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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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Amini K, Motallebi MJ, Bakhtiari K, Hajmiri MS, Zamanirafe M, Sharifikia M, Ranjbar A, Keshavarzi A, Mirjalili M, Mehrpooya M. Effects of atypical antipsychotics on serum asprosin level and other metabolic parameters in patients with schizophrenia. Hum Psychopharmacol 2024:e2907. [PMID: 38940745 DOI: 10.1002/hup.2907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND In this cross-sectional study, we compared fasting serum asprosin levels and metabolic parameters between patients receiving one of three atypical antipsychotics (olanzapine, risperidone, or aripiprazole) and healthy subjects. METHODS The study population included 62 adult outpatients with schizophrenia and 22 healthy controls, matched for age and gender. Patients were in remission and had been on stable monotherapy with one of these atypical antipsychotics for over 6 months. Body Mass Index (BMI) and fasting serum levels of asprosin, glucose, HA1c, insulin, and lipid profile were compared across the investigated groups. Additionally, the number of participants meeting the insulin resistance criterion, defined as homeostasis model assessment for insulin resistance (HOMA-IR) >2.5, as well as the number of participants with elevated BMI levels (men >27 kg/m2, women >25 kg/m2) were compared among the groups. RESULTS We observed statistically significant differences in BMI and fasting serum levels of glucose, HA1c, insulin, triglyceride (TG), high-density lipoprotein cholesterol, and asprosin among patients receiving olanzapine or risperidone, as compared to those receiving aripiprazole and healthy subjects. Patients on aripiprazole exhibited values comparable to healthy subjects, whereas those on risperidone or olanzapine showed significantly higher values, with the highest observed in the olanzapine group. Additionally, the prevalence of participants meeting the insulin resistance criterion and those with elevated BMI was also greater in individuals receiving olanzapine or risperidone compared to those on aripiprazole and healthy subjects. Serum asprosin levels showed a significant positive correlation with BMI and several metabolic parameters, including HbA1c, fasting insulin, HOMA-IR, and TG. No significant differences were observed among the investigated groups in terms of serum levels of total cholesterol and low-density lipoprotein cholesterol. CONCLUSIONS Our cross-sectional study highlights the association between elevated asprosin levels, weight gain, and metabolic disorders in patients treated with olanzapine and risperidone. Given the bidirectional nature of the relationship between serum asprosin levels and these metabolic disturbances, further research is warranted to elucidate potential causative pathways.
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Affiliation(s)
- Kiumarth Amini
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad-Javad Motallebi
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Kimia Bakhtiari
- Occupational Therapist, School of Rehabilitation, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Minoo Sadat Hajmiri
- Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Zamanirafe
- Medical Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdis Sharifikia
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Ranjbar
- Department of Pharmacology Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Keshavarzi
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahtabalsadat Mirjalili
- Department of Clinical Pharmacy, School of Pharmacy, Yazd University of Medical Sciences, Yazd, Iran
| | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
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Echeveste-Navarrete J, Zavaleta-Ramírez P, Castilla-Peon MF. Trajectory of the body mass index of children and adolescents attending a reference mental health center. J Pediatr Endocrinol Metab 2024; 37:559-568. [PMID: 38634616 DOI: 10.1515/jpem-2024-0039] [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: 01/19/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES The primary objective was to describe the standardized body mass index (z-BMI) trajectory of children and adolescents admitted to a psychiatric reference center in Mexico City according to their diagnosis and medication use. The secondary objective was to compare z-BMI between antipsychotic users and non-users. METHODS This is a retrospective cohort study. The psychiatric diagnosis, prescribed medications, serial heights, and weights were collected from the medical records. RESULTS The median baseline z-BMI of the 129 analyzed cases was 0.88 (interquartile range [IQR]: 0-1.92), and the prevalence of excessive weight (obesity or overweight) was 46.8 %. At the end of follow-up (median 50.3 weeks), the median change in z-BMI was -0.09 (IQR: -0.68 to 0.42). New long-term users of antipsychotics (n=29) had an increase in their z-BMI, in contrast to never-users (median difference 0.73, p=0.01) and to previous users (median difference 0.92, p=0.047). The 59 subjects with excessive weight at admission had a median z-BMI change of -0.39 (IQR: -0.81 to -0.04). Among patients with excessive weight and depression, there was a greater decrease in z-BMI in sertraline users (n=13) compared with fluoxetine users (n=15) (median -0.65 vs. 0.21, p<0.001). CONCLUSIONS New long-term users of antipsychotics showed a significant increase in their z-BMI. Patients with depressive disorders and obesity on sertraline therapy tended to show a decrease in their z-BMI.
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Affiliation(s)
- Juliana Echeveste-Navarrete
- Pharmacist, Hospital Psiquiátrico Infantil 'Dr. Juan N. Navarro', Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Patricia Zavaleta-Ramírez
- Child and Adolescent Psychiatrist, Research Division Director, Hospital Psiquiátrico Infantil 'Dr. Juan N. Navarro', Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Maria Fernanda Castilla-Peon
- Pediatric Endocrinologist, Researcher at Hospital Psiquiátrico Infantil 'Dr. Juan N. Navarro', Comisión Nacional de Salud Mental y Adicciones, Mexico City, México
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Arrue A, Olivas O, Erkoreka L, Alvarez FJ, Arnaiz A, Varela N, Bilbao A, Rodríguez JJ, Moreno-Calle MT, Gordo E, Marín E, Garcia-Cano J, Saez E, Gonzalez-Torres MÁ, Zumárraga M, Basterreche N. Multilocus Genetic Profile Reflecting Low Dopaminergic Signaling Is Directly Associated with Obesity and Cardiometabolic Disorders Due to Antipsychotic Treatment. Pharmaceutics 2023; 15:2134. [PMID: 37631349 PMCID: PMC10459305 DOI: 10.3390/pharmaceutics15082134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Treatment with second-generation antipsychotics (SGAs) can cause obesity and other cardiometabolic disorders linked to D2 receptor (DRD2) and to genotypes affecting dopaminergic (DA) activity, within reward circuits. We explored the relationship of cardiometabolic alterations with single genetic polymorphisms DRD2 rs1799732 (NG_008841.1:g.4750dup -> C), DRD2 rs6277 (NG_008841.1:g.67543C>T), COMT rs4680 (NG_011526.1:g.27009G>A), and VNTR in both DRD4 NC_000011.10 (637269-640706) and DAT1 NC_000005.10 (1392794-1445440), as well as with a multilocus genetic profile score (MLGP). A total of 285 psychiatric patients treated with SGAs for at least three months were selected. Cardiometabolic parameters were classified according to ATP-III and WHO criteria. Blood samples were taken for routinely biochemical assays and PCR genotyping. Obesity (BMI, waist (W)), high diastolic blood pressure (DBP), and hypertriglyceridemia (HTG) were present in those genetic variants related to low dopaminergic activity: InsIns genotype in rs1799732 (BMI: OR: 2.91 [1.42-5.94]), DRD4-VNTR-L allele (W: OR: 1.73 [1.04-2.87]) and 9R9R variant in DAT1-VNTR (W: OR: 2.73 [1.16-6.40]; high DBP: OR: 3.33 [1.54-7.31]; HTG: OR: 4.38 [1.85-10.36]). A low MLGP score indicated a higher risk of suffering cardiometabolic disorders (BMI: OR: 1.23 [1.05-1.45]; W: OR: 1.18 [1.03-1.34]; high DBP: OR: 1.22 [1.06-1.41]; HTG: OR: 1.20 [1.04-1.39]). The MLGP score was more sensitive for detecting the risk of suffering these alterations. Low dopaminergic system function would contribute to increased obesity, BDP, and HTG following long-term SGA treatment.
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Affiliation(s)
- Aurora Arrue
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Neurochemical Research Unit, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48903 Barakaldo, Spain
| | - Olga Olivas
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Bizkaia Mental Health Network, Zaldibar Hospital, Osakidetza Basque Health Service, 48250 Zaldibar, Spain
| | - Leire Erkoreka
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Department of Psychiatry, Galdakao-Usánsolo University Hospital, Osakidetza Basque Health Service, 48960 Galdakao, Spain
- Department of Neurosciences, Faculty of Medicine and Dentistry, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Francisco Jose Alvarez
- Research Unit, Cruces University Hospital, Osakidetza Basque Health Service, 48903 Barakaldo, Spain
| | - Ainara Arnaiz
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Erandio Mental Health Center, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48950 Erandio, Spain
| | - Noemi Varela
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Uribe Mental Health Center, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48990 Getxo, Spain
| | - Ainhoa Bilbao
- Animal Research Facility, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Jose-Julio Rodríguez
- Department of Neurosciences, Faculty of Medicine and Dentistry, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Functional Neuroanatomy, BioCruces Bizkaia Health Research Institute, Ikerbasque Basque Foundation for Science, 48903 Barakaldo, Spain
| | - María Teresa Moreno-Calle
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Department of Psychiatry, Galdakao-Usánsolo University Hospital, Osakidetza Basque Health Service, 48960 Galdakao, Spain
| | - Estibaliz Gordo
- Bizkaia Mental Health Network, Zamudio Hospital, Osakidetza Basque Health Service, 48170 Zamudio, Spain
| | - Elena Marín
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Bizkaia Mental Health Network, Bermeo Hospital, Osakidetza Basque Health Service, 48370 Bermeo, Spain
| | - Javier Garcia-Cano
- Alternatives to Hospitalization in Bilbao, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48903 Bilbao, Spain
| | - Estela Saez
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Department of Psychiatry, Galdakao-Usánsolo University Hospital, Osakidetza Basque Health Service, 48960 Galdakao, Spain
| | - Miguel Ángel Gonzalez-Torres
- Department of Neurosciences, Faculty of Medicine and Dentistry, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Integrative Research Group in Mental Health, BioCruces Bizkaia Health Research Institute, 48013 Bilbao, Spain
- Department of Psychiatry, Basurto University Hospital, Osakidetza Basque Health Service, 48013 Bilbao, Spain
| | - Mercedes Zumárraga
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Neurochemical Research Unit, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48903 Barakaldo, Spain
| | - Nieves Basterreche
- Functional Neuroanatomy, BioCruces Bizkaia Health Research Institute, Ikerbasque Basque Foundation for Science, 48903 Barakaldo, Spain
- Integrative Research Group in Mental Health, BioCruces Bizkaia Health Research Institute, 48013 Bilbao, Spain
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Akinola PS, Tardif I, Leclerc J. Antipsychotic-Induced Metabolic Syndrome: A Review. Metab Syndr Relat Disord 2023; 21:294-305. [PMID: 37347965 DOI: 10.1089/met.2023.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Schizophrenia, a serious psychiatric disorder, is among the top 10 global causes of disability and affects nearly 1% of the world population. Antipsychotics constitute the best treatment for patients with schizophrenia, however, this treatment class carries a high risk of metabolic syndrome, including lipid abnormalities. Indeed, the risk of metabolic syndrome would be increased in the population with schizophrenia compared to the general population. The objective is to summarize the prevalence, the mechanisms, and the potential treatments of antipsychotic-induced metabolic syndrome. This is a narrative review of the literature. We searched the electronic database Medline, accessed through PubMed, to find studies that investigated the prevalence and treatments of metabolic syndrome in the adult population using antipsychotics. The prevalence of metabolic syndrome in patients treated with antipsychotics ranges from 37% to 63%. Antipsychotic iatrogenic effects include weight gain/increased waist circumference, dyslipidemia, insulin resistance/type 2 diabetes, and hypertension. Clozapine and olanzapine are reported to precipitate the onset of metabolic syndrome features. In patients with metabolic syndrome, an antipsychotic with less metabolic side effects such as lurasidone, lumateperone, ziprasidone, and aripiprazole should be prioritized. Unlike medications, aerobic exercise and dietetic counseling were found to be efficient as the nonpharmacologic treatment of antipsychotic-induced metabolic syndrome. Few pharmacological treatments were proven effective against weight gain in this patient population. The risk of metabolic syndrome induced by antipsychotics should be early recognized and closely monitored. Primary and secondary prevention of metabolic syndrome or onset of its feature might help reduce the risk of death for patients using antipsychotics.
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Affiliation(s)
- Pelumi Samuel Akinola
- College of Pharmacy, Rady Faculty of Health sciences, University of Manitoba, Winnipeg, Canada
| | | | - Jacinthe Leclerc
- Faculté de Pharmacie, Université Laval, Québec, Canada
- Centre de Recherche, Institut Universitaire de Cardiologie de Pneumologie de Québec-Université Laval, Québec, Canada
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Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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7
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Cookson J, Pimm J, Reynolds G. Partial agonists of dopamine receptors: clinical effects and dopamine receptor interactions in combining aripiprazole with a full antagonist in treating psychosis. BJPSYCH ADVANCES 2023. [DOI: 10.1192/bja.2022.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
SUMMARY
Partial agonists of dopamine receptors are used in combination with full antagonists in treating psychosis, either to mitigate side-effects or in the hope of increasing effectiveness. We examine how combinations may affect the occupancy of D2/D3 dopamine receptors and explore how these can explain the outcomes in the light of the dopamine hypothesis of psychosis. The combinations considered here are from published studies combining aripiprazole with amisulpride, with risperidone in people with hyperprolactinaemia and with olanzapine to mitigate weight gain. We discuss possible worsening of symptoms by the addition of a partial agonist or switching. We also examine the potentially adverse interaction with a full antagonist such as haloperidol given during a subsequent relapse to control severe agitation.
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Free RB, Nilson AN, Boldizsar NM, Doyle TB, Rodriguiz RM, Pogorelov VM, Machino M, Lee KH, Bertz JW, Xu J, Lim HD, Dulcey AE, Mach RH, Woods JH, Lane JR, Shi L, Marugan JJ, Wetsel WC, Sibley DR. Identification and Characterization of ML321: A Novel and Highly Selective D 2 Dopamine Receptor Antagonist with Efficacy in Animal Models That Predict Atypical Antipsychotic Activity. ACS Pharmacol Transl Sci 2023; 6:151-170. [PMID: 36654757 PMCID: PMC9841785 DOI: 10.1021/acsptsci.2c00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Indexed: 12/31/2022]
Abstract
We have developed and characterized a novel D2R antagonist with exceptional GPCR selectivity - ML321. In functional profiling screens of 168 different GPCRs, ML321 showed little activity beyond potent inhibition of the D2R and to a lesser extent the D3R, demonstrating excellent receptor selectivity. The D2R selectivity of ML321 may be related to the fact that, unlike other monoaminergic ligands, ML321 lacks a positively charged amine group and adopts a unique binding pose within the orthosteric binding site of the D2R. PET imaging studies in non-human primates demonstrated that ML321 penetrates the CNS and occupies the D2R in a dose-dependent manner. Behavioral paradigms in rats demonstrate that ML321 can selectively antagonize a D2R-mediated response (hypothermia) while not affecting a D3R-mediated response (yawning) using the same dose of drug, thus indicating exceptional in vivo selectivity. We also investigated the effects of ML321 in animal models that are predictive of antipsychotic efficacy in humans. We found that ML321 attenuates both amphetamine- and phencyclidine-induced locomotor activity and restored pre-pulse inhibition (PPI) of acoustic startle in a dose-dependent manner. Surprisingly, using doses that were maximally effective in both the locomotor and PPI studies, ML321 was relatively ineffective in promoting catalepsy. Kinetic studies revealed that ML321 exhibits slow-on and fast-off receptor binding rates, similar to those observed with atypical antipsychotics with reduced extrapyramidal side effects. Taken together, these observations suggest that ML321, or a derivative thereof, may exhibit ″atypical″ antipsychotic activity in humans with significantly fewer side effects than observed with the currently FDA-approved D2R antagonists.
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Affiliation(s)
- R. Benjamin Free
- Molecular
Neuropharmacology Section, National Institute of Neurological Disorders
and Stroke, Intramural Research Program, National Institutes of Health, 35 Convent Drive, MSC-3723, Bethesda, Maryland20892, United States
| | - Ashley N. Nilson
- Molecular
Neuropharmacology Section, National Institute of Neurological Disorders
and Stroke, Intramural Research Program, National Institutes of Health, 35 Convent Drive, MSC-3723, Bethesda, Maryland20892, United States
| | - Noelia M. Boldizsar
- Molecular
Neuropharmacology Section, National Institute of Neurological Disorders
and Stroke, Intramural Research Program, National Institutes of Health, 35 Convent Drive, MSC-3723, Bethesda, Maryland20892, United States
| | - Trevor B. Doyle
- Molecular
Neuropharmacology Section, National Institute of Neurological Disorders
and Stroke, Intramural Research Program, National Institutes of Health, 35 Convent Drive, MSC-3723, Bethesda, Maryland20892, United States
| | - Ramona M. Rodriguiz
- Department
of Psychiatry and Behavioral Sciences, Mouse Behavioral and Neuroendocrine
Analysis Core Facility, Duke University
Medical Center, 354 Sands Building, 303 Research Drive, Durham, North Carolina27710, United States
| | - Vladimir M. Pogorelov
- Department
of Psychiatry and Behavioral Sciences, Mouse Behavioral and Neuroendocrine
Analysis Core Facility, Duke University
Medical Center, 354 Sands Building, 303 Research Drive, Durham, North Carolina27710, United States
| | - Mayako Machino
- Computational
Chemistry and Molecular Biophysics Section, Molecular Targets and
Medications Discovery Branch, National Institute on Drug Abuse, Intramural
Research Program, National Institutes of
Health, 333 Cassell Drive, Baltimore, Maryland21224, United
States
| | - Kuo Hao Lee
- Computational
Chemistry and Molecular Biophysics Section, Molecular Targets and
Medications Discovery Branch, National Institute on Drug Abuse, Intramural
Research Program, National Institutes of
Health, 333 Cassell Drive, Baltimore, Maryland21224, United
States
| | - Jeremiah W. Bertz
- Department
of Pharmacology, University of Michigan
Medical School, 1150 W. Medical Center Dr., Ann Arbor, Michigan48109, United States
| | - Jinbin Xu
- Division
of Radiological Sciences, Department of Radiology, Mallinckrodt Institute
of Radiology, Washington University School
of Medicine, St. Louis, Missouri63110, United States
| | - Herman D. Lim
- Drug Discovery
Biology, Monash Institute of Pharmaceutical Sciences, Monash University, 399 Royal Parade, Parkville, VIC3052, Australia
| | - Andrés E. Dulcey
- Division
of Pre-Clinical Innovation, National Center for Advancing Translational
Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland20850, United States
| | - Robert H. Mach
- Department
of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania19104, United States
| | - James H. Woods
- Department
of Pharmacology, University of Michigan
Medical School, 1150 W. Medical Center Dr., Ann Arbor, Michigan48109, United States
| | - J Robert Lane
- Centre
of Membrane Proteins and Receptors, Universities
of Birmingham and Nottingham, NottinghamNG7 2UH, United Kingdom
| | - Lei Shi
- Computational
Chemistry and Molecular Biophysics Section, Molecular Targets and
Medications Discovery Branch, National Institute on Drug Abuse, Intramural
Research Program, National Institutes of
Health, 333 Cassell Drive, Baltimore, Maryland21224, United
States
| | - Juan J. Marugan
- Division
of Pre-Clinical Innovation, National Center for Advancing Translational
Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland20850, United States
| | - William C. Wetsel
- Department
of Psychiatry and Behavioral Sciences, Mouse Behavioral and Neuroendocrine
Analysis Core Facility, Duke University
Medical Center, 354 Sands Building, 303 Research Drive, Durham, North Carolina27710, United States
- Departments
of Neurobiology and Cell Biology, Duke University
Medical Center, 354 Sands Building, 303 Research Drive, Durham, North Carolina27710, United States
| | - David R. Sibley
- Molecular
Neuropharmacology Section, National Institute of Neurological Disorders
and Stroke, Intramural Research Program, National Institutes of Health, 35 Convent Drive, MSC-3723, Bethesda, Maryland20892, United States
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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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10
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Li S, Lu X, Chen X, Huang Z, Zhou H, Li Z, Ning Y. The prevalence and associated clinical correlates of hyperuricemia in patients with bipolar disorder. Front Neurosci 2022; 16:998747. [PMID: 36188459 PMCID: PMC9523783 DOI: 10.3389/fnins.2022.998747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective The prevalence and clinically associated factors of hyperuricemia (HUA) have been widely studied in the general population but rarely in patients with bipolar disorder (BPD) co-morbid with HUA. This study attempted to investigate the prevalence of HUA in BPD patients and analyze the associated correlates of HUA. Materials and methods In this study, 182 outpatients with BPD and 182 healthy controls participated. The demographic and clinical information were collected. The body weight, height, waist circumference (WC), hip circumference (HC), and blood pressure (BP) were measured. The levels of serum uric acid (UA), triglyceride (TG), high-density lipoprotein (HDL-C), and fasting blood glucose (FBG) were also determined. Results BPD patients had a significantly higher prevalence of HUA (40.7%) compared to healthy controls (30.2%) (χ2 = 4.335, P = 0.037). The systolic blood pressure (SBP), pulse pressure (PP), FBG, UA, and body mass index (BMI) were higher in the BPD group compared with those in the control group, while the diastolic blood pressure (DBP) and HDL-C level were lower (P < 0.05) in BPD patients. The prevalence of HUA was higher in BPD patients who used antipsychotics combined with mood stabilizers than that in BPD subjects receiving the mood stabilizers alone (P < 0.001). The prevalence of HUA and increased serum UA levels were higher in the manic group (62.1%) than in the depressive (34.3%) or euthymia group (17.0%) (P < 0.001). Additionally, the severity of mania was positively correlated with the UA level (r = 0.410, P < 0.001). There were significant differences in terms of MetS (29.7% vs. 14.8%), BMI, HC, WC, TG, and HDL-C between the HUA and the non-HUA groups (P < 0.05). The unconditional logistic regression analysis revealed that high BMI (OR = 1.210; 95%CI: 1.100–1.331) and high TG level (OR = 1.652; 95%CI: 1.058–2.580) were the major risk factorids for HUA in BPD patients. Conclusion Our study suggests that patients with BPD are prone to metabolic diseases such as HUA. Higher serum levels of TG and high BMI could be associated with HUA development. Clinicians need to regularly monitor and evaluate BPD patients for their serum UA levels, especially for BPD patients with manic/hypomanic episodes and/or under the treatment of antipsychotics combined with mood stabilizers.
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Affiliation(s)
- Shuyun Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaobing Lu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaodong Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zebin Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hui Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zezhi Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- *Correspondence: Zezhi Li,
| | - Yuping Ning
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- Yuping Ning,
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11
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Boyda HN, Pham M, Huang J, Ho AA, Procyshyn RM, Yuen JWY, Honer WG, Barr AM. Antipsychotic Drug-Induced Increases in Peripheral Catecholamines are Associated With Glucose Intolerance. Front Pharmacol 2022; 13:765905. [PMID: 35242029 PMCID: PMC8886888 DOI: 10.3389/fphar.2022.765905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
The second-generation antipsychotic drugs are widely used in the field of psychiatry, for an expanding number of different conditions. While their clinical efficacy remains indispensable, many of the drugs can cause severe metabolic side-effects, resulting in an increased risk of developing cardiometabolic disorders. The physiological basis of these side-effects remains an ongoing area of investigation. In the present study, we examined the potential role of peripheral catecholamines in antipsychotic-induced glucose intolerance. Adult female rats were acutely treated with either the first-generation antipsychotic drug haloperidol (0.1, 0.5 or 1 mg/kg) or the second-generation drugs risperidone (0.25, 1.0 or 2.5 mg/kg), olanzapine (1.5, 7.5 or 15 mg/kg) or clozapine (2, 10 or 20 mg/kg) or vehicle. Fasting glucose levels were measured and then animals were subjected to the intraperitoneal glucose tolerance test. Levels of peripheral norepinephrine, epinephrine and dopamine were concurrently measured in the same animals 75, 105 and 135 min after drug treatment. All antipsychotics caused glucose intolerance, with strongest effects by clozapine > olanzapine > risperidone > haloperidol. Plasma catecholamines were also increased by drug treatment, with greatest effects for norepinephrine and epinephrine caused by clozapine > risperidone > olanzapine > haloperidol. Importantly, there were strong and statistically significant associations between norepinephrine/epinephrine levels and glucose intolerance for all drugs. These findings confirm that increases in peripheral catecholamines co-occur in animals that exhibit antipsychotic-induced glucose intolerance, and these effects are strongly associated with each other, providing further evidence for elevated catecholamines as a substrate for antipsychotic metabolic side-effects.
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Affiliation(s)
- Heidi N Boyda
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Pham
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Joyce Huang
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amanzo A Ho
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Jessica W Y Yuen
- Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health & Substance Use Services Research Institute, Vancouver, BC, Canada
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12
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Wannasuphoprasit Y, Andersen SE, Arranz MJ, Catalan R, Jurgens G, Kloosterboer SM, Rasmussen HB, Bhat A, Irizar H, Koller D, Polimanti R, Wang B, Zartaloudi E, Austin-Zimmerman I, Bramon E. CYP2D6 Genetic Variation and Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis. Front Psychol 2022; 12:768748. [PMID: 35185676 PMCID: PMC8850377 DOI: 10.3389/fpsyg.2021.768748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Antipsychotic-induced weight gain is a contributing factor in the reduced life expectancy reported amongst people with psychotic disorders. CYP2D6 is a liver enzyme involved in the metabolism of many commonly used antipsychotic medications. We investigated if CYP2D6 genetic variation influenced weight or BMI among people taking antipsychotic treatment. METHODS We conducted a systematic review and a random effects meta-analysis of publications in Pubmed, Embase, PsychInfo, and CENTRAAL that had BMI and/or weight measurements of patients on long-term antipsychotics by their CYP2D6-defined metabolic groups (poor, intermediate, normal/extensive, and ultra-rapid metabolizers, UMs). RESULTS Twelve studies were included in the systematic review. All cohort studies suggested that the presence of reduced-function or non-functional alleles for CYP2D6 was associated with greater antipsychotic-induced weight gain, whereas most cross-sectional studies did not find any significant associations. Seventeen studies were included in the meta-analysis with clinical data of 2,041 patients, including 93 poor metabolizers (PMs), 633 intermediate metabolizers (IMs), 1,272 normal metabolizers (NMs), and 30 UMs. Overall, we did not find associations in any of the comparisons made. The estimated pooled standardized differences for the following comparisons were (i) PM versus NM; weight = -0.07 (95%CI: -0.49 to 0.35, p = 0.74), BMI = 0.40 (95%CI: -0.19 to 0.99, p = 0.19). (ii) IM versus NM; weight = 0.09 (95% CI: -0.04 to 0.22, p = 0.16) and BMI = 0.09 (95% CI: -0.24 to 0.41, p = 0.60). (iii) UM versus EM; weight = 0.01 (95% CI: -0.37 to 0.40, p = 0.94) and BMI = -0.08 (95%CI: -0.57 to 0.42, p = 0.77). CONCLUSION Our systematic review of cohort studies suggested that CYP2D6 poor metabolizers have higher BMI than normal metabolizers, but the data of cross-sectional studies and the meta-analysis did not show this association. Although our review and meta-analysis constitutes one of the largest studies with comprehensively genotyped samples, the literature is still limited by small numbers of participants with genetic variants resulting in poor or UMs status. We need further studies with larger numbers of extreme metabolizers to establish its clinical utility in antipsychotic treatment. CYP2D6 is a key gene for personalized prescribing in mental health.
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Affiliation(s)
| | | | - Maria J Arranz
- Fundació Docència I Recerca, Mútua Terrassa, Barcelona, Spain
- Barcelona Clinic Schizophrenia Unit, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Rosa Catalan
- Barcelona Clinic Schizophrenia Unit, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Gesche Jurgens
- Clinical Pharmacological Unit, Zealand University Hospital, Roskilde, Denmark
| | - Sanne Maartje Kloosterboer
- Department of Hospital Pharmacy and Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct Hans, Roskilde, Denmark
- Department of Science and Environment, Roskilde University Center, Roskilde, Denmark
| | - Anjali Bhat
- Division of Psychiatry, University College London, London, United Kingdom
| | - Haritz Irizar
- Division of Psychiatry, University College London, London, United Kingdom
| | - Dora Koller
- Division of Human Genetics, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
| | - Renato Polimanti
- Division of Human Genetics, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
| | - Baihan Wang
- Division of Psychiatry, University College London, London, United Kingdom
| | - Eirini Zartaloudi
- Division of Psychiatry, University College London, London, United Kingdom
| | - Isabelle Austin-Zimmerman
- Division of Psychiatry, University College London, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Elvira Bramon
- Division of Psychiatry, University College London, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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13
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Efthymiou D, Zekakos DX, Papatriantafyllou E, Ziagkas E, Petrelis AN, Vassilopoulou E. Gait Alterations in the Prediction of Metabolic Syndrome in Patients With Schizophrenia: A Pilot Study With PODOSmart ® Insoles. Front Psychiatry 2022; 13:756600. [PMID: 35153872 PMCID: PMC8829465 DOI: 10.3389/fpsyt.2022.756600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Second-generation antipsychotics (APs) are associated with metabolic syndrome (MetS), characterized by abnormal pro-inflammatory cytokine production and oxidative stress due to the reduced antioxidant systems, and neurological effects, including mobility impairment. This pilot study investigated relationships between inflammatory-metabolic biomarkers, MetS and gait alterations in patients with psychosis treated with APs. METHODS Patients with psychosis treated with APs, 20 with MetS (MPS group) and 20 without MetS (PS group) were studied, usinganthropometric data, blood measurements and gait analysis performed with the PODOSmart ® gait analysis device. RESULTS AND DISCUSSION The MPS group had significantly higher mean body mass index (BMI) and arterial blood pressure (BP) than the PS group. PODOSmart ® gait analysis recorded significant differences between groups in pronation-supination at Heel Off (HO), gaitline HO and gaitline Toe Off (TO). Multifactorial elastic net regression models demonstrated significant association with MetS of inflammatory markers, specific AP2 treatment, gender, age; BMI; BP and smoking (accuracy λ = 0.08), and in relation to gait parameters (accuracy λ = 0.750), the three pronation- supination variables, i.e., at HO, flat foot in (AP2 related) and TO, and propulsion speed. The gait parameters were at the edges of the model, thus indicating a more significant role of these parameters compared to the other clinical variables. Early diagnosis of MetS in patients with schizophrenia via identification of gait alterations can be a screening measure for serious cardiovascular complications related to psychosis and APs, to enable timely dietary intervention that can control the pro-inflammatory state and reduce oxidative stress.
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Affiliation(s)
- Dimitris Efthymiou
- Division of Neurosciences, Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Efthimis Ziagkas
- Laboratory of Motor Behaviour, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
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14
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Chang SC, Goh KK, Lu ML. Metabolic disturbances associated with antipsychotic drug treatment in patients with schizophrenia: State-of-the-art and future perspectives. World J Psychiatry 2021; 11:696-710. [PMID: 34733637 PMCID: PMC8546772 DOI: 10.5498/wjp.v11.i10.696] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/16/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Metabolic disturbances and obesity are major cardiovascular risk factors in patients with schizophrenia, resulting in a higher mortality rate and shorter life expectancy compared with those in the general population. Although schizophrenia and metabolic disturbances may share certain genetic or pathobiological risks, antipsychotics, particularly those of second generation, may further increase the risk of weight gain and metabolic disturbances in patients with schizophrenia. This review included articles on weight gain and metabolic disturbances related to antipsychotics and their mechanisms, monitoring guidelines, and interventions. Nearly all antipsychotics are associated with weight gain, but the degree of the weight gain varies considerably. Although certain neurotransmitter receptor-binding affinities and hormones are correlated with weight gain and specific metabolic abnormalities, the precise mechanisms underlying antipsychotic-induced weight gain and metabolic disturbances remain unclear. Emerging evidence indicates the role of genetic polymorphisms associated with antipsychotic-induced weight gain and antipsychotic-induced metabolic disturbances. Although many guidelines for screening and monitoring antipsychotic-induced metabolic disturbances have been developed, they are not routinely implemented in clinical care. Numerous studies have also investigated strategies for managing antipsychotic-induced metabolic disturbances. Thus, patients and their caregivers must be educated and motivated to pursue a healthier life through smoking cessation and dietary and physical activity programs. If lifestyle intervention fails, switching to another antipsychotic drug with a lower metabolic risk or adding adjunctive medication to mitigate weight gain should be considered. Antipsychotic medications are essential for schizophrenia treatment, hence clinicians should monitor and manage the resulting weight gain and metabolic disturbances.
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Affiliation(s)
- Shen-Chieh Chang
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Kah Kheng Goh
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
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15
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Borovcanin MM, Vesic K, Jovanovic M, Mijailovic NR. Galectin-3 possible involvement in antipsychotic-induced metabolic changes of schizophrenia: A minireview. World J Diabetes 2021; 12:1731-1739. [PMID: 34754374 PMCID: PMC8554363 DOI: 10.4239/wjd.v12.i10.1731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/24/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Recently, specific immunometabolic profiles have been postulated in patients with schizophrenia, even before full-blown disease and independent of antipsychotic treatment. Proteomic profiling studies offer a promising potential for elucidating the cellular and molecular pathways that may be involved in the onset and progression of schizophrenia symptoms, and co-occurrent metabolic changes. In view of all this, we were intrigued to explore galectin-3 (Gal-3) as a glycan, and in our previous study, we measured its elevated levels in remission of schizophrenia. The finding may be a consequence of antipsychotic treatment and may have an impact on the onset of inflammation, the development of obesity, and the presumed cognitive changes in schizophrenia. In the animal study, it was shown that downregulation of Gal-3 was beneficial in insulin regulation of obesity and cognitive preservation. Strategies involving plasma exchange are discussed in this review, particularly in the context of Gal-3 elimination.
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Affiliation(s)
- Milica M Borovcanin
- Department of Psychiatry, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
| | - Katarina Vesic
- Department of Neurology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
| | - Milena Jovanovic
- PhD Studies, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
- Clinic for Nephrology and Dialysis, University Clinical Center Kragujevac, Kragujevac 34000, Sumadija, Serbia
| | - Natasa R Mijailovic
- Department of Pharmacy, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
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16
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Martínez-Pinteño A, Gassó P, Prohens L, Segura AG, Parellada M, Saiz-Ruiz J, Cuesta MJ, Bernardo M, Lafuente A, Mas S, Rodríguez N. Identification of EP300 as a Key Gene Involved in Antipsychotic-Induced Metabolic Dysregulation Based on Integrative Bioinformatics Analysis of Multi-Tissue Gene Expression Data. Front Pharmacol 2021; 12:729474. [PMID: 34483940 PMCID: PMC8414590 DOI: 10.3389/fphar.2021.729474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/04/2021] [Indexed: 11/15/2022] Open
Abstract
Antipsychotics (APs) are associated with weight gain and other metabolic abnormalities such as hyperglycemia, dyslipidemia and metabolic syndrome. This translational study aimed to uncover the underlying molecular mechanisms and identify the key genes involved in AP-induced metabolic effects. An integrative gene expression analysis was performed in four different mouse tissues (striatum, liver, pancreas and adipose) after risperidone or olanzapine treatment. The analytical approach combined the identification of the gene co-expression modules related to AP treatment, gene set enrichment analysis and protein-protein interaction network construction. We found several co-expression modules of genes involved in glucose and lipid homeostasis, hormone regulation and other processes related to metabolic impairment. Among these genes, EP300, which encodes an acetyltransferase involved in transcriptional regulation, was identified as the most important hub gene overlapping the networks of both APs. Then, we explored the genetically predicted EP300 expression levels in a cohort of 226 patients with first-episode psychosis who were being treated with APs to further assess the association of this gene with metabolic alterations. The EP300 expression levels were significantly associated with increases in body weight, body mass index, total cholesterol levels, low-density lipoprotein cholesterol levels and triglyceride concentrations after 6 months of AP treatment. Taken together, our analysis identified EP300 as a key gene in AP-induced metabolic abnormalities, indicating that the dysregulation of EP300 function could be important in the development of these side effects. However, more studies are needed to disentangle the role of this gene in the mechanism of action of APs.
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Affiliation(s)
- Albert Martínez-Pinteño
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Patricia Gassó
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Llucia Prohens
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Alex G Segura
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Jerónimo Saiz-Ruiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Manuel J Cuesta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Miguel Bernardo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Amalia Lafuente
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergi Mas
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Rodríguez
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
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17
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Reynolds GP. The Etiology of Metabolic Disturbances in Schizophrenia: Drugs, Genes, and Environment. Int J Neuropsychopharmacol 2021; 24:854-855. [PMID: 34252192 PMCID: PMC8538903 DOI: 10.1093/ijnp/pyab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/10/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Gavin P Reynolds
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Howard Street, Sheffield, UK,Correspondence: Gavin P. Reynolds, PhD, Biomolecular Sciences Research Centre, Sheffield Hallam University, Howard Street, Sheffield S1 1WB, UK ()
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18
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Kucera J, Horska K, Hruska P, Kuruczova D, Micale V, Ruda-Kucerova J, Bienertova-Vasku J. Interacting effects of the MAM model of schizophrenia and antipsychotic treatment: Untargeted proteomics approach in adipose tissue. Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110165. [PMID: 33152383 DOI: 10.1016/j.pnpbp.2020.110165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022]
Abstract
Schizophrenia is a severe neuropsychiatric disease associated with substantially higher mortality. Reduced life expectancy in schizophrenia relates to an increased prevalence of metabolic disturbance, and antipsychotic medication is a major contributor. Molecular mechanisms underlying adverse metabolic effects of antipsychotics are not fully understood; however, adipose tissue homeostasis deregulation appears to be a critical factor. We employed mass spectrometry-based untargeted proteomics to assess the effect of chronic olanzapine, risperidone, and haloperidol treatment in visceral adipose tissue of prenatally methylazoxymethanol (MAM) acetate exposed rats, a well-validated neurodevelopmental animal model of schizophrenia. Bioinformatics analysis of differentially expressed proteins was performed to highlight the pathways affected by MAM and the antipsychotics treatment. MAM model was associated with the deregulation of the TOR (target of rapamycin) signalling pathway. Notably, alterations in protein expression triggered by antipsychotics were observed only in schizophrenia-like MAM animals where we revealed hundreds of affected proteins according to our two-fold threshold, but not in control animals. Treatments with all antipsychotics in MAM rats resulted in the downregulation of mRNA processing and splicing, while drug-specific effects included among others upregulation of insulin resistance (olanzapine), upregulation of fatty acid metabolism (risperidone), and upregulation of nucleic acid metabolism (haloperidol). Our data indicate that deregulation of several energetic and metabolic pathways in adipose tissue is associated with APs administration and is prominent in MAM schizophrenia-like model but not in control animals.
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Affiliation(s)
- Jan Kucera
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Katerina Horska
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic; Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
| | - Pavel Hruska
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniela Kuruczova
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vincenzo Micale
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy; National Institute of Mental Health, Klecany, Czech Republic
| | - Jana Ruda-Kucerova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Julie Bienertova-Vasku
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic; Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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19
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Zito MF, Marder SR. Rethinking the risks and benefits of long-term maintenance in schizophrenia. Schizophr Res 2020; 225:77-81. [PMID: 31806525 DOI: 10.1016/j.schres.2019.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022]
Abstract
This review addresses the risks and benefits of long-term maintenance antipsychotic treatment for patients that extends beyond two years. It focuses on framing discussions with patients who are recovering from a first episode. For these patients the evidence strongly supports the benefits over the risk for the first two years. However, both the clinical side effects of antipsychotics and the possible long-term effects of dopamine blocking drugs on the brain require a more nuanced discussion beyond this initial period. In most cases, the decision will be to continue antipsychotics but to consider strategies for mitigating the risks of drugs. This review provides information about the relative risks of dose reduction and intermittent treatment.
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Affiliation(s)
- Michael F Zito
- Semel Institute for Neuroscience at UCLA and the VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
| | - Stephen R Marder
- Semel Institute for Neuroscience at UCLA and the VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA.
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20
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Mazereel V, Detraux J, Vancampfort D, van Winkel R, De Hert M. Impact of Psychotropic Medication Effects on Obesity and the Metabolic Syndrome in People With Serious Mental Illness. Front Endocrinol (Lausanne) 2020; 11:573479. [PMID: 33162935 PMCID: PMC7581736 DOI: 10.3389/fendo.2020.573479] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
People with serious mental illness (SMI), including schizophrenia, bipolar disorder, and major depressive disorder, have a higher mortality rate and shortened life expectancy. This is mainly attributable to physical diseases, particularly cardiovascular diseases (CVDs). Important risk factors for CVDs are obesity and other metabolic abnormalities, which are especially prevalent in people with SMI. Several factors contribute to this increased risk, including unhealthy lifestyles. Psychotropic medication independently further increases this risk. In this review we want to examine the relationship between obesity and other components of the metabolic syndrome and psychotropic medication in people with SMI.
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Affiliation(s)
- Victor Mazereel
- Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Johan Detraux
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Davy Vancampfort
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ruud van Winkel
- Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Marc De Hert
- Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
- Antwerp Health Law and Ethics Chair, AHLEC University Antwerpen, Antwerp, Belgium
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21
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Horska K, Kotolova H, Karpisek M, Babinska Z, Hammer T, Prochazka J, Stark T, Micale V, Ruda-Kucerova J. Metabolic profile of methylazoxymethanol model of schizophrenia in rats and effects of three antipsychotics in long-acting formulation. Toxicol Appl Pharmacol 2020; 406:115214. [PMID: 32866524 DOI: 10.1016/j.taap.2020.115214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/15/2022]
Abstract
Mortality in psychiatric patients with severe mental illnesses reaches a 2-3 times higher mortality rate compared to the general population, primarily due to somatic comorbidities. A high prevalence of cardiovascular morbidity can be attributed to the adverse metabolic effects of atypical antipsychotics (atypical APs), but also to metabolic dysregulation present in drug-naïve patients. The metabolic aspects of neurodevelopmental schizophrenia-like models are understudied. This study evaluated the metabolic phenotype of a methylazoxymethanol (MAM) schizophrenia-like model together with the metabolic effects of three APs [olanzapine (OLA), risperidone (RIS) and haloperidol (HAL)] administered via long-acting formulations for 8 weeks in female rats. Body weight, feed efficiency, serum lipid profile, gastrointestinal and adipose tissue-derived hormones (leptin, ghrelin, glucagon and glucagon-like peptide 1) were determined. The lipid profile was assessed in APs-naïve MAM and control cohorts of both sexes. Body weight was not altered by the MAM model, though cumulative food intake and feed efficiency was lowered in the MAM compared to CTR animals. The effect of the APs was also present; body weight gain was increased by OLA and RIS, while OLA induced lower weight gain in the MAM rats. Further, the MAM model showed lower abdominal adiposity, while OLA increased it. Serum lipid profile revealed MAM model-induced alterations in both sexes; total, HDL and LDL cholesterol levels were increased. The MAM model did not exert significant alterations in hormonal parameters except for elevation in leptin level. The results support intrinsic metabolic dysregulation in the MAM model in both sexes, but the MAM model did not manifest higher sensitivity to metabolic effects induced by antipsychotic treatment.
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Affiliation(s)
- Katerina Horska
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho trida 1946/1, 612 00 Brno, Czech Republic; Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Palackeho trida 1946/1, 612 00 Brno, Czech Republic
| | - Hana Kotolova
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho trida 1946/1, 612 00 Brno, Czech Republic; Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Palackeho trida 1946/1, 612 00 Brno, Czech Republic
| | - Michal Karpisek
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho trida 1946/1, 612 00 Brno, Czech Republic; Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Palackeho trida 1946/1, 612 00 Brno, Czech Republic; R&D Department, Biovendor - Laboratorni Medicina, Karasek 1, 621 00 Brno, Czech Republic
| | - Zuzana Babinska
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Tomas Hammer
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho trida 1946/1, 612 00 Brno, Czech Republic; Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Palackeho trida 1946/1, 612 00 Brno, Czech Republic
| | - Jiri Prochazka
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho trida 1946/1, 612 00 Brno, Czech Republic; Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Palackeho trida 1946/1, 612 00 Brno, Czech Republic
| | - Tibor Stark
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; Department of Stress Neurobiology and Neurogenetics, Neuronal Plasticity Group, Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, Germany
| | - Vincenzo Micale
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Via Santa Sofia 97, I-95123 Catania, Italy; National Institute of Mental Health, Topolova 748, 250 67 Klecany, Czech Republic
| | - Jana Ruda-Kucerova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic.
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22
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Regan AS, Valcourt SC. Metabolic Syndrome in Bipolar Disorder: Review and Management. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200713-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Higgins-Chen AT, Boks MP, Vinkers CH, Kahn RS, Levine ME. Schizophrenia and Epigenetic Aging Biomarkers: Increased Mortality, Reduced Cancer Risk, and Unique Clozapine Effects. Biol Psychiatry 2020; 88:224-235. [PMID: 32199607 PMCID: PMC7368835 DOI: 10.1016/j.biopsych.2020.01.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Schizophrenia (SZ) is associated with increased all-cause mortality, smoking, and age-associated proteins, yet multiple previous studies found no association between SZ and biological age using Horvath's epigenetic clock, a well-established aging biomarker based on DNA methylation. However, numerous epigenetic clocks that may capture distinct aspects of aging have been developed. This study tested the hypothesis that altered aging in SZ manifests in these other clocks. METHODS We performed a comprehensive analysis of 14 epigenetic clocks categorized according to what they were trained to predict: chronological age, mortality, mitotic divisions, or telomere length. To understand the etiology of biological age differences, we also examined DNA methylation predictors of smoking, alcohol, body mass index, serum proteins, and cell proportions. We independently analyzed 3 publicly available multiethnic DNA methylation data sets from whole blood, a total of 567 SZ cases and 594 nonpsychiatric controls. RESULTS All data sets showed accelerations in SZ for the 3 mortality clocks up to 5 years, driven by smoking and elevated levels of 6 age-associated proteins. The 2 mitotic clocks were decelerated in SZ related to antitumor natural killer and CD8T cells, which may help explain conflicting reports about low cancer rates in epidemiological studies of SZ. One cohort with available medication data showed that clozapine is associated with male-specific decelerations up to 7 years in multiple chronological age clocks. CONCLUSIONS Our study demonstrates the utility of studying the various epigenetic clocks in tandem and highlights potential mechanisms by which mental illness influences long-term outcomes, including cancer and early mortality.
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Affiliation(s)
- Albert T Higgins-Chen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
| | - Marco P Boks
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Christiaan H Vinkers
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Morgan E Levine
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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24
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Severe weight gain as an adverse drug reaction of psychotropics: Data from the AMSP project between 2001 and 2016. Eur Neuropsychopharmacol 2020; 36:60-71. [PMID: 32536570 DOI: 10.1016/j.euroneuro.2020.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 12/18/2022]
Abstract
Severe weight gain induced by psychotropics is a known problem in psychiatry. Various drugs from different classes may lead to weight gain that may further lead to potentially life-shortening diseases, such as diabetes or cardiovascular disease. A total of 344 cases of severe weight gain (>10% of body weight) have been documented by the drug safety in psychiatry program AMSP between 2001 and 2016. Patients gained 12.7 ± 5.5 kg weight within 12±15 weeks. This equals a Body Mass Index (BMI) gain of 4.4 ± 1.9 kg/m² to a final BMI of 28.8 ± 5.5 kg/m². In addition, 142 retrospective reports documented at admission have been analyzed. Within one year these patients gained 6.4 ± 4.0 kg/m² to a final BMI of 31.9 kg/m². The weight gain was extreme in some cases. For example, 35% of the patients gained more than 20 kg. On average the patients reached overweight or even adiposity. Only 27% of the patients could loose some weight at the end of their stay. This emphasizes the relevance of this long-term problem for the patients' health. Mostly second generation antipsychotics, and therein olanzapine, as well as antidepressants and anticonvulsants have been imputed. Severe weight gain is a slow process and it is rarely documented as adverse drug reaction under real-life conditions compared to the high percentage of patients with weight gain in clinical studies. It might often remain unnoticed due to shorter stationary treatment and changing treatment settings.
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25
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Lian J, Deng C. The dosage-dependent effects of cevimeline in preventing olanzapine-induced metabolic side-effects in female rats. Pharmacol Biochem Behav 2020; 191:172878. [PMID: 32112786 DOI: 10.1016/j.pbb.2020.172878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/28/2020] [Accepted: 02/20/2020] [Indexed: 01/08/2023]
Abstract
Olanzapine has been used for the treatment of schizophrenia and other mental disorders. However, it is associated with serious weight gain and other metabolic side-effects. The antagonistic affinity of olanzapine to muscarinic M3 receptors has been evidenced as one of the main contributors for its weight gain and other metabolic side-effects. Therefore, this study investigated whether the co-treatment of cevimeline (a M3 receptor agonist) could prevent the metabolic side-effects associated with olanzapine medication. Female Sprague Dawley rats were treated orally with olanzapine (2 mg/kg, t.i.d.) and/or cevimeline at 3 dosages (3, 6, 9 mg/kg, t.i.d.), or vehicle for two weeks. Weight gain and food/water intake were measured throughout the drug treatment period. Intraperitoneal glucose tolerance tests and open field tests were conducted. Olanzapine-treated rats demonstrated significantly elevated body weight gain, food intake, feeding efficiency, total white fat mass, liver mass, and plasma triglyceride levels, which could be partly reversed by the co-treatment with cevimeline in a dosage-dependent manner. In general, the body weight gain can only be reversed by the co-treatment of 9 mg/kg cevimeline. The cevimeline co-treatment decreased plasma triglyceride and glucose levels compared with olanzapine only treatment. The results suggested a dosage-dependent effect of cevimeline in ameliorating olanzapine-induced weight gain and metabolic side-effects, which supports further clinical trials using cevimeline to control weight gain and metabolic side-effects caused by antipsychotic medications.
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Affiliation(s)
- Jiamei Lian
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, 2522, NSW, Australia; School of Medicine, and Molecular Horizons, University of Wollongong, Wollongong 2522, NSW, Australia
| | - Chao Deng
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, 2522, NSW, Australia; School of Medicine, and Molecular Horizons, University of Wollongong, Wollongong 2522, NSW, Australia.
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26
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Deng C, Yao JK. Editorial: Metabolic Disturbances in Mental Illness: Neuropathogenetic Mechanisms and Therapeutic Implications. Front Neurosci 2020; 14:21. [PMID: 32063831 PMCID: PMC7000652 DOI: 10.3389/fnins.2020.00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/10/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Chao Deng
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia
| | - Jeffrey K Yao
- Medical Research Service, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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27
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Li N, Cao T, Wu X, Tang M, Xiang D, Cai H. Progress in Genetic Polymorphisms Related to Lipid Disturbances Induced by Atypical Antipsychotic Drugs. Front Pharmacol 2020; 10:1669. [PMID: 32116676 PMCID: PMC7011106 DOI: 10.3389/fphar.2019.01669] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 12/20/2019] [Indexed: 12/11/2022] Open
Abstract
Metabolic side effects such as weight gain and disturbed lipid metabolism are often observed in the treatment of atypical antipsychotic drugs (AAPDs), which contribute to an excessive prevalence of metabolic syndrome among schizophrenic patients. Great individual differences are observed but the underlying mechanisms are still uncertain. Research on pharmacogenomics indicates that gene polymorphisms involved in the pathways controlling food intake and lipid metabolism may play a significant role. In this review, relevant genes (HTR2C, DRD2, LEP, NPY, MC4R, BDNF, MC4R, CNR1, INSIG2, ADRA2A) and genetic polymorphisms related to metabolic side effects of AAPDs especially dyslipidemia were summarized. Apart from clinical studies, in vitro and in vivo evidence is also analyzed to support related theories. The association of central and peripheral mechanisms is emphasized, enabling the possibility of using peripheral gene expression to predict the central status. Novel methodological development of pharmacogenomics is in urgent need, so as to provide references for individualized medication and further to shed some light on the mechanisms underlying AAPD-induced lipid disturbances.
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Affiliation(s)
- Nana Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ting Cao
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xiangxin Wu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute of Hospital Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Daxiong Xiang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Hualin Cai
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
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28
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Zhuravleva EO, Vel’ts NY, Snegireva II, Kutekhova GV, Alyautdin RN. Pharmacogenetic Tests for Antipsychotic-Induced Weight Gain. Pharm Chem J 2019. [DOI: 10.1007/s11094-019-02059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Enriched developmental biology molecular pathways impact on antipsychotics-induced weight gain. Pharmacogenet Genomics 2019; 30:9-20. [PMID: 31651721 DOI: 10.1097/fpc.0000000000000390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Psychotropic-induced weight gain (PIWG) may lead to increased risk for cardiovasculardiseases, metabolic disorders and treatment discontinuation. PIWG may be genetically driven. The analysis of complete molecular pathways may grant suffcient power to tackle the biologic variance of PIWG. Such identifcation would help to move a step forward in the direction of personalized treatment in psychiatry. A genetic sample from the CATIE trial (n = 765; M = 556, mean age = 40.93 ± 11.03) treated with diverse antipsychotic drugs was investigated. A molecular pathway analysis was conducted for the identifcation of the molecular pathways enriched in variations associated with PIWG. The developmental biology molecular pathway was signifcantly (P.adj = 0.018) enriched in genetic variations signifcantly (P < 0.01) associated with PIWG. A total of 18 genes were identifed and discussed. The developmental biology molecular pathway is involved in the regulation of β-cell development, and the transcriptional regulation of white adipocyte differentiation. Results from the current contribution correlate with previous evidence and it is consistent with our earlier result on the STAR*D sample. Furthermore, the involvement of the β-cell development and the transcriptional regulation of white adipocyte differentiation pathways stress the relevance of the peripheral tissue rearrangement, rather than increased food intake, in the biologic modifcations that follow psychotropic treatment and may lead to PIWG. Further research is warranted.
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31
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Whicher C, Brewster S, Holt RIG. Antipsychotics and schizophrenia, and their relationship to diabetes. PRACTICAL DIABETES 2019. [DOI: 10.1002/pdi.2235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Richard IG Holt
- Professor in Diabetes and EndocrinologyUniversity of Southampton Southampton UK
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Agarwal SM, 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. Hippokratia 2019. [DOI: 10.1002/14651858.cd013337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Zohra A Ahsan
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Jonathan T Lockwood
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Markus J Duncan
- University of British Columbia; School of Kinesiology; 2146 Health Sciences Mall Room 4606 Vancouver Canada
| | - Hiroyoshi Takeuchi
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Tony Cohn
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Valerie H Taylor
- Women's College Hospital, University of Toronto; Department of Psychiatry; 7th Floor, Women's College Hospital 76 Grenville Street Toronto Ontario Canada M5S 1B2
| | - Gary Remington
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Guy E J Faulkner
- University of British Columbia; School of Kinesiology; 2146 Health Sciences Mall Room 4606 Vancouver Canada
| | - Margaret Hahn
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
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Hahn M, Agarwal SM, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H, Cohn T, Taylor VH, Remington G, Faulkner GEJ. Pharmacological interventions for reduction of weight gain in people with schizophrenia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Margaret Hahn
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Zohra A Ahsan
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Jonathan T Lockwood
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Markus J Duncan
- University of British Columbia; School of Kinesiology; 2146 Health Sciences Mall Room 4606 Vancouver Canada
| | - Hiroyoshi Takeuchi
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Tony Cohn
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Valerie H Taylor
- Women's College Hospital, University of Toronto; Department of Psychiatry; 7th Floor, Women's College Hospital 76 Grenville Street Toronto Ontario Canada M5S 1B2
| | - Gary Remington
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Guy E J Faulkner
- University of British Columbia; School of Kinesiology; 2146 Health Sciences Mall Room 4606 Vancouver Canada
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Luo C, Wang X, Huang H, Mao X, Zhou H, Liu Z. Effect of Metformin on Antipsychotic-Induced Metabolic Dysfunction: The Potential Role of Gut-Brain Axis. Front Pharmacol 2019; 10:371. [PMID: 31024322 PMCID: PMC6465968 DOI: 10.3389/fphar.2019.00371] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/26/2019] [Indexed: 12/31/2022] Open
Abstract
Antipsychotics are the first-line medications prescribed for patients with schizophrenia or other mental disorders. Cumulative evidence has revealed that metabolic dysfunctions frequently occur in patients receiving antipsychotics, especially second-generation antipsychotics, and these effects may decrease patient compliance and increase health costs. Metformin is an effective pharmaceutical adjuvant for ameliorating antipsychotic-induced metabolic dysfunction (AIMD) in clinical practice. However, the mechanism of the effects of metformin on AIMD remains unclear. The gut-brain axis is a bidirectional communication system between the gastrointestinal tract and the central nervous system and has been associated with many pathological and physiological conditions, such as those related to metabolism. Antipsychotics interact with and have affinity for dopamine receptors and other receptors in the brain, and treatment with these antipsychotics has been shown to influence gut microbiota metabolism and composition, as observed in both animal and human studies. Metformin exerts an antidiabetic effect that is correlated with activation of AMP-kinase in the hypothalamus, and metformin also influences gut flora. Therefore, the gut-brain axis may play a role in the effect of metformin on AIMD. Since no direct evidence is available, this perspective may provide a direction for further research.
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Affiliation(s)
- Chao Luo
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Xu Wang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Hanxue Huang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Xiaoyuan Mao
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Honghao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhaoqian Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Limandri BJ. Clinical Use of Dopamine Modulators as Third-Generation Antipsychotic Agents. J Psychosoc Nurs Ment Health Serv 2019; 57:7-11. [PMID: 30703220 DOI: 10.3928/02793695-20190116-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When dopamine was identified as a primary target for schizophrenia, the dopamine antagonists, now referred to as first-generation antipsychotics, were added to our pharmacopeia. In the 1990s, with the discovery of risperidone and clozapine, the mechanism of dopamine receptor antagonism was paired with serotonin receptor antagonism to give rise to second-generation antipsychotics. A decade later these mechanisms were further refined to selective dopamine receptors antagonism and serotonin receptors antagonism and agonism to create a modulation or stabilization of dopamine nerve firing in differential ways. This new wave may be referred to as the third generation. The current article reviews the pharmacodynamics and pharmacokinetics of these dopamine modulators. [Journal of Psychosocial Nursing and Mental Health Services, 57(2), 7-11.].
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Goh KK, Chen CH, Lu ML. Topiramate mitigates weight gain in antipsychotic-treated patients with schizophrenia: meta-analysis of randomised controlled trials. Int J Psychiatry Clin Pract 2019; 23:14-32. [PMID: 29557263 DOI: 10.1080/13651501.2018.1449864] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Weight gain is one of the most challenging issues in patients with schizophrenia treated with antipsychotics. Several meta-analyses have been conducted to review the efficacy of topiramate in reducing weight, however, several issues regarding the methodology had arisen of which make the results remain ambiguous. METHODS We conducted a meta-analysis of randomised controlled trials about the use of topiramate in patients with schizophrenia for weight reduction. Ten double-blinded randomised placebo-controlled trials and seven open-label randomised controlled trials included 905 patients. RESULTS Patients treated with topiramate experienced a greater reduction in body weight and BMI. Patients in countries of the lower overweight population showed more significant BMI reduction. Besides, studies from the Middle East and South Asia showed the greatest effect in body weight change, followed by East Asia, then Europe/America. Topiramate group was outperformed control group with significant psychopathology improvement. No difference between two groups regarding the overall side effects. CONCLUSIONS Topiramate was significantly superior to control group in mitigating weight gain and psychopathology in antipsychotic-treated patients with schizophrenia. The effects of topiramate augmentation need further investigations in larger definitive studies using methodological rigor and thorough assessments.
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Affiliation(s)
- Kah Kheng Goh
- a Department of Psychiatry , Wan-Fang Hospital, Taipei Medical University , Taipei , Taiwan
| | - Chun-Hsin Chen
- a Department of Psychiatry , Wan-Fang Hospital, Taipei Medical University , Taipei , Taiwan.,b Department of Psychiatry , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
| | - Mong-Liang Lu
- a Department of Psychiatry , Wan-Fang Hospital, Taipei Medical University , Taipei , Taiwan.,b Department of Psychiatry , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
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37
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Skonieczna-Żydecka K, Łoniewski I, Misera A, Stachowska E, Maciejewska D, Marlicz W, Galling B. Second-generation antipsychotics and metabolism alterations: a systematic review of the role of the gut microbiome. Psychopharmacology (Berl) 2019; 236:1491-1512. [PMID: 30460516 PMCID: PMC6598971 DOI: 10.1007/s00213-018-5102-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/31/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE Multiple drugs are known to induce metabolic malfunctions, among them second-generation antipsychotics (SGAs). The pathogenesis of such adverse effects is of multifactorial origin. OBJECTIVES We investigated whether SGAs drive dysbiosis, assessed whether gut microbiota alterations affect body weight and metabolic outcomes, and looked for the possible mechanism of metabolic disturbances secondary to SGA treatment in animal and human studies. METHODS A systematic literature search (PubMed/Medline/Embase/ClinicalTrials.gov/PsychInfo) was conducted from database inception until 03 July 2018 for studies that reported the microbiome and weight alterations in SGA-treated subjects. RESULTS Seven articles reporting studies in mice (experiments = 8) and rats (experiments = 3) were included. Olanzapine was used in five and risperidone in six experiments. Only three articles (experiments = 4) in humans fit our criteria of using risperidone and mixed SGAs. The results confirmed microbiome alterations directly (rodent experiments = 5, human experiments = 4) or indirectly (rodent experiments = 4) with predominantly increased Firmicutes abundance relative to Bacteroidetes, as well as weight gain in rodents (experiments = 8) and humans (experiments = 4). Additionally, olanzapine administration was found to induce both metabolic alterations (adiposity, lipogenesis, plasma free fatty acid, and acetate levels increase) (experiments = 3) and inflammation (experiments = 2) in rodents, whereas risperidone suppressed the resting metabolic rate in rodents (experiments = 5) and elevated fasting blood glucose, triglycerides, LDL, hs-CRP, antioxidant superoxide dismutase, and HOMA-IR in humans (experiment = 1). One rodent study suggested a gender-dependent effect of dysbiosis on body weight. CONCLUSIONS Antipsychotic treatment-related microbiome alterations potentially result in body weight gain and metabolic disturbances. Inflammation and resting metabolic rate suppression seem to play crucial roles in the development of metabolic disorders.
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Affiliation(s)
| | - Igor Łoniewski
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland ,Sanprobi sp. z o.o. sp. k, Szczecin, Poland
| | - Agata Misera
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ewa Stachowska
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland
| | - Dominika Maciejewska
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Britta Galling
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany ,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health,, Glen Oaks, NY USA ,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY USA
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Gianfrancesco O, Bubb VJ, Quinn JP. Treating the "E" in "G × E": Trauma-Informed Approaches and Psychological Therapy Interventions in Psychosis. Front Psychiatry 2019; 10:9. [PMID: 30761022 PMCID: PMC6363686 DOI: 10.3389/fpsyt.2019.00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/08/2019] [Indexed: 12/31/2022] Open
Abstract
Despite advances in genetic research, causal variants affecting risk for schizophrenia remain poorly characterized, and the top 108 loci identified through genome-wide association studies (GWAS) explain only 3.4% of variance in risk profiles. Such work is defining the highly complex nature of this condition, with omnigenic models of schizophrenia suggesting that gene regulatory networks are sufficiently interconnected such that altered expression of any "peripheral" gene in a relevant cell type has the capacity to indirectly modulate the expression of "core" schizophrenia-associated genes. This wealth of associated genes with small effect sizes makes identifying new druggable targets difficult, and current pharmacological treatments for schizophrenia can involve serious side effects. However, the fact that the majority of schizophrenia genome-wide associated variants fall within non-coding DNA is suggestive of their potential to modulate gene regulation. This would be consistent with risks that can be mediated in a "gene × environment" (G × E) manner. Stress and trauma can alter the regulation of key brain-related pathways over the lifetime of an individual, including modulation of brain development, and neurochemistry in the adult. Recent studies demonstrate a significant overlap between psychotic symptoms and trauma, ranging from prior trauma contributing to psychosis, as well as trauma in response to the experience of psychosis itself or in response to treatment. Given the known effects of trauma on both CNS gene expression and severity of psychosis symptoms, it may be that pharmacological treatment alone risks leaving individuals with a highly stressful and unresolved environmental component that continues to act in a "G × E" manner, with the likelihood that this would negatively impact recovery and relapse risk. This review aims to cover the recent advances elucidating the complex genetic architecture of schizophrenia, as well as the long-term effects of early life trauma on brain function and future mental health risk. Further, the evidence demonstrating the role of ongoing responses to trauma or heightened stress sensitivity, and their impact on the course of illness and recovery, is presented. Finally, the need for trauma-informed approaches and psychological therapy-based interventions is discussed, and a brief overview of the evidence to determine their utility is presented.
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Affiliation(s)
- Olympia Gianfrancesco
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Vivien J Bubb
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - John P Quinn
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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Kao ACC, Burnet PWJ, Lennox BR. Can prebiotics assist in the management of cognition and weight gain in schizophrenia? Psychoneuroendocrinology 2018; 95:179-185. [PMID: 29883788 DOI: 10.1016/j.psyneuen.2018.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/14/2018] [Accepted: 05/18/2018] [Indexed: 01/11/2023]
Abstract
Schizophrenia is among the top half of the 25 leading causes of disabilities worldwide with a 10-20 year decrease in life expectancy. Ineffective pharmacotherapy in the management of cognitive deficits and weight gain are known to be significant contributors; therefore interventions that may mitigate one, or both, of these parameters would be highly beneficial. Manipulation of the gut microbiome using dietary supplements such as prebiotics may be one such intervention. Preclinical studies have shown that a 2-4 week dietary supplementation with a prebiotic has beneficial effects on learning and memory, and prevents pro-inflammatory signals that are detrimental to cognitive processes. Furthermore, prebiotics influence metabolism, and in obesity they increase the expression of anorexigenic gut hormones such as peptide tyrosine tyrosine, glucagon-like peptide 1 and leptin, as well as decrease levels of orexigenic hormones such as ghrelin. Despite compelling evidence for the pro-cognitive and neuroprotective effects of prebiotics in rodents, their ability to alleviate cognitive deficits or enhance cognition needs to be evaluated in humans. Here we suggest that important symptoms associated with schizophrenia, such as cognitive impairment and weight gain, may benefit from concurrent prebiotic therapy.
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Affiliation(s)
- Amy Chia-Ching Kao
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
| | - Philip W J Burnet
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
| | - Belinda R Lennox
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom.
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40
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Bush ND, Townsend LK, Wright DC. AICAR Prevents Acute Olanzapine-Induced Disturbances in Glucose Homeostasis. J Pharmacol Exp Ther 2018; 365:526-535. [DOI: 10.1124/jpet.118.248393] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023] Open
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41
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Dourish CT, Clifton PG. Multidisciplinary approaches to the study of eating disorders and obesity: Recent progress in research and development and future prospects. J Psychopharmacol 2017; 31:1383-1387. [PMID: 29157103 DOI: 10.1177/0269881117740779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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