Moez K, Elsayed M, Hassan H. Second-generation antipsychotic medications and metabolic disturbance in children and adolescents. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:14. [DOI: 10.1186/s41983-023-00612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/16/2023] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
The second-generation antipsychotics (SGAs) are a group of antipsychotic drugs, used to treat psychiatric conditions. SGAs have been shown to precipitate rapid weight gain and dyslipidemia, as well as to promote insulin resistance, leading to the emergence of type 2 diabetes and metabolic syndrome. Prescriptions of SGAs in children have increased 6- to 10-fold during the last decade. This research work designed to find correlation between duration of second-generation antipsychotics (SGA) use, in children and adolescent, and the increase in metabolic syndrome disturbance components including weight gain, hypertension, hyperlipidemia and diabetes mellitus. This is cross-sectional analytic study was carried out in Suez Canal University Hospital, Psychiatry Outpatient Clinic on Children and adolescent aged 4–17 years. It included 151 children and adolescents diagnosed by Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). They were divided into two groups, 72 patients who regular on (SGA) as treated group and 79 patients who did not receive pharmacological medication as control group.
Results
The overall prevalence of metabolic syndrome in the current study was high 27.81% in SGA-treated children compared to 0.60% in control group. In the SGA-treated group, 22.22% had type 2 diabetes, compared with 2.53% in the control group. SGA-treated patients showed a highly significant increase in their weight, body mass index and waist circumference compared to their control group patients. The correlation of different metabolic syndrome indices and SGAs duration showed positive correlation with body mass index, fasting blood sugar, and blood lipids (low density lipoproteins and cholesterol) but negative correlation with high density lipoproteins. Blood pressure did not correlate with SGA-duration in the studied patients. Indices which showed correlation could be predictors of the metabolic syndrome developments. Although the correlation and regression model showed moderate degree of association, this is considered important issue for the young patients.
Conclusion
SGA treatment in children and adolescence confers a significantly increased risk for metabolic syndrome and SGA-treatment duration is important for MtS development.
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Campforts B, Drukker M, Crins J, van Amelsvoort T, Bak M. Association between antipsychotic medication and clinically relevant weight change: meta-analysis. BJPsych Open 2023; 9:e18. [PMID: 36651070 PMCID: PMC9885350 DOI: 10.1192/bjo.2022.619] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous meta-analyses have shown that almost all antipsychotics are associated with weight gain. However, mean weight gain is not informative about clinically relevant weight gain or weight loss. AIMS To provide further insight into the more severe body weight changes associated with antipsychotic use, we assessed the proportion of patients with clinically relevant weight gain (CRWG) and clinically relevant weight loss (CRWL), defined as ≥7% weight gain and ≥7% weight loss. METHOD We searched PubMed, Embase and PsycInfo for randomised controlled trials of antipsychotics that reported CRWG and CRWL in study populations aged 15 years or older. We conducted meta-analyses stratified by antipsychotic and study duration using a random-effects model. We performed meta-regression analyses to assess antipsychotic-naive status and psychiatric diagnosis as modifiers for CRWG. PROSPERO: CRD42020204734. RESULTS We included 202 articles (201 studies). Almost all included antipsychotics were associated with CRWG. For CRWL, available data were too limited to draw firm conclusions. For some antipsychotics, CRWG was more pronounced in individuals who were antipsychotic-naive than in individuals switching to another antipsychotic. Moreover, a longer duration of antipsychotic use was associated with more CRWG, but not CRWL. For some antipsychotics, CRWG was higher in people diagnosed with schizophrenia, but this was inconsistent. CONCLUSIONS Switching antipsychotic medication is associated with both weight gain and weight loss, but the level of CRWG is higher than CRWL in antipsychotic-switch studies. CRWG was more pronounced in antipsychotic-naive patients, highlighting their vulnerability to weight gain. The impact of diagnosis on CRWG remains inconclusive.
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Affiliation(s)
- Bea Campforts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joost Crins
- Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Thorey S, Blanchet C, Guessoum SB, Moro MR, Ludot M, Carretier E. Efficacy and tolerance of second-generation antipsychotics in anorexia nervosa: A systematic scoping review. PLoS One 2023; 18:e0278189. [PMID: 36928656 PMCID: PMC10019643 DOI: 10.1371/journal.pone.0278189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/03/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Second-generation antipsychotics (SGAs) are frequently prescribed for the treatment of resistant anorexia nervosa. However, few clinical trials have been conducted so far and no pharmacological treatment has yet been approved by the Food and Drug Administration. The aim of this paper is to conduct a systematic scoping review exploring the effectiveness and safety of atypical antipsychotics in anorexia nervosa (AN). METHOD We conducted a systematic scoping review of the effectiveness and tolerability of SGAs in the management of AN. We included articles published from January 1, 2000, through September 12, 2022 from the PubMed and PsycInfo databases and a complementary manual search. We selected articles about adolescents and adults treated for AN by four SGAs (risperidone, quetiapine, aripiprazole or olanzapine). This work complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRIMA-ScR) and was registered in the Open Science Framework (OSF) repository. RESULTS This review included 55 articles: 48 assessing the effectiveness of SGAs in AN and 7 focusing only on their tolerability and safety. Olanzapine is the treatment most frequently prescribed and studied with 7 randomized double-blind controlled trials. Other atypical antipsychotics have been evaluated much less often, such as aripiprazole (no randomized trials), quetiapine (two randomized controlled trials), and risperidone (one randomized controlled trial). These treatments are well tolerated with mild and transient adverse effects in this population at particular somatic risk. DISCUSSION Limitations prevent the studies both from reaching conclusive, reliable, robust, and reproducible results and from concluding whether or not SGAs are effective in anorexia nervosa. Nonetheless, they continue to be regularly prescribed in clinical practice. International guidelines suggest that olanzapine and aripiprazole can be interesting in severe or first-line resistant clinical situations.
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Affiliation(s)
- Solène Thorey
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Corinne Blanchet
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
| | - Sélim Benjamin Guessoum
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
- Laboratoire de Psychologie Clinique, Psychopathologie et Psychanalyse, Paris Cité University, Boulogne-Billancourt, France
| | - Marie Rose Moro
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
- Laboratoire de Psychologie Clinique, Psychopathologie et Psychanalyse, Paris Cité University, Boulogne-Billancourt, France
| | - Maude Ludot
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
- Laboratoire de Psychologie Clinique, Psychopathologie et Psychanalyse, Paris Cité University, Boulogne-Billancourt, France
| | - Emilie Carretier
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
- Laboratoire de Psychologie Clinique, Psychopathologie et Psychanalyse, Paris Cité University, Boulogne-Billancourt, France
- * E-mail:
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Bespalov A, van Gaalen M, Steckler T. Back to the Future of Neuropsychopharmacology. ADVANCES IN NEUROBIOLOGY 2023; 30:207-224. [PMID: 36928852 DOI: 10.1007/978-3-031-21054-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Disappointments in translating preclinical findings into clinical efficacy have triggered a number of changes in neuroscience drug discovery ranging from investments diverted to other therapeutic areas to reduced reliance on efficacy claims derived from preclinical models. In this chapter, we argue that there are several existing examples that teach us on what needs to be done to improve the success rate. We advocate the reverse engineering approach that shifts the focus from preclinical efforts to "model" human disease states to pharmacodynamic activity as a common denominator in the journey to translate clinically validated phenomena to preclinical level and then back to humans. Combined with the research rigor, openness, and transparency, this reverse engineering approach is well set to bring new effective and safe medications to patients in need.
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AlQudah M, Khalifeh M, Al-Azaizeh R, Masaadeh A, Al-Rusan OM, Haddad HK. Hyperbaric oxygen exposure alleviate metabolic side-effects of olanzapine treatment and is associated with Langerhans islet proliferation in rats. Pathol Oncol Res 2022; 28:1610752. [PMID: 36590387 PMCID: PMC9801520 DOI: 10.3389/pore.2022.1610752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
Introduction: Olanzapine (OLZ) is one of the second-generation antipsychotics drugs (APDs) used to treat several psychiatric illnesses. Olanzapine treatment is often associated with many metabolic side effects in a dose dependent manner such as obesity, dyslipidemia and insulin resistance, induction of type II diabetes and acute pancreatitis in some patients. Methods: Hyperbaric Oxygen therapy (HBOT) was investigated as a tool to mitigate olanzapine metabolic side effects in rats. Thirty-six female Sprague Dawley (SD) rats were divided into 4 groups; rats on olanzapine treatment either exposed to hyperbaric oxygen therapy (HBOOLZ) or left without exposure (OLZ) then non-treated rats that either exposed to hyperbaric oxygen therapy or left without exposure (control). Rats received Hyperbaric Oxygen therapy for 35 days at 2.4 atmospheres absolute (ATA) for 2.5 h daily followed by intraperitoneal injection of olanzapine at 10 mg/kg or placebo. Results: Rats on either hyperbaric oxygen therapy or olanzapine had a significant loss in body weight. Olanzapine treatment showed a decrease in serum insulin level, triglyceride, highdensity lipoprotein (HDL) cholesterol, and lipase level but an increase in fasting blood sugar (FBS), insulin resistance index (HOMA-IR) and amylase, while rats' exposure to hyperbaric oxygen therapy reversed these effects. The Pancreatic Langerhans islets were up-regulated in both hyperbaric oxygen therapy and olanzapine treatments but the combination (HBOOLZ) doubled these islets number. Discussion: This study advocated that hyperbaric oxygen therapy can be an alternative approach to control or reverse many metabolic disorders (MDs) associatedwith olanzapine treatment. In addition, it seems that hyperbaric oxygen therapy positively affect the pancreatic Langerhans cells activity and architecture.
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Affiliation(s)
- Mohammad AlQudah
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan,*Correspondence: Mohammad AlQudah,
| | - Mohammad Khalifeh
- Department of Veterinary Basic Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Rasha Al-Azaizeh
- Department of Veterinary Basic Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Amr Masaadeh
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan,University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Omar M. Al-Rusan
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan,Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Husam K. Haddad
- Department of Pathology and Laboratory Medicine, Ministry of Health, Amman, Jordan
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Ferreira V, Folgueira C, Guillén M, Zubiaur P, Navares M, Sarsenbayeva A, López-Larrubia P, Eriksson JW, Pereira MJ, Abad-Santos F, Sabio G, Rada P, Valverde ÁM. Modulation of hypothalamic AMPK phosphorylation by olanzapine controls energy balance and body weight. Metabolism 2022; 137:155335. [PMID: 36272468 DOI: 10.1016/j.metabol.2022.155335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/29/2022] [Accepted: 10/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Second-generation antipsychotics (SGAs) are a mainstay therapy for schizophrenia. SGA-treated patients present higher risk for weight gain, dyslipidemia and hyperglycemia. Herein, we evaluated the effects of olanzapine (OLA), widely prescribed SGA, in mice focusing on changes in body weight and energy balance. We further explored OLA effects in protein tyrosine phosphatase-1B deficient (PTP1B-KO) mice, a preclinical model of leptin hypersensitivity protected against obesity. METHODS Wild-type (WT) and PTP1B-KO mice were fed an OLA-supplemented diet (5 mg/kg/day, 7 months) or treated with OLA via intraperitoneal (i.p.) injection or by oral gavage (10 mg/kg/day, 8 weeks). Readouts of the crosstalk between hypothalamus and brown or subcutaneous white adipose tissue (BAT and iWAT, respectively) were assessed. The effects of intrahypothalamic administration of OLA with adenoviruses expressing constitutive active AMPKα1 in mice were also analyzed. RESULTS Both WT and PTP1B-KO mice receiving OLA-supplemented diet presented hyperphagia, but weight gain was enhanced only in WT mice. Unexpectedly, all mice receiving OLA via i.p. lost weight without changes in food intake, but with increased energy expenditure (EE). In these mice, reduced hypothalamic AMPK phosphorylation concurred with elevations in UCP-1 and temperature in BAT. These effects were also found by intrahypothalamic OLA injection and were abolished by constitutive activation of AMPK in the hypothalamus. Additionally, OLA i.p. treatment was associated with enhanced Tyrosine Hydroxylase (TH)-positive innervation and less sympathetic neuron-associated macrophages in iWAT. Both central and i.p. OLA injections increased UCP-1 and TH in iWAT, an effect also prevented by hypothalamic AMPK activation. By contrast, in mice fed an OLA-supplemented diet, BAT thermogenesis was only enhanced in those lacking PTP1B. Our results shed light for the first time that a threshold of OLA levels reaching the hypothalamus is required to activate the hypothalamus BAT/iWAT axis and, therefore, avoid weight gain. CONCLUSION Our results have unraveled an unexpected metabolic rewiring controlled by hypothalamic AMPK that avoids weight gain in male mice treated i.p. with OLA by activating BAT thermogenesis and iWAT browning and a potential benefit of PTP1B inhibition against OLA-induced weight gain upon oral treatment.
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Affiliation(s)
- Vitor Ferreira
- Instituto de Investigaciones Biomedicas Alberto Sols (IIBM), CSIC-UAM, Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERdem), ISCIII, Spain
| | - Cintia Folgueira
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Maria Guillén
- Instituto de Investigaciones Biomedicas Alberto Sols (IIBM), CSIC-UAM, Madrid, Spain
| | - Pablo Zubiaur
- Clinical Pharmacology Department, School of Medicine, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain; UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Marcos Navares
- UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Assel Sarsenbayeva
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Pilar López-Larrubia
- Instituto de Investigaciones Biomedicas Alberto Sols (IIBM), CSIC-UAM, Madrid, Spain
| | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Maria J Pereira
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, School of Medicine, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain; UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Guadalupe Sabio
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Patricia Rada
- Instituto de Investigaciones Biomedicas Alberto Sols (IIBM), CSIC-UAM, Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERdem), ISCIII, Spain.
| | - Ángela M Valverde
- Instituto de Investigaciones Biomedicas Alberto Sols (IIBM), CSIC-UAM, Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERdem), ISCIII, Spain.
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Rodrigues-Neves AC, Ambrósio AF, Gomes CA. Microglia sequelae: brain signature of innate immunity in schizophrenia. Transl Psychiatry 2022; 12:493. [PMID: 36443303 PMCID: PMC9705537 DOI: 10.1038/s41398-022-02197-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
Schizophrenia is a psychiatric disorder with significant impact on individuals and society. The current pharmacologic treatment, which principally alleviates psychosis, is focused on neurotransmitters modulation, relying on drugs with severe side effects and ineffectiveness in a significant percentage of cases. Therefore, and due to difficulties inherent to diagnosis and treatment, it is vital to reassess alternative cellular and molecular drug targets. Distinct risk factors - genetic, developmental, epigenetic, and environmental - have been associated with disease onset and progression, giving rise to the proposal of different pathophysiological mechanisms and putative pharmacological targets. Immunity is involved and, particularly microglia - innate immune cells of the central nervous system, critically involved in brain development - have captured attention as cellular players. Microglia undergo marked morphologic and functional alterations in the human disease, as well as in animal models of schizophrenia, as reported in several original papers. We cluster the main findings of clinical studies by groups of patients: (1) at ultra-high risk of psychosis, (2) with a first episode of psychosis or recent-onset schizophrenia, and (3) with chronic schizophrenia; in translational studies, we highlight the time window of appearance of particular microglia alterations in the most well studied animal model in the field (maternal immune activation). The organization of clinical and translational findings based on schizophrenia-associated microglia changes in different phases of the disease course may help defining a temporal pattern of microglia changes and may drive the design of novel therapeutic strategies.
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Affiliation(s)
- A. Catarina Rodrigues-Neves
- grid.8051.c0000 0000 9511 4342Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Univ Coimbra, Faculty of Pharmacy, Coimbra, Portugal
| | - António. F. Ambrósio
- grid.8051.c0000 0000 9511 4342Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Catarina A. Gomes
- grid.8051.c0000 0000 9511 4342Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Univ Coimbra, Faculty of Pharmacy, Coimbra, Portugal
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Investigating the effects of antipsychotics on brain insulin action: Study protocol for a multi-modality magnetic resonance imaging (MRI) study in healthy controls. PLoS One 2022; 17:e0277211. [PMID: 36441736 PMCID: PMC9704670 DOI: 10.1371/journal.pone.0277211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
Antipsychotics (APs) are the cornerstone of treatment for schizophrenia (SCZ) but are unfortunately associated with serious metabolic adverse effects including weight gain and type 2 diabetes. The pathophysiology of AP-induced metabolic dysfunction is largely undetermined. Brain insulin resistance has been posited to be at the cross-roads of many cognitive and metabolic disorders, and disruption of central insulin action has emerged as a possible explanatory mechanism underlying AP induced metabolic dysfunction. Previous studies suggest that change in neuroimaging-based parameters with intranasal insulin administration can be leveraged to investigate brain insulin resistance. In this proof-of-concept study, we will utilize neural signatures of insulin action in the brain to examine if APs disrupt brain insulin signaling. It is hypothesized that: 1) intranasal insulin (INI), but not intranasal placebo (INP), will change cerebral blood flow and resting state connectivity, as well as increase glutamate levels in the striatum and dorsolateral prefrontal cortex; 2) oral olanzapine (OLA), but not oral placebo (PL), will inhibit the effect of INI on these parameters. Thirty-two healthy volunteers will undergo a single blind, cross-over design, wherein all participants receive the following four treatment combinations, 2-6 weeks apart, in a random sequence: INP + PL, INP + OLA, INI + PL, and INI + OLA. Participants will undergo an MRI-based assay of brain insulin resistance 15 minutes after administering 160 IU INI or INP. The scanning protocol includes resting and task-based functional MRI, arterial spin labelling, and proton magnetic resonance spectroscopy. Demonstrating that OLA can acutely induce brain insulin resistance is clinically relevant to metabolic health in SCZ. Evidence of brain insulin resistance induced by acute AP dosing can inform the early use of adjunctive insulin sensitizers for the treatment of metabolic comorbidities associated with AP treatment in severe mental illness. Trial registration ClinicalTrials.gov Registration: NCT03741478.
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Halting the Metabolic Complications of Antipsychotic Medication in Patients with a First Episode of Psychosis: How Far Can We Go with the Mediterranean Diet? A Pilot Study. Nutrients 2022; 14:nu14235012. [PMID: 36501042 PMCID: PMC9738803 DOI: 10.3390/nu14235012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Patients with first-episode psychosis (FEP) often adopt unhealthy dietary patterns, with a risk of weight gain and metabolic and cardiovascular disease. In 21 FEP patients receiving nutritional intervention based on the Mediterranean diet (MedDiet), we explored differences in anthropometric and biometric parameters, according to their antipsychotic (AP) medication: AP1, associated with a lower risk, or AP2, associated with a higher risk of weight gain and metabolic complications. The blood biochemical profile was recorded before and after dietary intervention, and dietary habits and body composition were monitored for six months. Following intervention, all of the patients recorded significant increases in the consumption of fruit and vegetables and decreases in red meat and poultry consumption, with closer adherence to the MedDiet and a reduction in the daily intake of calories, carbohydrates, and sodium. Vegetable consumption and energy, protein, and carbohydrate intake were lower in AP1 patients than in AP2 patients. There was no significant weight gain overall. A reduction was demonstrated in total and LDL cholesterol, sodium, urea, and iron (lower in AP1 patients). It was evident that AP medication affected blood levels of lipids, urea, and iron of FEP patients, but MedDiet nutritional intervention led to a significant improvement in their eating habits, with a restriction in weight gain and a decrease in blood sodium and urea.
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Kajero JA, Seedat S, Ohaeri J, Akindele A, Aina O. Effects of cannabidiol on vacuous chewing movements, plasma glucose and oxidative stress indices in rats administered high dose risperidone. Sci Rep 2022; 12:19718. [PMID: 36385633 PMCID: PMC9669024 DOI: 10.1038/s41598-022-24235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Atypical antipsychotics, despite their rapid dissociation from dopamine receptors and reduced tendency to induce oxidative stress, have been associated with difficult-to-manage movement disorders, including tardive dyskinesia (TD). The study set out to investigate the effects of cannabidiol (CBD), a potent antioxidant, on risperidone-induced behavioural and motor disturbances; namely vacuous chewing movements (VCM), and oxidative stress markers (e.g. superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), malondialdehyde (MDA), Nitric oxide (NO), and DPPH (2,2-diphenyl-1-picrylhydrazyl)). Oral risperidone (10 mg/kg) or oral CBD (5 mg/kg) were administered to six experimental groups. While risperidone alone was administered for 28 days, CBD concomitantly or in sequential order with risperidone, was administered for 28 days; and CBD alone was administered for 21 days. Behavioural, motor, and specific biochemical parameters, which included VCM, muscle tone, fasting blood sugar (FBS), and oxidative stress markers were assessed at different time points after the last dose of medication. Oral CBD (5 mg/kg) significantly reduced risperidone-induced elevated FBS when given after the administration of risperidone. Oral CBD also had effects on VCM when administered before risperidone and similarly, attenuated risperidone-induced increased muscle tone. It was also established that concomitant or sequential administration of CBD and risperidone did not have any adverse effects on cognition or locomotion. Both CBD and risperidone increased the activity of antioxidant enzymes and decreased the activity of pro-oxidant enzymes. This study suggests CBD could mitigate metabolic dysregulation and extrapyramidal side effects associated with risperidone without producing cognitive impairments.
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Affiliation(s)
- Jaiyeola Abiola Kajero
- grid.11956.3a0000 0001 2214 904XDepartment of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive Tygerberg, PO Box 241, Cape Town, 7505 South Africa ,grid.490120.e0000 0004 9338 1163Present Address: Federal Neuropsychiatric Hospital, 8, Harvey Road, P.M.B 2008, Yaba, Lagos Nigeria
| | - Soraya Seedat
- grid.11956.3a0000 0001 2214 904XDepartment of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive Tygerberg, PO Box 241, Cape Town, 7505 South Africa
| | - Jude Ohaeri
- grid.10757.340000 0001 2108 8257Department of Psychological Medicine, Teaching Hospital, University of Nigeria, P.O. Box 3236, Enugu, Enugu State Nigeria
| | - Abidemi Akindele
- grid.411782.90000 0004 1803 1817Department of Pharmacology, Therapeutics & Toxicology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Private Mail Bag 12003, Lagos, Nigeria
| | - Oluwagbemiga Aina
- grid.416197.c0000 0001 0247 1197Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, 6 Edmund Crescent, Off Murtala Mohammed Way, P.M.B. 2013, Yaba, Lagos, 100001 Nigeria
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Agarwal SM, Stogios N, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H, Cohn T, Taylor VH, Remington G, Faulkner GEJ, Hahn M. Pharmacological interventions for prevention of weight gain in people with schizophrenia. Cochrane Database Syst Rev 2022; 10:CD013337. [PMID: 36190739 PMCID: PMC9528976 DOI: 10.1002/14651858.cd013337.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Antipsychotic-induced weight gain is an extremely common problem in people with schizophrenia and is associated with increased morbidity and mortality. Adjunctive pharmacological interventions may be necessary to help manage antipsychotic-induced weight gain. This review splits and updates a previous Cochrane Review that focused on both pharmacological and behavioural approaches to this problem. OBJECTIVES To determine the effectiveness of pharmacological interventions for preventing antipsychotic-induced weight gain in people with schizophrenia. SEARCH METHODS The Cochrane Schizophrenia Information Specialist searched Cochrane Schizophrenia's Register of Trials on 10 February 2021. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that examined any adjunctive pharmacological intervention for preventing weight gain in people with schizophrenia or schizophrenia-like illnesses who use antipsychotic medications. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data and assessed the quality of included studies. For continuous outcomes, we combined mean differences (MD) in endpoint and change data in the analysis. For dichotomous outcomes, we calculated risk ratios (RR). We assessed risk of bias for included studies and used GRADE to judge certainty of evidence and create summary of findings tables. The primary outcomes for this review were clinically important change in weight, clinically important change in body mass index (BMI), leaving the study early, compliance with treatment, and frequency of nausea. The included studies rarely reported these outcomes, so, post hoc, we added two new outcomes, average endpoint/change in weight and average endpoint/change in BMI. MAIN RESULTS Seventeen RCTs, with a total of 1388 participants, met the inclusion criteria for the review. Five studies investigated metformin, three topiramate, three H2 antagonists, three monoamine modulators, and one each investigated monoamine modulators plus betahistine, melatonin and samidorphan. The comparator in all studies was placebo or no treatment (i.e. standard care alone). We synthesised all studies in a quantitative meta-analysis. Most studies inadequately reported their methods of allocation concealment and blinding of participants and personnel. The resulting risk of bias and often small sample sizes limited the overall certainty of the evidence. Only one reboxetine study reported the primary outcome, number of participants with clinically important change in weight. Fewer people in the treatment condition experienced weight gains of more than 5% and more than 7% of their bodyweight than those in the placebo group (> 5% weight gain RR 0.27, 95% confidence interval (CI) 0.11 to 0.65; 1 study, 43 participants; > 7% weight gain RR 0.24, 95% CI 0.07 to 0.83; 1 study, 43 participants; very low-certainty evidence). No studies reported the primary outcomes, 'clinically important change in BMI', or 'compliance with treatment'. However, several studies reported 'average endpoint/change in body weight' or 'average endpoint/change in BMI'. Metformin may be effective in preventing weight gain (MD -4.03 kg, 95% CI -5.78 to -2.28; 4 studies, 131 participants; low-certainty evidence); and BMI increase (MD -1.63 kg/m2, 95% CI -2.96 to -0.29; 5 studies, 227 participants; low-certainty evidence). Other agents that may be slightly effective in preventing weight gain include H2 antagonists such as nizatidine, famotidine and ranitidine (MD -1.32 kg, 95% CI -2.09 to -0.56; 3 studies, 248 participants; low-certainty evidence) and monoamine modulators such as reboxetine and fluoxetine (weight: MD -1.89 kg, 95% CI -3.31 to -0.47; 3 studies, 103 participants; low-certainty evidence; BMI: MD -0.66 kg/m2, 95% CI -1.05 to -0.26; 3 studies, 103 participants; low-certainty evidence). Topiramate did not appear effective in preventing weight gain (MD -4.82 kg, 95% CI -9.99 to 0.35; 3 studies, 168 participants; very low-certainty evidence). For all agents, there was no difference between groups in terms of individuals leaving the study or reports of nausea. However, the results of these outcomes are uncertain given the very low-certainty evidence. AUTHORS' CONCLUSIONS There is low-certainty evidence to suggest that metformin may be effective in preventing weight gain. Interpretation of this result and those for other agents, is limited by the small number of studies, small sample size, and short study duration. In future, we need studies that are adequately powered and with longer treatment durations to further evaluate the efficacy and safety of interventions for managing weight gain.
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Affiliation(s)
- Sri Mahavir Agarwal
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Zohra A Ahsan
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Jonathan T Lockwood
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Markus J Duncan
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Hiroyoshi Takeuchi
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Tony Cohn
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Gary Remington
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Guy E J Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Margaret Hahn
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
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Gao YN, Olfson M. National trends in metabolic risk of psychiatric inpatients in the United States during the atypical antipsychotic era. Schizophr Res 2022; 248:320-328. [PMID: 36155305 PMCID: PMC10135373 DOI: 10.1016/j.schres.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/02/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Although the cardiometabolic effects of atypical antipsychotics have been well-described in clinical samples, less is known about the longer-term impacts of these treatments. We report rates of metabolic syndrome in a nationally representative sample of U.S. adult inpatients 1993-2018 admitted for schizophrenia-spectrum disorders (n = 1,785,314), any mental health disorder (n = 8,378,773), or neither (n = 14,458,616) during a period of widespread atypical antipsychotic use. Metabolic syndrome, derived from additional diagnoses, was defined as three or more of hypertension, dyslipidemia, type II diabetes, hyperglycemia, and overweight or obese. Using an ecological age and period design, a 4-level period variable was constructed to proxy for atypical antipsychotic exposure as the minimum of age minus 20 years or the calendar year minus 1997 in accord with the disease course for schizophrenia-spectrum illness and the market share of atypical antipsychotics in the U.S. Logistic regression models, adjusted for age, year, and exposure main effects, estimated odds ratios (ORs) of metabolic syndrome. Relative to other mental health or other discharges, schizophrenia-spectrum discharges had an elevated risk for metabolic syndrome regardless of potential atypical antipsychotic exposure (OR = 1.46; 95 % CI, 1.30-1.64). For schizophrenia-spectrum discharges, periods of potential atypical antipsychotic exposure conferred additional metabolic syndrome risk OR = 1.21; 95 % CI, 1.04-1.41 for exposures of 1-2 years, OR = 1.29; 95 % CI, 1.13-1.46 for 3-7 years, OR = 1.27; 95 % CI, 1.12-1.44 for 8-12 years, and OR = 1.10; 95 % CI 0.98-1.24 for >12 years. In summary, cardiometabolic disease and related risks were elevated among a nationally representative sample of adult inpatients with schizophrenia-spectrum disorders during a period of pervasive atypical antipsychotic use.
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Affiliation(s)
- Y Nina Gao
- Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University and New York State Psychiatric Institute, New York, USA.
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University and New York State Psychiatric Institute, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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Xing M, Sheng J, Cui M, Su Y, Zhang C, Chen X, Fang Y, Cui D, Li Z. Differing Prevalence and Correlates of Metabolic Syndromes Between Chlorpromazine and Clozapine: A 10-year Retrospective Study of a Male Chinese Cohort. Curr Neuropharmacol 2022; 20:1969-1977. [PMID: 35236263 PMCID: PMC9886797 DOI: 10.2174/1570159x20666220302153123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Antipsychotics are known to be associated with metabolic syndromes (MetS). Chlorpromazine (CPZ) and Clozapine (CLZ) are currently the most commonly used antipsychotics in low-income districts of China. However, potential differences in the long-term effects of CPZ and CLZ on MetS in schizophrenia inpatients are not well understood. Here, we aimed to identify any MetS profile differences between long-term schizophrenia patients who were prescribed either CPZ or CLZ at a primary psychiatric hospital. METHODS We recruited a total of 204 male schizophrenia patients who received either CPZ or CLZ. We measured their weight, height, body mass index (BMI), waist circumference (WC), diastolic blood pressure (DBP), and systolic blood pressure (SBP), as well as their biochemical indicators, including fasting blood glucose (FBS), triglycerides (TG), cholesterol (TC), high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c). RESULTS The MetS prevalence in the CPZ and CLZ groups was 31% and 37.5%, respectively. The CLZ group had significantly higher DBP levels and a higher incidence of dyslipidemia (HDL-c) but lower HDL-c and TC levels than the CPZ group. We also determined that smoking history, BMI, and duration of hospitalisation were risk factors for the development of MetS. Moreover, we found that CPZ and CLZ were correlated with the same risk for developing MetS and that BMI was a vital risk factor of MetS for both the CPZ and CLZ groups. CONCLUSION Long-term CPZ and CLZ prescriptions were associated with similar profiles for developing MetS of schizophrenia patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Donghong Cui
- Address correspondence to these authors at the Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China; Tel: 86-135-6464-8631; E-mail: , Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai 200030, China; Tel: 86-21-52219033; E-mail:
| | - Zezhi Li
- Address correspondence to these authors at the Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China; Tel: 86-135-6464-8631; E-mail: , Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai 200030, China; Tel: 86-21-52219033; E-mail:
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Gandhi AA, Wilson TA, Sisley S, Elsea SH, Foster RH. Relationships between food-related behaviors, obesity, and medication use in individuals with Smith-Magenis syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 127:104257. [PMID: 35597045 DOI: 10.1016/j.ridd.2022.104257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/01/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Smith-Magenis syndrome (SMS) is a complex neurodevelopmental disorder that includes obesity and food-seeking/satiety-related behaviors. AIMS This study examined associations between food-related/hyperphagic behaviors, weight, and medication use in individuals with SMS. METHODS/PROCEDURES Caregivers of individuals with SMS in the Parents and Researchers Interested in SMS (PRISMS) Patient Registry completed a demographic/medication questionnaire, the Hyperphagia Questionnaire for Clinical Trials, and the Food Related Problems Questionnaire. OUTCOMES/RESULTS Among 49 participants (Mage = 16.41 ± 12.73 years, range = 4-69 years, 55% girls/women), individuals with SMS with overweight/obesity (n = 22) had worse overall food-related problems including greater impaired satiety (p < 0.05), maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.01), and hyperphagia (p < 0.01) compared to individuals of normal/underweight (n = 27). Those taking anti-depressants/anxiolytics (n = 16) had greater maladaptive eating behaviors (p < 0.05), hyperphagic behaviors (p < 0.05), and hyperphagic severity (p < 0.05) than those not taking anti-depressants/anxiolytics (n = 33). Boys/men with SMS had greater maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.05), and hyperphagic drive (p < 0.01) than girls/women with SMS. CONCLUSIONS/IMPLICATIONS Maladaptive food-related behaviors were higher in individuals with SMS with overweight/obesity, taking anti-depressants/anxiolytics, or who were male. Medications in this population should be chosen with weight-related side effects in mind.
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Affiliation(s)
- Anusha A Gandhi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Theresa A Wilson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stephanie Sisley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Children's Nutrition Research Center, Houston, TX 77030, USA
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Rebecca H Foster
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
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Figueroa JF, Phelan J, Newton H, Orav EJ, Meara ER. ACO Participation Associated With Decreased Spending For Medicare Beneficiaries With Serious Mental Illness. HEALTH AFFAIRS (PROJECT HOPE) 2022; 41:1182-1190. [PMID: 35914206 DOI: 10.1377/hlthaff.2022.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Serious mental illness (SMI) is a major source of suffering among Medicare beneficiaries. To date, limited evidence exists evaluating whether Medicare accountable care organizations (ACOs) are associated with decreased spending among people with SMI. Using national Medicare data from the period 2009-17, we performed difference-in-differences analyses evaluating changes in spending and use associated with enrollment in the Medicare Shared Savings Program (MSSP) among beneficiaries with SMI. After five years, participation in MSSP ACOs was associated with small savings for beneficiaries with SMI (-$233 per person per year) in total health care spending, primarily related to savings from chronic medical conditions (excluding mental health; -$227 per person per year) and not from savings related to mental health services (-$6 per person per year). Savings were driven by reductions in acute and postacute care for medical conditions. Further work is needed to ensure that Medicare ACOs invest in strategies to reduce potentially unnecessary care related to mental health disorders and to improve health outcomes.
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Affiliation(s)
- José F Figueroa
- José F. Figueroa , Harvard University and Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Helen Newton
- Helen Newton, Yale University, New Haven, Connecticut
| | - E John Orav
- E. John Orav, Harvard University and Brigham and Women's Hospital
| | - Ellen R Meara
- Ellen R. Meara, Harvard University; Dartmouth College, Lebanon, New Hampshire; and National Bureau of Economic Research, Cambridge, Massachusetts
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Long-term treatment of antipsychotics and combined therapy with other psychotropic medications inducing weight gain in patients with non-affective psychotic disorder: Evidence from GROUP, a longitudinal study. Psychiatry Res 2022; 314:114680. [PMID: 35753222 DOI: 10.1016/j.psychres.2022.114680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/02/2022] [Accepted: 06/11/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Antipsychotics (APs) can cause weight gain. Little is known about changes in weight when APs are combined with other psychotropics. This study examines the weight change in patients undergoing long-term treatment with APs or with AP combined with other psychotropics. METHODS Patients with non-affective psychotic disorder from the GROUP study were divided into three groups: AP medication group (APm) (n = 100), AP in combination with other psychotropics (APc) (n = 73), and medication-free (Meds-free) (n = 100). Weight change was examined at inclusion and after three years using a paired-sample t-test. An Independent-sample t-test was performed to evaluate weight change among patients taking clozapine, olanzapine, and quetiapine and individuals not taking these medications. Linear regression was performed to evaluate the association between covariates and weight. RESULTS Patients in the APm group [mean = 1.800 kg, t(99)=2.849, 95% CI(0.546, 3.054), p = 0.005] and the APc group [mean = 1.877 kg, t(72)=2.688, 95% CI(0.485, 3.268), p = 0.009] showed significant weight gain. Patients taking clozapine, olanzapine or quetiapine showed significant weight gain compared to those not taking these medications [mean difference=1.707 kg, t(271)= 2.061, 95% CI(0.077, 3.337), p = 0.040)]. CONCLUSION Patients receiving APs and APs with other psychotropics gain weight during long-term treatment. It is possible that weight gain is mainly driven by APs.
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Muñoz Ladrón de Guevara C, Reyes del Paso GA, Fernández Serrano MJ, Montoro CI. Fibromyalgia Syndrome and Cognitive Decline: The Role of Body Mass Index and Clinical Symptoms. J Clin Med 2022; 11:jcm11123404. [PMID: 35743474 PMCID: PMC9224759 DOI: 10.3390/jcm11123404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/27/2023] Open
Abstract
The high prevalence of obesity and overweight in fibromyalgia (FM) may be an important factor in the well-known cognitive deficits seen in the disorder. This study analyzed the influence of body mass index (BMI) and primary clinical symptoms of FM (pain, fatigue, insomnia, anxiety, and depression) on attention, memory, and processing speed in FM. Fifty-two FM patients and thirty-two healthy participants completed cognitive tasks assessing selective, sustained, and divided attention; visuospatial and verbal memory; and information processing speed. Furthermore, they were evaluated in terms of the main clinical symptoms of the disorder. FM patients showed a marked reduction of cognitive performance in terms of selective, sustained, and divided attention; visuospatial memory; and processing speed, but no group differences were observed in verbal memory. BMI negatively affects sustained and selective attention, verbal memory, and processing speed and is the main predictor of performance in these basic cognitive domains. Our findings confirm the presence of cognitive deficits with respect to attention and visual memory, as well as slower processing speed, in FM. Moreover, the results support a role of BMI in the observed cognitive deficits. Interventions increasing physical activity and promoting cognitive stimulation could be useful for strengthening cognitive function in FM patients.
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Affiliation(s)
| | | | | | - Casandra I. Montoro
- Department of Psychology, University of Jaén, 23071 Jaén, Spain;
- Correspondence: (C.M.L.d.G.); (C.I.M.)
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Comardelle N, Edinoff A, Fort J. Delusions of Glass Under Skin: An Unusual Case of Somatic-Type Delusional Disorder Treated with Olanzapine. Health Psychol Res 2022; 10:35500. [DOI: 10.52965/001c.35500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The management of delusional disorder (DD) remains difficult due to poor patient insight and a lack of definitive treatment guidelines. For the somatic subtype specifically, prior studies have shown successful treatment with the first-generation antipsychotics (FGA) pimozide, but these studies did not specify the nature of the delusions. It has been theorized that pimozide effectiveness is due to its unique ability to relieve itching sensations, which are commonly associated with somatic delusions (e.g., delusions of parasitosis). The use of FGAs is not without risk, however, and should be avoided when possible due to the significant side-effect profile. Thus, there is a need for safer alternatives for the treatment of somatic-type DD. This manuscript discusses a case of DD characterized by painful sensations of glass under the skin managed with the second-generation antipsychotic olanzapine. Case A 67-year-old female with a past medical history including depression presented to the ED with complaints of glass in her hands and fingernails bilaterally. The patient has been evaluated by several physicians in the past without any evidence of glass being found. She was able factually able to describe that others viewed her complaints as irrational, but she refused to accept this as truth. Cognitive screening testing was normal, and a physical exam showed several areas of excoriation on the hands and arms bilaterally, a removed left thumbnail, and a thin frame (BMI: 18.02). The patient was admitted to the psychiatry service, where organic causes were ruled out (infection, metabolic abnormalities, drug use). The patient received olanzapine 5mg PO nightly treatment with adjunctive psychotherapy and experienced acute psychotic relief after a two-day admission period. She did not endorse any side effects from the medication. Discussion To our knowledge, there haven’t been prior studies exploring treatment efficacy in somatic-type DD subdivided by the nature of false bodily sensation. Despite this limitation, it was found that most cases of somatic-type DD characterized by foreign bodies under the skin were treated with pimozide. Although this drug appears to be a reasonable option for the more common presentation involving false pruritis, it might not be recommended for rare presentations that don’t involve itchiness due to the high risk of adverse symptoms. Accordingly, clinicians should consider the nature of the delusions along with the unique side effect profile of the pharmacological therapy as any harm might outweigh the potential benefit. This was highlighted in the current presentation as clinicians determined olanzapine to be the most appropriate treatment despite no similar cases of DD described in the literature. Furthermore, this case exemplified the utility of second-generation antipsychotics in the treatment of somatic-type DD.
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Huang J, Liu C, Yang Y, Kang D, Xiao J, Long Y, Lang B, Peng X, Wang W, Wang X, Liu F, Zhao J, Shi Z, Yuan TF, Wu R. The effects of probiotics plus dietary fiber on antipsychotic-induced weight gain: a randomized clinical trial. Transl Psychiatry 2022; 12:185. [PMID: 35508529 PMCID: PMC9068806 DOI: 10.1038/s41398-022-01958-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022] Open
Abstract
Probiotics plus dietary fiber has demonstrated efficacy in improving metabolic abnormalities. However, the efficacy of probiotics and dietary fiber as well as their association with microbiota in attenuating antipsychotic-induced weight gain and metabolic disturbance remains poorly understood. Here we analyzed results from the double-blind, randomized, placebo-controlled study to compare and evaluate the effects of probiotics, dietary fiber, and their combination for antipsychotic-induced weight gain in patients with a severe mental disorder. We found that probiotics plus dietary fiber was significantly superior to probiotics alone, dietary fiber only, and the placebo for weight, BMI, and total cholesterol reduction; insulin resistance was worse in the placebo group, with significant increases during the 12-week treatment; probiotics plus dietary fiber significantly reduced weight and prevented further deterioration of metabolic disturbances; and probiotics or dietary fiber alone can prevent further weight gain. We further performed 16 S ribosomal RNA sequencing revealed an increased abundance of microbiota after probiotics plus dietary fiber treatment. Moreover, logistic regression analyses revealed that the higher richness of microbiota was associated with favorable weight loss. These findings suggested that probiotics and dietary fiber co-administration were safe and effective interventions to reduce weight gain in patients treated with antipsychotic medications.
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Affiliation(s)
- Jing Huang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Chenchen Liu
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Ye Yang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Dongyu Kang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Jingmei Xiao
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Yujun Long
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Bing Lang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Xingjie Peng
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Weiyan Wang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Xiaoyi Wang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Fangkun Liu
- grid.452223.00000 0004 1757 7615Department of Neurosurgery, Xiangya Hospital, Central South University, 410008 Changsha, Hunan China
| | - Jingping Zhao
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China
| | - Zhe Shi
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011 Changsha, Hunan China ,grid.488482.a0000 0004 1765 5169Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, 410208 Changsha, Hunan China ,grid.415630.50000 0004 1782 6212Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China. .,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.
| | - Renrong Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China.
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He M, Yao J, Zhang Z, Zhang Y, Chen R, Gu Z, Huang X, Deng C, Zhou R, Fan J, Zhang B, Xie Y, Gao G, Sun T. Gold nanoclusters eliminate obesity induced by antipsychotics. Sci Rep 2022; 12:5502. [PMID: 35365730 PMCID: PMC8975852 DOI: 10.1038/s41598-022-09541-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/24/2022] [Indexed: 12/18/2022] Open
Abstract
Obesity induced by antipsychotics have plagued more than 20 million people worldwide. However, no drug is available to eliminate the obesity induced by antipsychotics. Here we examined the effect and potential mechanisms of a gold nanoclusters (AuNCs) modified by N-isobutyryl-L-cysteine on the obesity induced by olanzapine, the most prescribed but obesogenic antipsychotics, in a rat model. Our results showed that AuNCs completely prevented and reversed the obesity induced by olanzapine and improved glucose metabolism profile in rats. Further mechanism investigations revealed that AuNCs exert its anti-obesity function through inhibition of olanzapine-induced dysfunction of histamine H1 receptor and proopiomelanocortin signaling therefore reducing hyperphagia, and reversing olanzapine-induced inhibition of uncoupling-protein-1 signaling which increases thermogenesis. Together with AuNCs' good biocompatibility, these findings not only provide AuNCs as a promising nanodrug candidate for treating obesity induced by antipsychotics, but also open an avenue for the potential application of AuNCs-based nanodrugs in treating general obesity.
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Affiliation(s)
- Meng He
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, 430070, China
| | - Jing Yao
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, 430070, China
| | - Zijun Zhang
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, 430070, China
| | - Ying Zhang
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, 430070, China
| | - Rui Chen
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, 430070, China
| | - Zhenhua Gu
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, 430070, China
| | - XuFeng Huang
- School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Chao Deng
- School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Ruqin Zhou
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, 430070, China
| | - Jun Fan
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, 430070, China
| | - Baohua Zhang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Capital Medical University, Beijing, 100191, China
| | - Yanqian Xie
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, 430070, China
| | - Guanbin Gao
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, 430070, China.
| | - Taolei Sun
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, 430070, China. .,State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, 430070, China.
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