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Wang KC, Chan HY, Yang WS, Huang YM, Ho YF, Hwang TJ. Cardiometabolic biomarkers and comorbid metabolic syndrome in schizophrenia: A cross-sectional study of long-term clozapine/olanzapine users. Asian J Psychiatr 2024; 102:104244. [PMID: 39298914 DOI: 10.1016/j.ajp.2024.104244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/31/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES Second-generation antipsychotics (SGAs) are often prescribed for patients with schizophrenia; however, SGAs are associated with the risk of metabolic syndrome (MetS). This study aimed to investigate the clinical and biochemical determinants of SGA-related MetS. METHODS Patients with schizophrenia, aged between 20 and 65 years, and under clozapine or olanzapine treatment for at least 9 months, were recruited from a mental hospital. Demographic, comorbidity, clinical status, laboratory, and drug regimen data were collected through chart review. Circulating levels of adiponectin, thyroid hormone responsive protein, and fatty acid binding protein 4 (FABP4) were assayed. Multiple logistic regression was used to identify risk predictors of MetS. RESULTS A total of 176 participants were enrolled, including 138 (78.4 %) clozapine users and 38 (21.6 %) olanzapine users. Forty-five (25.6 %) patients were classified as having MetS. The duration of clozapine or olanzapine usage was significantly shorter in those with MetS (p=0.026) than those without MetS. Patients with MetS had a significantly higher serum FABP4 concentration than their counterparts (22.5 ± 8.8 ng/mL vs. 15.7 ± 6.7 ng/mL, p<0.001), and also a significantly lower adiponectin level (6.9 ±4.0 mg/mL vs. 11.6 ± 6.6 mg/mL, p<0.001). A FABP4 level ≥ 16.98 ng/mL (OR: 24.16, 95 % CI: 7.47-78.09, p<0.001) was positively correlated with MetS, whereas serum adiponectin level was inversely correlated with MetS (OR: 0.7980, 95 % CI: 0.70-0.90, p<0.001). CONCLUSIONS Adiponectin, FABP4, and certain clinical covariates and comedications were highly correlated with SGA-related MetS. Further studies are required to investigate the underlying mechanisms.
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Affiliation(s)
- Kuo-Chan Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, NTU Cancer Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yu Chan
- Department of Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan
| | - Wei-Shiung Yang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University and Department of Internal Medicine (Division of Endocrinology & Metabolism), National Taiwan University, Taipei, Taiwan
| | - Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yunn-Fang Ho
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan.
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2
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Kar N, Barreto S. Influence of Lifestyle Factors on Metabolic Syndrome in Psychiatric Patients Attending a Community Mental Health Setting: A Cross-sectional Study. Indian J Psychol Med 2024; 46:313-322. [PMID: 39056040 PMCID: PMC11268271 DOI: 10.1177/02537176231219770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
Background Metabolic syndrome (MetS) is a concern in psychiatric patients. We aimed to study the influence of the modifiable lifestyle factors on MetS in adult psychiatric patients along with associated clinical factors and quality of life. Methods Factors such as diet (Healthy Eating Index), exercise, substance use, cardiovascular risk (QRISK), illness severity (Clinical Global Impression), medications, adverse events (Systematic Monitoring of Adverse Events Related to Treatments), and quality of life (Recovering Quality of Life Scale) were assessed along with clinical components for MetS in 323 psychiatric patients receiving routine care and monitoring in a Community Mental Health Team. Results MetS was present in 50.5% (95% CI: 45.0-55.9). It was significantly associated with higher age, duration of mental illness, body mass index (BMI), QTc, QRISK, and antipsychotic drugs. In logistic regression, age, QTc, QRISK, and BMI remained significantly linked to MetS. Patients with or without MetS were comparable in their lifestyle factors such as diet, exercise, and substance use, along with the family history of metabolic disorders, age at onset of mental illness, duration of antipsychotic medication, side effects, psychiatric diagnoses, and quality of life. However, many patients with or without MetS had poorer diet and physical inactivity, indicating scope for interventions. Conclusions Around half of the psychiatric patients had MetS, and modifiable lifestyle factors did not differentiate individuals with or without MetS. The need for further research on the prevention and management of MetS in psychiatric patients is highlighted.
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Affiliation(s)
- Nilamadhab Kar
- University of Wolverhampton, United Kingdom
- Dept. of Psychiatry, Black Country Healthcare NHS Foundation Trust, Wolverhampton, United Kingdom
| | - Socorro Barreto
- Dept. of Psychiatry, Black Country Healthcare NHS Foundation Trust, Wolverhampton, United Kingdom
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Poudel R, Lerner B. The Tarnished Legacy of a Wonder Drug: Revisiting the Complicated History of Clozapine. Harv Rev Psychiatry 2024; 32:40-46. [PMID: 38181102 DOI: 10.1097/hrp.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Anecdotal evidence of superior efficacy and lack of extrapyramidal symptoms in treating schizophrenia made clozapine a promising therapy in the United States during the early 1970s. In 1975, however, numerous fatal cases of clozapine-related agranulocytosis in Finland nearly ended the drug's development. Convinced of the significant benefits to patients, some clinicians in the United States advocated having clozapine available on a case-by-case humanitarian basis, which eventually helped resurrect the drug for Food and Drug Administration approval in 1989. This article builds on previous literature by utilizing oral histories from clinicians, researchers, and a patient's family member to understand how clozapine was saved. Exploring these stakeholders' perspectives has value to modern clinicians, who underprescribe the drug despite demonstrable benefits for treatment-resistant schizophrenia and suicide prevention.
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Affiliation(s)
- Roshan Poudel
- From New York University Grossman School of Medicine
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Ben-Azu B, Uruaka CI, Ajayi AM, Jarikre TA, Nwangwa KE, Chilaka KC, Chijioke BS, Omonyeme MG, Ozege CB, Ofili EC, Warekoromor EB, Edigbue NL, Esiekpe UV, Akaenyi DE, Agu GO. Reversal and Preventive Pleiotropic Mechanisms Involved in the Antipsychotic-Like Effect of Taurine, an Essential β-Amino Acid in Ketamine-Induced Experimental Schizophrenia in Mice. Neurochem Res 2023; 48:816-829. [PMID: 36350433 DOI: 10.1007/s11064-022-03808-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/28/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
Schizophrenia is a life disabling, multisystem neuropsychiatric disease mostly derived from complex epigenetic-mediated neurobiological changes causing behavioural deficits. Neurochemical disorganizations, neurotrophic and neuroimmune alterations are some of the challenging neuropathologies proving unabated during psychopharmacology of schizophrenia, further bedeviled by drug-induced metabolic derangements including alteration of amino acids. In first-episode schizophrenia patients, taurine, an essential β-amino acid represses psychotic-symptoms. However, its anti-psychotic-like mechanisms remain incomplete. This study evaluated the ability of taurine to prevent or reverse ketamine-induced experimental psychosis and the underlying neurochemical, neurotrophic and neuroinmune mechanisms involved in taurine's clinical action. The study consisted of three different experiments with Swiss mice (n = 7). In the drug alone, mice received saline (10 mL/kg/p.o./day), taurine (50 and 100 mg/kg/p.o./day) and risperidone (0.5 mg/kg/p.o./day) for 14 days. In the preventive study of separate cohort, mice were concomitantly given ketamine (20 mg/kg/i.p./day) from days 8 to 14. In the reversal study, mice received ketamine for 14 days before taurine or risperidone treatments from days 8 to 14 respectively. Afterwards, stereotypy behaviour, social, non-spatial memory deficits, and body weights were assessed. Neurochemical (dopamine, 5-hydroxytryptamine, glutamic acid decarboxylase, (GAD)), brain derived-neurotrophic factor (BDNF) and pro-inflammatory cytokines [tumor necrosis factor-alpha, (TNF-α), interleukin-6, (IL-6)] were assayed in the striatum, prefrontal-cortex and hippocampal area. Taurine attenuates ketamine-induced schizophrenia-like behaviour without changes in body weight. Taurine reduced ketamine-induced dopamine and 5-hydroxytryptamine changes, and increased GAD and BDNF levels in the striatum, prefrontal-cortex and hippocampus, suggesting increased GABAergic and neurotrophic transmissions. Taurine decreases ketamine-induced increased in TNF-α and IL-6 concentrations in the striatum, prefrontal-cortex and hippocampus. These findings also suggest that taurine protects against schizophrenia through neurochemical modulations, neurotrophic enhancement, and inhibition of neuropathologic cytokine activities.
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Affiliation(s)
- Benneth Ben-Azu
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria. .,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
| | - Christian I Uruaka
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine, Rivers State University, Port Harcourt, Rivers State, Nigeria
| | - Abayomi M Ajayi
- Neuropharmacology Unit, Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Thiophilus Aghogho Jarikre
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kingsley E Nwangwa
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Kingsley C Chilaka
- Department of Pharmacology and Therapeutics, College of Health Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Bienose S Chijioke
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Marymagdalene G Omonyeme
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Chineye B Ozege
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Emmanuella C Ofili
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Ebidenara B Warekoromor
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Nwanneka L Edigbue
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Ufoma V Esiekpe
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Dabrechi E Akaenyi
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Gladys O Agu
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, Afe Babalo University, Ado-Ekiti, Ado-Ekiti, Nigeria
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Investigating the effects of antipsychotics on brain insulin action: Study protocol for a multi-modality magnetic resonance imaging (MRI) study in healthy controls. PLoS One 2022; 17:e0277211. [PMID: 36441736 PMCID: PMC9704670 DOI: 10.1371/journal.pone.0277211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
Antipsychotics (APs) are the cornerstone of treatment for schizophrenia (SCZ) but are unfortunately associated with serious metabolic adverse effects including weight gain and type 2 diabetes. The pathophysiology of AP-induced metabolic dysfunction is largely undetermined. Brain insulin resistance has been posited to be at the cross-roads of many cognitive and metabolic disorders, and disruption of central insulin action has emerged as a possible explanatory mechanism underlying AP induced metabolic dysfunction. Previous studies suggest that change in neuroimaging-based parameters with intranasal insulin administration can be leveraged to investigate brain insulin resistance. In this proof-of-concept study, we will utilize neural signatures of insulin action in the brain to examine if APs disrupt brain insulin signaling. It is hypothesized that: 1) intranasal insulin (INI), but not intranasal placebo (INP), will change cerebral blood flow and resting state connectivity, as well as increase glutamate levels in the striatum and dorsolateral prefrontal cortex; 2) oral olanzapine (OLA), but not oral placebo (PL), will inhibit the effect of INI on these parameters. Thirty-two healthy volunteers will undergo a single blind, cross-over design, wherein all participants receive the following four treatment combinations, 2-6 weeks apart, in a random sequence: INP + PL, INP + OLA, INI + PL, and INI + OLA. Participants will undergo an MRI-based assay of brain insulin resistance 15 minutes after administering 160 IU INI or INP. The scanning protocol includes resting and task-based functional MRI, arterial spin labelling, and proton magnetic resonance spectroscopy. Demonstrating that OLA can acutely induce brain insulin resistance is clinically relevant to metabolic health in SCZ. Evidence of brain insulin resistance induced by acute AP dosing can inform the early use of adjunctive insulin sensitizers for the treatment of metabolic comorbidities associated with AP treatment in severe mental illness. Trial registration ClinicalTrials.gov Registration: NCT03741478.
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Hsu HE, Chen PY, Chang HM, Pan CH, Su SS, Tsai SY, Chen CC, Kuo CJ. Incidence of and risk factors for alcohol dependence in bipolar disorder: A population-based cohort and nested case-control study. Aust N Z J Psychiatry 2022; 57:725-735. [PMID: 35642594 DOI: 10.1177/00048674221100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although alcohol dependence is highly prevalent in patients with bipolar disorder, the causal relationship is not yet well-established. This study estimated the incidence of alcohol dependence in a nationwide bipolar disorder cohort and examined risk factors for alcohol dependence. METHODS Patients aged 15-65 years with consistent bipolar disorder who had their first psychiatric admission between 1999 and 2012 (n = 21,791) were enrolled from the National Health Insurance Research Database in Taiwan. We calculated the adjusted incidence rate ratio of alcohol dependence in the bipolar cohort relative to the general population after stratification by age and sex. In the nested case-control study, we included patients with incident alcohol dependence as cases and four age- and sex-matched controls for each case to analyze health care utilization, comorbidities and concomitant medications between them. RESULTS We identified 1261 patients with bipolar disorder with incident alcohol dependence. Relative to the general population, the adjusted incidence rate ratio of alcohol dependence was 9.20 in the bipolar cohort. All adjusted incidence rate ratios were high across all age subgroups. Cases had higher psychiatric and nonpsychiatric health care utilization than did controls. Multivariate analysis revealed that cases tended to have cardiovascular disease, diabetes mellitus, chronic hepatic disease, pneumonia and delirium before alcohol dependence diagnosis. Cases had higher psychiatric comorbidities, namely drug-induced mental disorders, anxiety disorder, personality disorder, adjustment disorder and sleep disorder. CONCLUSION The bipolar cohort had a higher incidence of alcohol dependence. We identified specific groups with a high risk of alcohol dependence. Additional strategies for early detection, treatment and intervention for alcohol dependence should be developed.
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Affiliation(s)
- Haw-En Hsu
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Po-Yu Chen
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Hu-Ming Chang
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Chun-Hung Pan
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei.,Department of Psychology, National Chengchi University, Taipei
| | - Sheng-Shiang Su
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Psychiatry, Mackay Memorial Hospital, Taipei.,Department of Psychiatry, Mackay Medical College, Taipei
| | - Chian-Jue Kuo
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei
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7
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Johnson K, Tepper M, Leff HS, Mullin BO, Cook BL, Progovac AM. Assessing the Long-Term Effectiveness of a Behavioral Health Home for Adults With Bipolar and Psychotic Disorders. Psychiatr Serv 2022; 73:172-179. [PMID: 34346734 DOI: 10.1176/appi.ps.202000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to examine the impact of a behavioral health home (BHH) to better understand its potential to improve health for individuals with serious mental illness. METHODS Propensity score-weighted interrupted time series analysis was used to estimate service utilization and chronic disease management through 3.5 years after BHH implementation and to compre BHH enrollees (N=413) with other patients with serious mental illness in the same health system (N=1,929). RESULTS Relative to control group members, BHH patients had an immediate increase in primary care visits (+0.18 visits/month), which remained higher throughout follow-up, and an immediate decrease in emergency department visits (-0.031 visits/month). Behavioral health outpatient visits, which were increasing for BHH participants before implementation, began decreasing postimplementation; this decrease (-0.016 visits/month) was significantly larger than for the control group. Inpatient and outpatient visits for general medical health were decreasing over time for both groups before implementation but decreased more slowly for BHH patients postimplementation. Although behavioral health inpatient visits decreased for both groups around the start of the BHH program and remained lower, this initial drop was larger for the non-BHH group. BHH participation was associated with decreases in hemoglobin A1c values but no shift in low-density lipoprotein cholesterol values. CONCLUSIONS The results reflect the challenges of improving health for patients with serious mental illness, even as access to primary care is increased. Further study is needed about which complex interventions inside and outside of the health care system can help offset the 20- to 30-year mortality gap faced by this population.
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Affiliation(s)
- Karl Johnson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - Miriam Tepper
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - H Stephen Leff
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - Brian O Mullin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - Benjamin L Cook
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - Ana M Progovac
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
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Abbas MM, Soto P, Ramalingam L, El-Manzalawy Y, Bensmail H, Moustaid-Moussa N. Sex Differences in Fish Oil and Olanzapine Effects on Gut Microbiota in Diet-Induced Obese Mice. Nutrients 2022; 14:349. [PMID: 35057526 PMCID: PMC8780445 DOI: 10.3390/nu14020349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 02/05/2023] Open
Abstract
Children are prescribed second-generation antipsychotic (SGA) medications, such as olanzapine (OLZ) for FDA-approved and "off-label" indications. The long-term impact of early-life SGA medication exposure is unclear. Olanzapine and other SGA medications are known to cause excessive weight gain in young and adult patients, suggesting the possibility of long-term complications associated with the use of these drugs, such as obesity, diabetes, and heart disease. Further, the weight gain effects of OLZ have previously been shown to depend on the presence of gut bacteria and treatment with OLZ, which shifts gut bacteria toward an "obesogenic" profile. The purpose of the current study was to evaluate changes in gut bacteria in adult mice following early life treatment with OLZ and being fed either a high-fat diet or a high-fat diet supplemented with fish oil, which has previously been shown to counteract gut dysbiosis, weight gain, and inflammation produced by a high-fat diet. Female and male C57Bl/6J mice were fed a high fat diet without (HF) or with the supplementation of fish oil (HF-FO) and treated with OLZ from postnatal day (PND) 37-65 resulting in four groups of mice: mice fed a HF diet and treated with OLZ (HF-OLZ), mice fed a HF diet and treated with vehicle (HF), mice fed a HF-FO diet and treated with OLZ (HF-FO-OLZ), and mice fed a HF-FO diet and treated with vehicle (HF-FO). Following euthanasia at approximately 164 days of age, we determined changes in gut bacteria populations and serum LPS binding protein, an established marker of gut inflammation and dysbiosis. Our results showed that male HF-FO and HF-FO-OLZ mice had lower body weights, at sacrifice, compared to the HF group, with a comparable body weight across groups in female mice. HF-FO and HF-FO-OLZ male groups also exhibited lower serum LPS binding protein levels compared to the HF group, with no differences across groups in female mice. Gut microbiota profiles were also different among the four groups; the Bacteroidetes-to-Firmicutes (B/F) ratio had the lowest value of 0.51 in the HF group compared to 0.6 in HF-OLZ, 0.9 in HF-FO, and 1.1 in HF-FO-OLZ, with no differences in female mice. In conclusion, FO reduced dietary obesity and its associated inflammation and increased the B/F ratio in male mice but did not benefit the female mice. Although the weight lowering effects of OLZ were unexpected, FO effects persisted in the presence of olanzapine, demonstrating its potential protective effects in male subjects using antipsychotic drugs.
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Affiliation(s)
- Mostafa M. Abbas
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA 17822, USA; (M.M.A.); (Y.E.-M.)
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha 5825, Qatar
| | - Paul Soto
- Department of Nutritional Sciences, Obesity Research Institute, Texas Tech University, Lubbock, TX 79409, USA; (P.S.); (L.R.)
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70803, USA
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Latha Ramalingam
- Department of Nutritional Sciences, Obesity Research Institute, Texas Tech University, Lubbock, TX 79409, USA; (P.S.); (L.R.)
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY 13210, USA
| | - Yasser El-Manzalawy
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA 17822, USA; (M.M.A.); (Y.E.-M.)
| | - Halima Bensmail
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha 5825, Qatar
| | - Naima Moustaid-Moussa
- Department of Nutritional Sciences, Obesity Research Institute, Texas Tech University, Lubbock, TX 79409, USA; (P.S.); (L.R.)
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Meta-analysis of Total Effect Decomposition in the Presence of Multiple Mediators: The Example of Schizophrenia Treatment. Epidemiology 2021; 32:120-130. [PMID: 33181564 DOI: 10.1097/ede.0000000000001269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Causal mediation analysis addresses mechanistic questions by decomposing and quantifying effects operating through different pathways. Because most individual studies are underpowered to detect mediating effects, we outlined a parametric approach to meta-analyzing causal mediation and interaction analyses with multiple mediators, compared it with a bootstrap-based alternative, and discussed its limitations. METHODS We employed fixed- and random-effects multivariate meta-analyses to integrate evidence on treatment-mediators and mediators-outcome associations across trials. We estimated path-specific effects as functions of meta-analyzed regression coefficients; we obtained standard errors using the delta method. We evaluated the performance of this approach in simulations and applied it to assess the mediating roles of positive symptoms of schizophrenia and weight gain in the treatment effect of paliperidone ER on negative symptoms across four efficacy trials. RESULTS Both simulations and the application showed that the meta-analytic approaches increased statistical power. In the application, we observed substantial mediating effects of positive symptoms (proportions mediated from fixed-effects meta-analysis: (Equation is included in full-text article.)). Weight gain may have beneficial mediating effects; however, such benefit may disappear at high doses when metabolic side effects were excessive. CONCLUSIONS Meta-analyzing causal mediation analysis combines evidence from multiple sources and improves power. Targeting positive symptoms may be an effective way to reduce negative symptoms that are challenging to treat. Future work should focus on extending the existing methods to allow for more flexible modeling of mediation.
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10
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Mielnik CA, Lam VM, Ross RA. CB 1 allosteric modulators and their therapeutic potential in CNS disorders. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110163. [PMID: 33152384 DOI: 10.1016/j.pnpbp.2020.110163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 01/05/2023]
Abstract
CB1 is the most abundant GPCR found in the mammalian brain. It has garnered considerable attention as a potential therapeutic drug target. CB1 is involved in a wide range of physiological and psychiatric processes and has the potential to be targeted in a wide range of disease states. However, most of the selective and non-selective synthetic CB1 agonists and antagonists/inverse agonists developed to date are primarily used as research tools. No novel synthetic cannabinoids are currently in the clinic for use in psychiatric illness; synthetic analogues of the phytocannabinoid THC are on the market to treat nausea and vomiting caused by cancer chemotherapy, along with off-label use for pain. Novel strategies are being explored to target CB1, but with emphasis on the elimination or mitigation of the potential psychiatric adverse effects that are observed by central agonism/antagonism of CB1. New pharmacological options are being pursued that may avoid these adverse effects while preserving the potential therapeutic benefits of CB1 modulation. Allosteric modulation of CB1 is one such approach. In this review, we will summarize and critically analyze both the in vitro characterization and in vivo validation of CB1 allosteric modulators developed to date, with a focus on CNS therapeutic effects.
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Affiliation(s)
- Catharine A Mielnik
- Department of Pharmacology & Toxicology, University of Toronto, ON M5S 1A8, Canada
| | - Vincent M Lam
- Department of Pharmacology & Toxicology, University of Toronto, ON M5S 1A8, Canada
| | - Ruth A Ross
- Department of Pharmacology & Toxicology, University of Toronto, ON M5S 1A8, Canada.
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Progovac AM, Tepper MC, Stephen Leff H, Cortés DE, (Cohen) Colts A, Ault-Brutus A, Hou SSY, Lu F, Banbury S, Sunder D, Cook BL. Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211043791. [PMID: 37089996 PMCID: PMC9978621 DOI: 10.1177/26334895211043791] [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] [Indexed: 11/16/2022] Open
Abstract
Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees' transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6-7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6-7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.
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Affiliation(s)
- Ana M Progovac
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - Miriam C Tepper
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - H. Stephen Leff
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dharma E Cortés
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | | | - Andrea Ault-Brutus
- Office of Health Equity, Nassau County Department of
Health, Mineola, NY, USA
| | - Sherry S-Y Hou
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Frederick Lu
- Boston University School of
Medicine, Boston, MA, USA
| | - Sara Banbury
- University of Pennsylvania Perelman
School of Medicine, Philadelphia, PA, USA
| | | | - Benjamin L Cook
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
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12
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A novel allosteric modulator of the cannabinoid CB 1 receptor ameliorates hyperdopaminergia endophenotypes in rodent models. Neuropsychopharmacology 2021; 46:413-422. [PMID: 33036015 PMCID: PMC7852560 DOI: 10.1038/s41386-020-00876-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
The endocannabinoid system (eCBs) encompasses the endocannabinoids, their synthetic and degradative enzymes, and cannabinoid (CB) receptors. The eCBs mediates inhibition of neurotransmitter release and acts as a major homeostatic system. Many aspects of the eCBs are altered in a number of psychiatric disorders including schizophrenia, which is characterized by dysregulation of dopaminergic signaling. The GluN1-Knockdown (GluN1KD) and Dopamine Transporter Knockout (DATKO) mice are models of hyperdopaminergia, which display abnormal psychosis-related behaviors, including hyperlocomotion and changes in pre-pulse inhibition (PPI). Here, we investigate the ability of a novel CB1 receptor (CB1R) allosteric modulator, ABM300, to ameliorate these dysregulated behaviors. ABM300 was characterized in vitro (receptor binding, β-arrestin2 recruitment, ERK1/2 phosphorylation, cAMP inhibition) and in vivo (anxiety-like behaviors, cannabimimetic effects, novel environment exploratory behavior, pre-pulse inhibition, conditioned avoidance response) to assess the effects of the compound in dysregulated behaviors within the transgenic models. In vitro, ABM300 increased CB1R agonist binding but acted as an inhibitor of CB1R agonist induced signaling, including β-arrestin2 translocation, ERK phosphorylation and cAMP inhibition. In vivo, ABM300 did not elicit anxiogenic-like or cannabimimetic effects, but it decreased novelty-induced hyperactivity, exaggerated stereotypy, and vertical exploration in both transgenic models of hyperdopaminergia, as well as normalizing PPI in DATKO mice. The data demonstrate for the first time that a CB1R allosteric modulator ameliorates the behavioral deficits in two models of increased dopamine, warranting further investigation as a potential therapeutic target in psychiatry.
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Yuen JWY, Kim DD, Procyshyn RM, Panenka WJ, Honer WG, Barr AM. A Focused Review of the Metabolic Side-Effects of Clozapine. Front Endocrinol (Lausanne) 2021; 12:609240. [PMID: 33716966 PMCID: PMC7947876 DOI: 10.3389/fendo.2021.609240] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/15/2021] [Indexed: 12/13/2022] Open
Abstract
The second generation antipsychotic drug clozapine represents the most effective pharmacotherapy for treatment-resistant psychosis. It is also associated with low rates of extrapyramidal symptoms and hyperprolactinemia compared to other antipsychotic drugs. However, clozapine tends to be underutilized in clinical practice due to a number of disabling and serious side-effects. These are characterized by a constellation of metabolic side-effects which include dysregulation of glucose, insulin, plasma lipids and body fat. Many patients treated with clozapine go on to develop metabolic syndrome at a higher rate than the general population, which predisposes them for Type 2 diabetes mellitus and cardiovascular disease. Treatments for the metabolic side-effects of clozapine vary in their efficacy. There is also a lack of knowledge about the underlying physiology of how clozapine exerts its metabolic effects in humans. In the current review, we focus on key studies which describe how clozapine affects each of the main symptoms of the metabolic syndrome, and cover some of the treatment options. The clinical data are then discussed in the context of preclinical studies that have been conducted to identify the key biological substrates involved, in order to provide a better integrated overview. Suggestions are provided about key areas for future research to better understand how clozapine causes metabolic dysregulation.
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Affiliation(s)
- Jessica W. Y. Yuen
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David D. Kim
- 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
| | - William J. Panenka
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Alasdair M. Barr,
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Kim YH, Ryu S, Nam HJ, Kim M, Jhon M, Lee JY, Kim JM, Shin MH, Chung YC, Kim SW. The Psychology of Food Cravings in Patients With First-Episode Psychosis. Front Psychiatry 2020; 11:587486. [PMID: 33362604 PMCID: PMC7759520 DOI: 10.3389/fpsyt.2020.587486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: Food cravings may cause weight gain in patients with schizophrenia. This study investigated psychological characteristics associated with food cravings in patients with first-episode psychosis. Methods: This study analyzed data from a clinical cohort of first-episode psychosis patients taking antipsychotics for 3 months or less. The strength of food cravings was measured using the General Food Cravings Questionnaire-Trait (G-FCQ-T). Psychological characteristics and psychiatric symptoms were investigated with the Positive and Negative Symptom Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Assessment Scale, Rosenberg Self-Esteem Scale (RSES), and Perceived Stress Scale (PSS). Clinical characteristics were compared according to significant weight gain (≥10% increase in body weight compared to baseline) over 3 months. Associations between the G-FCQ-T and other psychiatric scales were investigated. We conducted sex-stratified analyses. Results: In total, 182 patients (78 males and 104 females) with first-episode psychosis were enrolled in this study. In females, the G-FCQ-T total score at baseline was associated with baseline body weight and significant weight gain over 3 months. The PSS scales were significantly associated the G-FCQ-T total and all subscale scores in female participants. Scores on the RSES and CDSS were significantly associated with the G-FCQ-T total score and with the preoccupation and loss of control subscale scores. The PANSS negative and general subscales were significantly associated with the positive outcome expectancy and loss of control subscales of the G-FCQ-T, respectively. In males, the only significant association was between the loss of control subscale and RSES scores. Linear regression analysis showed significant associations of PSS scores with the total and all subscale scores of the G-FCQ-T despite the loss of significance for other variables. Conclusion: These results indicate that the food cravings in patients with first-episode psychosis, which were associated with weight gain, were influenced by perceived stress in females. To reduce food cravings in female patients with schizophrenia, interventions aimed at perceived stress should be considered.
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Affiliation(s)
- Young-Hyuk Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Seunghyong Ryu
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee-Jung Nam
- Department of Psychiatry, Seoul Medical Center, Seoul, South Korea
| | - Mina Kim
- Gwangju Mental Health and Welfare Commission, Gwangju, South Korea
- Department of Nursing, Graduate School, Chonnam National University, Gwangju, South Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
- Gwangju Mental Health and Welfare Commission, Gwangju, South Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, South Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, South Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
- Gwangju Mental Health and Welfare Commission, Gwangju, South Korea
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15
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Progovac AM, Cortés DE, Chambers V, Adams LB, Jean‐Claude S, Willison CE, Flores M, Creedon TB, Cook BL. Addressing Major Health Disparities Related to Coronavirus for People With Behavioral Health Conditions Requires Strength-Based Capacity Building and Intentional Community Partnership. WORLD MEDICAL & HEALTH POLICY 2020; 12:242-255. [PMID: 32904922 PMCID: PMC7461022 DOI: 10.1002/wmh3.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/27/2020] [Indexed: 11/07/2022]
Abstract
Far from being an equalizer, as some have claimed, the COVID‐19 pandemic has exposed just how vulnerable many of our social, health, and political systems are in the face of major public health shocks. Rapid responses by health systems to meet increased demand for hospital beds while continuing to provide health services, largely via a shift to telehealth services, are critical adaptations. However, these actions are not sufficient to mitigate the impact of coronavirus for people from marginalized communities, particularly those with behavioral health conditions, who are experiencing disproportional health, economic, and social impacts from the evolving pandemic. Helping these communities weather this storm requires partnering with existing community‐based organizations and local governments to rapidly and flexibly meet the needs of vulnerable populations.
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16
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A pooled post hoc analysis evaluating the safety and tolerability of cariprazine in bipolar depression. J Affect Disord 2020; 263:386-395. [PMID: 31969269 DOI: 10.1016/j.jad.2019.11.098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/29/2019] [Accepted: 11/21/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The safety and efficacy of cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist and serotonin 5-HT1A receptor partial agonist, was evaluated in 4 randomized, double-blind, placebo-controlled trials in patients with bipolar depression. METHODS Safety and tolerability were evaluated in 2 post hoc analyses. Modal dose analysis: pooled data from all 4 flexible/fixed-dose trials (dose groups: <1.5, 1.5, 3 mg/d). Fixed-dose analysis: pooled data from 2 identically designed fixed-dose trials (1.5 and 3 mg/d dose groups). RESULTS The modal dose and fixed-dose analyses evaluated data from 1775 and 970 patients, respectively. Cariprazine was generally safe and well tolerated; study completion rates were 78% and 82% in the modal dose and fixed-dose analyses, respectively. In modal dose analysis, treatment-emergent adverse events (TEAEs) occurred in 60% of overall cariprazine- and 55% of placebo-treated patients; nausea (8% vs 3%) and akathisia (7% vs 2%) occurred in ≥5% of cariprazine patients and twice the rate of placebo. Metabolic changes were small and generally similar for cariprazine and placebo; mean increase in glucose was 3.1 mg/dL for cariprazine and 2.6 mg/dL for placebo. Fixed-dose and modal dose findings were generally consistent; values for most metabolic parameters were slightly higher for fixed-dose 3 mg/d versus 1.5 mg/d. LIMITATIONS Post hoc analyses, modal dose groups, short treatment duration. CONCLUSIONS In modal dose (0.25-3 mg/d) and fixed-dose (1.5 and 3 mg/d) analyses, cariprazine was generally safe and well tolerated in the treatment of bipolar depression. Slightly improved tolerability was observed with fixed-dose cariprazine 1.5 mg/d versus 3 mg/d. TRIAL REGISTRATION clinicaltrials.gov NCT00852202, NCT01396447, NCT02670538, NCT02670551.
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17
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Bazo-Alvarez JC, Morris TP, Carpenter JR, Hayes JF, Petersen I. Effects of long-term antipsychotics treatment on body weight: A population-based cohort study. J Psychopharmacol 2020; 34:79-85. [PMID: 31724905 PMCID: PMC6947810 DOI: 10.1177/0269881119885918] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antipsychotics are often prescribed for long-term periods, however, most evidence of their impact on body weight comes from short-term clinical trials. Particularly, impact associated with dosage has been barely studied. AIMS The aim of this study was to describe the short- and long-term change in body weight of people initiated on high or low doses of the three most commonly prescribed second-generation antipsychotics. METHODS Retrospective cohorts of individuals with a diagnosed psychotic disorder observed from 2005 to 2015 in the UK primary care. The exposure was the first prescription of olanzapine, quetiapine or risperidone. The main outcome was change in body weight four years before and four years after initiation of antipsychotic treatment, stratified on sex and 'low' or 'high' dose. RESULTS In total, 22,306 women and 16,559 men were observed. Olanzapine treatment was associated with the highest change in weight, with higher doses resulting in more weight gain. After 4 years, given a high dose of olanzapine (> 5 mg), women gained on average +6.1 kg; whereas given a low dose (⩽ 5 mg), they gained +4.4 kg. During the first six weeks of olanzapine treatment, they gained on average +3.2 kg on high dose and +1.9 kg on low dose. The trends were similar for men. Individuals prescribed risperidone and quetiapine experienced less weight gain in both the short- and long-term. CONCLUSIONS Olanzapine treatment was associated with the highest increase in weight. Higher doses were associated with more weight gain. Doctors should prescribe the lowest effective dose to balance mental-health benefits, weight gain and other adverse effects.
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Affiliation(s)
- Juan Carlos Bazo-Alvarez
- Research Department of Primary Care and Population Health, University College London, London, UK,Instituto de Investigación, Universidad Católica los Ángeles de Chimbote, Peru,Juan Carlos Bazo-Alvarez, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK.
| | - Tim P Morris
- MRC Clinical Trials Unit at University College London, London, UK
| | - James R Carpenter
- MRC Clinical Trials Unit at University College London, London, UK,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, UK,Department of Clinical Epidemiology, Aarhus University, Denmark
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Olmos-Ochoa TT, Niv N, Hellemann G, Cohen AN, Oberman R, Goldberg R, Young AS. Barriers to participation in web-based and in-person weight management interventions for serious mental illness. Psychiatr Rehabil J 2019; 42:220-228. [PMID: 31081651 PMCID: PMC6715516 DOI: 10.1037/prj0000363] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study examines barriers to participation and retention in 2 modalities (web-based and in-person) of a weight-management intervention tailored for individuals with serious mental illness (SMI). METHOD Using a mixed-methods approach, we explored the barriers veterans with SMI face when participating in a web-based (WebMOVE) or in-person (MOVE-SMI) version of the same SMI-adapted MOVE weight-management program. Participants in the randomized controlled trial (n = 277) were recruited from specialty mental health clinics at a Veterans Affairs medical center. Barriers were analyzed across treatment condition and program attendance (engagement) at baseline and follow-up using a generalized lineal model. Post hoc analyses assessed whether changes in the trajectory of barriers over time were associated with engagement. A subsample of participants (n = 48) from the WebMOVE and MOVE-SMI treatment conditions completed a qualitative interview, and 2 coders used open coding to analyze the data. RESULTS Although barriers specific to treatment modality existed, most barriers cut across intervention modality, including financial hardship, lack of reliable housing and transportation, comorbid physical and mental health issues, and competing demands on personal time. Results of post hoc analyses found the association between engagement and emotional and motivational factors to be statistically significant. CONCLUSIONS This study is the 1st to identify barriers in a web-based intervention for SMI. Similar barriers persisted across treatment modalities. Known barriers, particularly socioeconomic barriers, should be addressed to improve engagement and retention of individuals in weight-management interventions adapted for SMI, irrespective of modality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Tanya T Olmos-Ochoa
- Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center
| | - Noosha Niv
- Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Amy N Cohen
- Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Rebecca Oberman
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Richard Goldberg
- VA Capitol Healthcare Network Mental Illness, Research, Education, and Clinical Center
| | - Alexander S Young
- VA Greater Los Angeles Healthcare System, and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Knudsen LB. Inventing Liraglutide, a Glucagon-Like Peptide-1 Analogue, for the Treatment of Diabetes and Obesity. ACS Pharmacol Transl Sci 2019; 2:468-484. [PMID: 32259078 DOI: 10.1021/acsptsci.9b00048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 01/08/2023]
Abstract
Glucagon-like peptide-1 (GLP-1) has been in focus since the early 1980s as a long looked for incretin hormone, released from the gastrointestinal tract and with an important effect on glucose-dependent insulin secretion, providing efficient glucose lowering, with little risk for hypoglycemia. The enzyme dipeptidyl peptidase-4 (DPP-4) degrades GLP-1 very fast, and the remaining metabolite is cleared rapidly by the kidneys. Liraglutide is a fatty acid acylated analogue of GLP-1 that provides efficacy for 24 h/day. The mechanism of action for liraglutide is reviewed in detail with focus on pancreatic efficacy and safety, thyroid safety, and weight loss mechanism. Evolving science hypothesizes that GLP-1 has important effects on atherosclerosis, relevant for the cardiovascular benefit seen in the treatment of diabetes and obesity. Also, GLP-1 may be relevant in neurodegenerative diseases.
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Affiliation(s)
- Lotte Bjerre Knudsen
- Global Drug Discovery, Novo Nordisk, Novo Nordisk Park, DK-2760 Maaloev, Denmark
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20
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Getting to precision psychopharmacology: Combining clinical and genetic information to predict fat gain from aripiprazole. J Psychiatr Res 2019; 114:67-74. [PMID: 31039482 PMCID: PMC6546502 DOI: 10.1016/j.jpsychires.2019.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION All atypical antipsychotics are associated with some degree of weight gain. We applied a novel statistical approach to identify moderators of aripiprazole-induced fat gain using clinical and genetic data from a randomized clinical trial (RCT) of treatment resistant depression in older adults. MATERIALS AND METHODS Adults aged ≥60 years with non-response to a prospective trial of venlafaxine were randomized to 12 weeks of aripiprazole augmentation (n = 91) or placebo (n = 90). Dual energy x-ray absorptiometry (DEXA) measured adiposity at baseline and 12 weeks. Independent moderators of total body fat gain were used to generate two combined multiple moderators, one including clinical data alone and one including both clinical and genetic data to characterize individuals who gained fat during aripiprazole augmentation. RESULTS The value of the combined genetic + clinical multiple moderator (Mcg) was 0.57 [95% CI 0.46, 0.68] (effect size: 0.57), compared to the combined clinical moderator (Mc) value of 0.49 [0.34, 0.63] (effect size: 0.49). Individuals who gained adiposity in this study were more likely to be female and younger in age, have lower weight, fasting glucose and lipids at baseline and positive for the HTR2C polymorphism. DISCUSSION These results demonstrate a combined multiple moderator approach, including both clinical and genetic moderators, can be applied to existing clinical trial data to understand adverse treatment effects. This method allowed for more specific characterization of individuals at risk for the outcome of interest. Further work is needed to identify additional genetic moderators and to validate the approach.
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Spertus J, Horvitz-Lennon M, Normand SLT. Bayesian Meta-analysis of Multiple Continuous Treatments with Individual Participant-Level Data: An Application to Antipsychotic Drugs. Med Decis Making 2019; 39:583-592. [PMID: 31375050 PMCID: PMC6786940 DOI: 10.1177/0272989x19856884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Modeling dose-response relationships of drugs is essential to understanding their safety effects on patients under realistic circumstances. While intention-to-treat analyses of clinical trials provide the effect of assignment to a particular drug and dose, they do not capture observed exposure after factoring in nonadherence and dropout. We develop a Bayesian method to flexibly model the dose-response relationships of binary outcomes with continuous treatment, permitting multiple evidence sources, treatment effect heterogeneity, and nonlinear dose-response curves. In an application, we examine the risk of excessive weight gain for patients with schizophrenia treated with the second-generation antipsychotics paliperidone, risperidone, or olanzapine in 14 clinical trials. We define exposure as total cumulative dose (daily dose × duration) and convert to units equivalent to 100 mg of olanzapine (OLZ doses). Averaging over the sample population of 5891 subjects, the median dose ranged from 0 (placebo randomized participants) to 6.4 OLZ doses (paliperidone randomized participants). We found paliperidone to be least likely to cause excessive weight gain across a range of doses. Compared with 0 OLZ doses, at 5.0 OLZ doses, olanzapine subjects had a 15.6% (95% credible interval: 6.7, 27.1) excess risk of weight gain; corresponding estimates for paliperidone and risperidone were 3.2% (1.5, 5.2) and 14.9% (0.0, 38.7), respectively. Moreover, compared with nonblack participants, black participants had a 6.8% (1.0, 12.4) greater risk of excessive weight gain at 10.0 OLZ doses of paliperidone. Nevertheless, our findings suggest that paliperidone is safer in terms of weight gain risk than risperidone or olanzapine for all participants at low to moderate cumulative OLZ doses.
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Affiliation(s)
- Jacob Spertus
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Marcela Horvitz-Lennon
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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Al-Seddik G, Hachem D, Haddad C, Hallit S, Salameh P, Nabout R, Zoghbi M. Cardiovascular events in hospitalised patients with schizophrenia: a survival analysis. Int J Psychiatry Clin Pract 2019; 23:106-113. [PMID: 30741069 DOI: 10.1080/13651501.2018.1545910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: To evaluate the occurrence of cardiovascular (CV), cerebrovascular events and mortality rates, and compare the predictive ability of two scores, Framingham Risk Score (FRS) and Atherosclerotic Cardiovascular Disease (ASCVD), of detecting a cardiovascular event in a cohort of schizophrenic patients. Methods: A cohort of 329 hospitalised schizophrenic patients is being monitored since 1 January 2013. Patients' file review was performed to detect the CV events of interest. Results: Out of the 329 patients with schizophrenia, with a mean study follow-up of 41.07 ± 12.55 months, 29 cardiovascular events were recorded; of those events, we recorded 4 myocardial infarction, 1 stroke, 6 heart failure and 18 cardiovascular deaths. The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years. The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient). The association between survival curve of patients with high and low CVR according to FRS score tended to significance (RR = 1.90, p = .078). Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival (RR = 3.35, p = .005). Conclusion: The ASCVD items should be included in the medical assessment in any patient with severe mental illness. Key points The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years. The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient). The association between survival curve of patients with high and low CVR according to FRS score tended to significance. Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival. The ASCVD items should be included in the medical assessment in any patient with severe mental illness.
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Affiliation(s)
- Ghina Al-Seddik
- a Faculty of Sciences , Lebanese University , Beirut , Lebanon
| | - Dory Hachem
- b Psychiatric Hospital of the Cross , Jal Eddib , Lebanon
| | - Chadia Haddad
- b Psychiatric Hospital of the Cross , Jal Eddib , Lebanon
| | - Souheil Hallit
- b Psychiatric Hospital of the Cross , Jal Eddib , Lebanon.,d Faculty of Medicine and Medical Sciences , Holy Spirit University , Kaslik , Lebanon.,e INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie , Beirut , Lebanon
| | - Pascale Salameh
- c Faculty of Pharmacy , Lebanese University , Beirut , Lebanon.,e INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie , Beirut , Lebanon.,f Faculty of Medicine , Lebanese University , Beirut , Lebanon
| | - Rita Nabout
- a Faculty of Sciences , Lebanese University , Beirut , Lebanon
| | - Marouan Zoghbi
- b Psychiatric Hospital of the Cross , Jal Eddib , Lebanon.,g Faculty of Medicine , Saint-Joseph University , Beirut , Lebanon
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Yang CP, Wang YY, Lin SY, Hong YJ, Liao KY, Hsieh SK, Pan PH, Chen CJ, Chen WY. Olanzapine Induced Dysmetabolic Changes Involving Tissue Chromium Mobilization in Female Rats. Int J Mol Sci 2019; 20:E640. [PMID: 30717287 PMCID: PMC6387243 DOI: 10.3390/ijms20030640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 12/30/2022] Open
Abstract
Atypical antipsychotics, such as olanzapine, are commonly prescribed to patients with schizophrenic symptoms and other psychiatric disorders. However, weight gain and metabolic disturbance cause adverse effects, impair patient compliance and limit clinical utility. Thus, a better understanding of treatment-acquired adverse effects and identification of targets for therapeutic intervention are believed to offer more clinical benefits for patients with schizophrenia. Beyond its nutritional effects, studies have indicated that supplementation of chromium brings about beneficial outcomes against numerous metabolic disorders. In this study, we investigated whether olanzapine-induced weight gain and metabolic disturbance involved chromium dynamic mobilization in a female Sprague-Dawley rat model, and whether a dietary supplement of chromium improved olanzapine-acquired adverse effects. Olanzapine medicated rats experienced weight gain and adiposity, as well as the development of hyperglycemia, hyperinsulinemia, insulin resistance, hyperlipidemia, and inflammation. The olanzapine-induced metabolic disturbance was accompanied by a decrease in hepatic Akt and AMP-activated Protein Kinase (AMPK) actions, as well as an increase in serum interleukin-6 (IL-6), along with tissue chromium depletion. A daily intake of chromium supplements increased tissue chromium levels and thermogenic uncoupling protein-1 (UCP-1) expression in white adipose tissues, as well as improved both post-olanzapine weight gain and metabolic disturbance. Our findings suggest that olanzapine medicated rats showed a disturbance of tissue chromium homeostasis by inducing tissue depletion and urinary excretion. This loss may be an alternative mechanism responsible for olanzapine-induced weight gain and metabolic disturbance.
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Affiliation(s)
- Ching-Ping Yang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Ya-Yu Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Yi-Jheng Hong
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan.
| | - Keng-Ying Liao
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan.
| | - Sheng-Kuo Hsieh
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung 402, Taiwan.
| | - Ping-Ho Pan
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan.
- Department of Pediatrics, Tungs' Taichung Metro Harbor Hospital, Taichung 435, Taiwan.
| | - Chun-Jung Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung 447, Taiwan.
| | - Wen-Ying Chen
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan.
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24
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Antipsychotics and cardiovascular risk: A case/non-case study. Psychiatry Res 2018; 270:341-347. [PMID: 30292087 DOI: 10.1016/j.psychres.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022]
Abstract
Severe mental disorders have been reported to be associated with an increased cardiovascular risk. To measure the potential risk excess as compared, not with the baseline cardiovascular risk for the general population, but with the cardiovascular risk associated with drug iatrogenia. 197 reported cases of cardiovascular adverse reaction to antipsychotic drugs as compared to the reported cases of this type of adverse reactions to drugs other than antipsychotics entered in the Spanish Pharmacovigilance System database (FEDRA) (1995-2018) in an observational case/non-case study. Risk estimates of association were reporting odds ratio (ROR), and, chi-square test (χ2). Overall disproportionality for the whole drug class was found [ROR 2.3 (95% CI 2.0-2.7)], χ2 = 127.07]. When the two types of antipsychotics (typical and atypical) were analysed separately, we also found statistically significant disproportionality, and this disproportionality is similar between both groups, with disproportionality measures around 2.30, with the confidence intervals not including the 1. The disproportionality observed suggests a risk excess that might be greater than expected, which holds particularly true for torsade de pointes, sudden death and cardiac arrhythmias in patients treated with any of the two types of antipsychotics. There was no significant risk for ischaemic heart disease.
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Abstract
UNLABELLED AimsPeople who have schizophrenia die earlier from somatic diseases than do people in the general population, but information about cardiovascular deaths in people who have schizophrenia is limited. We analysed mortality in all age groups of people with schizophrenia by specific cardiovascular diseases (CVDs), focusing on five CVD diagnoses: coronary heart disease, acute myocardial infarction, cerebrovascular disease, heart failure and cardiac arrhythmias. We also compared hospital admissions for CVDs in people who had schizophrenia with hospital admissions for CVDs in the general population. METHODS This national register study of 10 631 817 people in Sweden included 46 911 people who were admitted to the hospital for schizophrenia between 1 January 1987 and 31 December 2010. Information from national registers was used to identify people who had schizophrenia and obtain data about mortality, causes of death, medical diagnoses and hospitalisations. RESULTS CVDs were the leading cause of death in people who had schizophrenia (5245 deaths), and CVDs caused more excess deaths than suicide. The mean age of CVD death was 10 years lower for people who had schizophrenia (70.5 years) than the general population (80.7 years). The mortality rate ratio (MRR) for CVDs in all people who had schizophrenia was 2.80 (95% confidence interval (CI) 2.73-2.88). In people aged 15-59 years who had schizophrenia, the MRR for CVDs was 6.16 (95% CI 5.79-6.54). In all people who had schizophrenia, the MRR for coronary heart disease was 2.83 (95% CI 2.73-2.94); acute myocardial infarction, 2.62 (95% CI 2.49-2.75); cerebrovascular disease, 2.4 (95% CI 2.25-2.55); heart failure, 3.25 (95% CI 2.94-3.6); and cardiac arrhythmias, 2.06 (95% CI 1.75-2.43). Hospital admissions for coronary heart disease were less frequent in people who had schizophrenia than in the general population (admission rate ratio, 0.88 (95% CI 0.83-0.94). In all age groups, survival after hospital admission for CVD was lower in people who had schizophrenia than in the general population. CONCLUSIONS People who had schizophrenia died 10 years earlier from CVDs than did people in the general population. For all five CVD diagnoses, mortality risk was higher for those with schizophrenia than those in the general population. Survival after hospitalisation for CVDs in people who had schizophrenia was comparable with that of people in the general population who were several decades older.
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Robinson DJ, Coons M, Haensel H, Vallis M, Yale JF. Diabetes and Mental Health. Can J Diabetes 2018; 42 Suppl 1:S130-S141. [PMID: 29650085 DOI: 10.1016/j.jcjd.2017.10.031] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 01/28/2023]
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Owusu–Ansah A, Berko Panyin A, Obirikorang C, Agyare C, Acheampong E, Kwofie S, Odame Anto E, Nsenbah Batu E. Metabolic Syndrome among Schizophrenic Patients: A Comparative Cross-Sectional Study in the Middle Belt of Ghana. SCHIZOPHRENIA RESEARCH AND TREATMENT 2018; 2018:6542983. [PMID: 30050695 PMCID: PMC6046121 DOI: 10.1155/2018/6542983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 01/05/2023]
Abstract
The study determined the prevalence of MetS in patients with schizophrenia at the Psychiatric Unit of the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. This comparative cross-sectional study recruited 348 schizophrenic patients comprising 236 antipsychotic-treated and 112 newly diagnosed treatment-naïve patients. The MetS prevalence was assessed based on World Health Organization (WHO), International Diabetes Federation (IDF), and the National Cholesterol Education Programme, Adult Treatment Panel III (NCEP ATP III) criteria. The overall prevalence of MetS was 14.1%, 20.4%, and 23.6% using NCEP ATP III, WHO, and IDF criteria, respectively, compared to 7.8%, 3.9%, and 2.2% reported in the general Ghanaian population. The prevalence was significantly higher among treated psychiatric patients compared to treatment-naïve group based on NCEP ATP III (17.8% versus 6.2%; p = 0.0001), WHO (26.2% versus 8.0%; p < 0.0001), and IDF (30.3% versus 10.0%; p < 0.0001). MetS was prevalent among patients on atypical antipsychotics compared to typical antipsychotics irrespective of the criteria used (i.e., 17.1% versus 11.1% for NCEP ATP III; 29.5% versus 25.9% for WHO; and 44.3% versus 18.5% for IDF). Using logistic regression model, obesity, raised fasting blood sugar, raised total cholesterol, and decreased high density lipoprotein were observed to be significant predictors of MetS (p<0.05).The study found high prevalence of MetS in Ghanaians with schizophrenia and higher prevalence rate of MetS associated with monotherapy. Regular monitoring of cardiometabolic parameters should be an important therapeutic objective in the management of these patients.
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Affiliation(s)
- Angela Owusu–Ansah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Anto Berko Panyin
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Christian Agyare
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, WA, Australia
| | - Simon Kwofie
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Enoch Odame Anto
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, WA, Australia
| | - Emmanuella Nsenbah Batu
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Risk of weight gain for specific antipsychotic drugs: a meta-analysis. NPJ SCHIZOPHRENIA 2018; 4:12. [PMID: 29950586 PMCID: PMC6021430 DOI: 10.1038/s41537-018-0053-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/15/2017] [Accepted: 12/05/2017] [Indexed: 12/04/2022]
Abstract
People with schizophrenia are at considerably higher risk of cardiometabolic morbidity than the general population. Second-generation antipsychotic drugs contribute to that risk partly through their weight gain effects, exacerbating an already high burden of disease. While standard ‘as-randomized’ analyses of clinical trials provide valuable information, they ignore adherence patterns across treatment arms, confounding estimates of realized treatment exposure on outcome. We assess the effect of specific second-generation antipsychotics on weight gain, defined as at least a 7% increase in weight from randomization, using a Bayesian hierarchical model network meta-analysis with individual patient level data. Our data consisted of 14 randomized clinical trials contributing 5923 subjects (mean age = 39 [SD = 12]) assessing various combinations of olanzapine (n = 533), paliperidone (n = 3482), risperidone (n = 540), and placebo (n = 1368). The median time from randomization to dropout or trial completion was 6 weeks (range: 0–60 weeks). The unadjusted probability of weight gain in the placebo group was 4.8% across trials. For each 10 g chlorpromazine equivalent dose increase in olanzapine, the odds of weight gain increased by 5 (95% credible interval: 1.4, 5.3); the effect of risperidone (odds ratio = 1.6 [0.25, 9.1]) was estimated with considerable uncertainty but no different from paliperidone (odds ratio = 1.3 [1.2, 1.5]). People taking a commonly prescribed antipsychotic to treat schizophrenia have an increased risk of weight gain. Sharon-Lise Normand of Harvard Medical School in the US and colleagues analysed data from 14 randomized control trials representing almost 6000 people taking one of three antipsychotic drugs for schizophrenia, or a placebo. Using a unique statistical approach, they found that people taking the drug olanzapine had the highest risk of weight gain. People taking paliperidone had only a small risk, while there was uncertainty regarding the drug riperidone. Antipsychotic drugs can often be taken for decades, so understanding their cummulative effects on patient health is crucial to improving quality of life and preventing premature mortality. The method used in this study is unique and could be used to analyse other aspects of drug use.
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Ono S, Sugai T, Suzuki Y, Yamazaki M, Shimoda K, Mori T, Ozeki Y, Matsuda H, Sugawara N, Yasui-Furukori N, Okamoto K, Sagae T, Someya T. High-density lipoprotein-cholesterol and antipsychotic medication in overweight inpatients with schizophrenia: post-hoc analysis of a Japanese nationwide survey. BMC Psychiatry 2018; 18:180. [PMID: 29879941 PMCID: PMC5992846 DOI: 10.1186/s12888-018-1764-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/23/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients with schizophrenia have an increased prevalence of metabolic disturbances compared with the general population. However, the mechanisms underlying the metabolic side effects of antipsychotics are unknown. The aim of the present study was to compare the levels of high-density lipoprotein (HDL)-cholesterol in Japanese schizophrenia patients medicated with olanzapine, risperidone, or aripiprazole monotherapy. METHODS This study was a post-hoc analysis of a nationwide survey, which included 433 Japanese outpatients with schizophrenia and 674 inpatients. A brief questionnaire was compiled that covered demographic data, systolic blood pressure, diastolic blood pressure, and HDL-cholesterol after reviewing the relevant literature and guidelines. To compare demographic and clinical characteristics, analysis of variance was performed for continuous variables and the chi-square test was performed for categorical variables. For comparisons of HDL-cholesterol levels among the three antipsychotic groups, analysis of covariance was carried out with age, diastolic blood pressure, chlorpromazine-equivalent dosage, and waist circumference as confounding variables after stratification by body mass index (BMI) for each outpatient group and inpatient group. RESULTS The mean age was 57.9 ± 14.0 years and the mean BMI was 23.4 ± 4.5 kg/m2. HDL-cholesterol levels when stratified by BMI differed significantly (p = 0.019) between the three antipsychotic groups after age, diastolic blood pressure, chlorpromazine-equivalent dosage, and waist circumference in inpatients. A significant difference in HDL-cholesterol levels was only found in the overweight inpatient group, and no significant differences in HDL-cholesterol levels were found among the three antipsychotics for outpatients of all BMI stratifications or inpatients that were underweight or of normal weight. For post-hoc analysis of HDL-cholesterol levels in overweight inpatients, HDL-cholesterol was significantly lower in the olanzapine group than in the aripiprazole group (p = 0.023). CONCLUSIONS This study reveals a difference in HDL-cholesterol levels in overweight Japanese inpatients with schizophrenia resulting from the use of different antipsychotics. In the post-hoc analysis of HDL-cholesterol levels in overweight inpatients, HDL-cholesterol was significantly lower in the olanzapine group than in the aripiprazole group. Further studies incorporating more detailed evaluations, including diet and physical activity, are needed to clarify the differences in HDL-cholesterol according to antipsychotic use.
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Affiliation(s)
- Shin Ono
- 0000 0001 0671 5144grid.260975.fDepartment of Community Psychiatric Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan ,0000 0004 5897 9100grid.469781.5Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
| | - Takuro Sugai
- 0000 0004 5897 9100grid.469781.5Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,0000 0001 0671 5144grid.260975.fDepartment of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yutaro Suzuki
- 0000 0004 5897 9100grid.469781.5Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,0000 0001 0671 5144grid.260975.fDepartment of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Kazutaka Shimoda
- 0000 0004 5897 9100grid.469781.5Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,0000 0001 0702 8004grid.255137.7Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Takao Mori
- Japan Psychiatric Hospital Association, Tokyo, Japan
| | - Yuji Ozeki
- 0000 0004 5897 9100grid.469781.5Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,0000 0001 0702 8004grid.255137.7Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | | | - Norio Sugawara
- 0000 0004 5897 9100grid.469781.5Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,0000 0001 0673 6172grid.257016.7Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Norio Yasui-Furukori
- 0000 0004 5897 9100grid.469781.5Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan ,0000 0001 0673 6172grid.257016.7Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | - Toyoaki Sagae
- grid.472166.0Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences Faculty of Health and Nutrition, Yonezawa, Japan
| | - Toshiyuki Someya
- Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan. .,Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Lin CH, Lin SC, Huang YH, Wang FC, Huang CJ. Early prediction of olanzapine-induced weight gain for schizophrenia patients. Psychiatry Res 2018; 263:207-211. [PMID: 29574355 DOI: 10.1016/j.psychres.2018.02.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/24/2017] [Accepted: 02/28/2018] [Indexed: 01/19/2023]
Abstract
The aim of this study was to determine whether weight changes at week 2 or other factors predicted weight gain at week 6 for schizophrenia patients receiving olanzapine. This study was the secondary analysis of a six-week trial for 94 patients receiving olanzapine (5 mg/d) plus trifluoperazine (5 mg/d), or olanzapine (10 mg/d) alone. Patients were included in analysis only if they had completed the 6-week trial (per protocol analysis). Weight gain was defined as a 7% or greater increase of the patient's baseline weight. The receiver operating characteristic curve was employed to determine the optimal cutoff points of statistically significant predictors. Eleven of the 67 patients completing the 6-week trial were classified as weight gainers. Weight change at week 2 was the statistically significant predictor for ultimate weight gain at week 6. A weight change of 1.0 kg at week 2 appeared to be the optimal cutoff point, with a sensitivity of 0.92, a specificity of 0.75, and an AUC of 0.85. Using weight change at week 2 to predict weight gain at week 6 is favorable in terms of both specificity and sensitivity. Weight change of 1.0 kg or more at 2 weeks is a reliable predictor.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Chi Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Yu-Hui Huang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Fu-Chiang Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chun-Jen Huang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan.
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31
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Mulcahy AW, Normand SL, Newcomer JW, Colaiaco B, Donohue JM, Lave JR, Keeler E, Sorbero MJ, Horvitz-Lennon M. Simulated Effects of Policies to Reduce Diabetes Risk Among Adults With Schizophrenia Receiving Antipsychotics. Psychiatr Serv 2017; 68:1280-1287. [PMID: 28859580 PMCID: PMC5831671 DOI: 10.1176/appi.ps.201500485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Second-generation antipsychotics increase the risk of diabetes and other metabolic conditions among individuals with schizophrenia. Although metabolic testing is recommended to reduce this risk, low testing rates have prompted concerns about negative health consequences and downstream medical costs. This study simulated the effect of increasing metabolic testing rates on ten-year prevalence rates of prediabetes and diabetes (diabetes conditions) and their associated health care costs. METHODS A microsimulation model (N=21,491 beneficiaries) with a ten-year time horizon was used to quantify the impacts of policies that increased annual testing rates in a Medicaid population with schizophrenia. Data sources included California Medicaid data, National Health and Nutrition Examination Survey data, and the literature. In the model, metabolic testing increased diagnosis of diabetes conditions and diagnosis prompted prescribers to switch patients to lower-risk antipsychotics. Key inputs included observed diagnoses, prescribing rates, annual testing rates, imputed rates of undiagnosed diabetes conditions, and literature-based estimates of policy effectiveness. RESULTS Compared with 2009 annual testing rates, ten-year outcomes for policies that achieved universal testing reduced exposure to higher-risk antipsychotics by 14%, time to diabetes diagnosis by 57%, and diabetes prevalence by .6%. These policies were associated with higher spending because of testing and earlier treatment. CONCLUSIONS The model showed that policies promoting metabolic testing provided an effective approach to improve the safety of second-generation antipsychotic prescribing in a Medicaid population with schizophrenia; however, the policies led to additional costs at ten years. Simulation studies are a useful source of information on the potential impacts of these policies.
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Affiliation(s)
- Andrew W Mulcahy
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Sharon-Lise Normand
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - John W Newcomer
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Benjamin Colaiaco
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Julie M Donohue
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Judith R Lave
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Emmett Keeler
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Mark J Sorbero
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Marcela Horvitz-Lennon
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
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Phencyclidine increased while isolation rearing did not affect progressive ratio responding in rats: Investigating potential models of amotivation in schizophrenia. Behav Brain Res 2017; 364:413-422. [PMID: 29175446 DOI: 10.1016/j.bbr.2017.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Schizophrenia is a debilitating neurodevelopmental disorder affecting 1% of the global population with heterogeneous symptoms including positive, negative, and cognitive. While treatment for positive symptoms exists, none have been developed to treat negative symptoms. Animal models of schizophrenia are required to test targeted treatments and since patients exhibit reduced effort (breakpoints) for reward in a progressive ratio (PR) task, we examined the PR breakpoints of rats treated with the NMDA receptor antagonist phencyclidine or those reared in isolation - two common manipulations used to induce schizophrenia-relevant behaviors in rodents. METHODS In two cohorts, the PR breakpoint for a palatable food reward was examined in Long Evans rats after: 1) a repeated phencyclidine regimen; 2) A subchronic phencyclidine regimen followed by drug washout; and 3) post-weaning social isolation. RESULTS Rats treated with repeated phencyclidine and those following washout from phencyclidine exhibited higher PR breakpoints than vehicle-treated rats. The breakpoint of isolation reared rats did not differ from those socially reared, despite abnormalities of these rats in other schizophrenia-relevant behaviors. CONCLUSION Despite their common use for modeling other schizophrenia-relevant behaviors neither phencyclidine treatment nor isolation rearing recreated the motivational deficits observed in patients with schizophrenia, as measured by PR breakpoint. Other manipulations, and negative symptom-relevant behaviors, require investigation prior to testing putative therapeutics.
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Abstract
BACKGROUND A recent large database analysis raised concerns of potential acute kidney injury (AKI) risk associated with antipsychotics. However, whether individual atypical and typical antipsychotics are associated with differential AKI risks has not been investigated. OBJECTIVE The current study compared the risks of AKI and known causes of AKI associated with a broad range of atypical and typical antipsychotics. METHOD This retrospective cohort analysis used January 2007-June 2013 US nationwide Humana claims data to define episodes of antipsychotic drug therapy for patients with schizophrenia and bipolar disorder. Study drugs were aripiprazole, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone. Study outcomes were hospitalizations with AKI, and known causes of AKI, i.e., hypotension, acute urinary retention, neuroleptic malignant syndrome/rhabdomyolysis, and pneumonia. AKI was the primary outcome of the study. Cox regressions using haloperidol as the baseline comparator were used to estimate the impact of alternative antipsychotics on the risks of study adverse events following the initiation of treatment. The Cox models controlled for treatment history, comorbidities, and concomitant drug use in the prior 6 months. They also controlled for patient demographics and dose of current treatment. RESULTS The overall incidence of AKI was 25.0 per 1000 person-years. According to our multivariate regression results, the risk of AKI was significantly increased in patients taking olanzapine [hazard ratio (HR) 1.344, 95% confidence interval (CI) 1.057-1.708], quetiapine (HR 1.350, 95% CI 1.082-1.685), and ziprasidone (HR 1.338, 95% CI 1.035-1.729) relative to haloperidol. Aripiprazole (HR 1.152, 95% CI 0.908-1.462) and risperidone (HR 1.147, 95% CI 0.923-1.426) had insignificantly higher risks of AKI compared with haloperidol, whereas fluphenazine (HR 0.729, 95% CI 0.483-1.102) had an insignificantly lower risk of AKI. When compared between drug classes, atypical antipsychotics had a significantly higher risk of AKI (HR 1.313, 95% CI 1.083-1.591) than typical antipsychotics. CONCLUSIONS Antipsychotics are associated with differential AKI risks, with several atypical antipsychotics having higher risks than haloperidol. However, the overall incidence of AKI was moderate, and AKI risk should only raise concern for clinicians with elderly patients or patients who are vulnerable to kidney disease.
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Bole CB, Pišlar M, Šen M, Tavčar R, Mrhar A. Original research paper. Switching antipsychotics: Results of 16-month non-interventional, prospective, observational clinical research of inpatients with schizophrenia spectrum disorders. ACTA PHARMACEUTICA 2017; 67:99-112. [PMID: 28231044 DOI: 10.1515/acph-2017-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2016] [Indexed: 11/15/2022]
Abstract
The study aims to identify prescribing and switching patterns of antipsychotics in clinical practice. A 16-month, prospective study was conducted at the Psychiatric Hospital Idrija, Slovenia. Inpatients (N = 311) with schizophrenia spectrum disorders were observed. The causes for switching antipsychotics and switching strategies were analyzed. Analyzing a total of 3954 prescriptions, the collected data confirmed that treatment strategies in this psychiatric hospital are very complex. It was found that 37 percent of inpatients had at least one switch. Moreover, switches that included three or more antipsychotics were detected. The most common causes for switching antipsychotics were adverse reactions and inefficacy or lack of efficacy. Among switching options, abrupt switch was recorded several times. As some patients are receiving several antipsychotics at the same time, it is possible that unusual switching occurs in clinical practice. It seems that the choice of switching strategy is also affected by the cause and urgency for switching an antipsychotic.
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Ndukwe HC, Nishtala PS. Glucose monitoring in new users of second-generation antipsychotics in older people. Arch Gerontol Geriatr 2017; 70:136-140. [PMID: 28131975 DOI: 10.1016/j.archger.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Treatment guidelines published world-wide have highlighted concerns of increased metabolic risks associated with second-generation antipsychotics (SGAs). The aim of the study was to evaluate blood glucose monitoring rates for SGA new users in older people aged 65 years and above during the study period 2006-2012, and investigate the pre-post 2007 Best Practice Advocacy Centre's (bpacnz) glucose monitoring recommendation in New Zealand. METHODS The study was a population-based retrospective cohort of SGA new users (365days without pre-exposure to antipsychotics). Pharmaceutical collections data were extracted and used to identify older people dispensed SGAs and linked to the National Minimum Dataset and Laboratory Claims collection. WHO Methodology's Anatomical Therapeutic Chemical method's classification was used to characterise the SGAs dispensed. RESULTS Of the 25,603 new users dispensed SGAs, 63.5% received glycaemic control monitoring at least once during the study period. Of these, only 20.1% were monitored at baseline, 38.7% were monitored for glycaemic control within the first 90 days. Glycaemic control monitoring within the first 180days increased to more than half (57.5%) of the SGA new users. Proportion of individuals monitored were independent (χ2=6.1; P=0.4) of pre-post bpacnz recommendation. CONCLUSIONS Blood glucose monitoring was underutilized in new SGA users. No significant improvement in glycaemic control monitoring was observed after the 2007 bpacnz consensus statement release at baseline, 90days and at 180 days. Prescribers must be cautioned about the metabolic risks posed by SGAs and recommend glycaemic control monitoring.
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Affiliation(s)
- Henry C Ndukwe
- School of Pharmacy, P.O. Box 56, University of Otago, Dunedin, New Zealand.
| | - Prasad S Nishtala
- School of Pharmacy, P.O. Box 56, University of Otago, Dunedin, New Zealand.
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Loxapine for Reversal of Antipsychotic-Induced Metabolic Disturbances: A Chart Review. J Autism Dev Disord 2016; 46:1344-53. [PMID: 26687568 DOI: 10.1007/s10803-015-2675-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Loxapine substitution is a promising option for patients with autism spectrum disorder (ASD) who develop antipsychotic-induced metabolic illness. We performed a chart review of 15 adolescents and adults meeting DSM-IV-TR criteria for ASD, all with antipsychotic-associated weight gain, who received low dose loxapine in an attempt to taper or discontinue the weight gain-associated antipsychotic. Mean weight loss was -5.7 kg, mean BMI reduction was -1.9, and mean triglyceride reduction was -33.7 mg/dl. At chart review, 14 of 15 subjects were rated 2 (Much Improved) or 1 (Very Much Improved) on the Clinical Global Impressions-Improvement scale (CGI-I). Low dose loxapine addition in most cases enabled taper of offending antipsychotics, significantly reversed drug-induced metabolic disturbances and improved irritability.
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Chien IC, Lin CH. Increased risk of diabetes in patients with anxiety disorders: A population-based study. J Psychosom Res 2016; 86:47-52. [PMID: 27302546 DOI: 10.1016/j.jpsychores.2016.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Few known studies have investigated the epidemiology of diabetes in patients with anxiety disorders. Therefore, the study aimed to determine the prevalence and incidence of diabetes in patients with anxiety disorders. METHODS The National Health Research Institute provided a database of 1,000,000 random subjects for study. We obtained a random sample aged 18years and over 766,427 subjects in 2005. Those study subjects who had at least two primary or secondary diagnoses of anxiety disorders were identified. We compared the prevalence of diabetes in anxiety patients with the general population in 2005. Furthermore, we investigated this cohort from 2006 to 2010 to detect the incident cases of diabetes in anxiety patients compared with the general population. RESULTS The prevalence of diabetes in patients with anxiety disorders was higher than that in the general population (11.89% vs. 5.92%, odds ratio, 1.23; 95% confidence interval, 1.17-1.28) in 2005. The average annual incidence of diabetes in patients with anxiety disorders was also higher than that in the general population (2.25% vs. 1.11%, risk ratio 1.34; 95% confidence interval, 1.28-1.41) from 2006 to 2010. Compared with the general population, patients with anxiety disorders revealed a higher incidence of diabetes in all age groups among both females and males. CONCLUSIONS Patients with anxiety disorders had a much higher prevalence and incidence of diabetes in the younger adult age group than in the general population. The higher incidence of diabetes among anxiety patients was related to increased age, antipsychotic use, hypertension, and hyperlipidemia.
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Affiliation(s)
- I-Chia Chien
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan; Department of Public Health & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
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Jung E, Wiesjahn M, Wendt H, Bock T, Rief W, Lincoln TM. Symptoms, functioning and coping strategies in individuals with schizophrenia spectrum disorders who do not take antipsychotic medication: a comparative interview study. Psychol Med 2016; 46:2179-2188. [PMID: 27269768 DOI: 10.1017/s0033291716000775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A considerable proportion of people with schizophrenia spectrum disorders do not take antipsychotic medication but seem to be functioning well. However, little is known about this group. To test the assumption that absence of medication is compensated for by more effective coping and increased social support, this study compared symptoms, functioning, coping strategies and social support in non-medicated and medicated individuals with schizophrenia spectrum disorders. METHOD In all, 48 participants with a DSM-IV schizophrenia spectrum disorder who were taking (n = 25) or not taking antipsychotic medication (n = 23) were included. Assessment consisted of self-ratings of symptoms, symptom-related distress and social support combined with a semi-structured interview that assessed general and social functioning, subjective evaluation of symptoms and coping strategies. RESULTS Symptom severity and distress did not differ between the groups. However, the non-medicated participants had significantly higher levels of general functioning than medicated participants and a longer duration of being non-medicated was significantly associated with a higher level of general functioning. In contrast to the hypotheses, not taking medication was not associated with more effective coping strategies or with higher levels of social support. Medicated participants more frequently reported the use of professional help as a coping strategy. CONCLUSIONS Our results corroborate previous studies finding improved functioning in individuals with schizophrenia spectrum disorders who do not take medication compared with those who take medication, but do not support the notion that this difference is explicable by better coping or higher levels of social support. Alternative explanations and avenues for research are discussed.
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Affiliation(s)
- E Jung
- Department of Psychology,Division of Clinical Psychology and Psychotherapy,Philipps-University Marburg,Marburg,Germany
| | - M Wiesjahn
- Department of Psychology,Division of Clinical Psychology and Psychotherapy,Philipps-University Marburg,Marburg,Germany
| | - H Wendt
- Department of Clinical Psychology and Psychotherapy,Institute of Psychology,University of Hamburg,Hamburg,Germany
| | - T Bock
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Hamburg,Germany
| | - W Rief
- Department of Psychology,Division of Clinical Psychology and Psychotherapy,Philipps-University Marburg,Marburg,Germany
| | - T M Lincoln
- Department of Clinical Psychology and Psychotherapy,Institute of Psychology,University of Hamburg,Hamburg,Germany
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Atypical antipsychotics and effects on feeding: from mice to men. Psychopharmacology (Berl) 2016; 233:2629-53. [PMID: 27251130 DOI: 10.1007/s00213-016-4324-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/15/2016] [Indexed: 12/22/2022]
Abstract
RATIONALE So-called atypical antipsychotics (AAPs) are associated with varying levels of weight gain and associated metabolic disturbances, which in patients with serious mental illness (SMI) have been linked to non-compliance and poor functional outcomes. Mechanisms underlying AAP-induced metabolic abnormalities are only partially understood. Antipsychotic-induced weight gain may occur as a result of increases in food intake and/or changes in feeding. OBJECTIVE In this review, we examine the available human and preclinical literature addressing AAP-related changes in feeding behavior, to determine whether changes in appetite and perturbations in regulation of food intake could be contributing factors to antipsychotic-induced weight gain. RESULTS In general, human studies point to disruption by AAPs of feeding behaviors and food consumption. In rodents, increases in cumulative food intake are mainly observed in females; however, changes in feeding microstructure or motivational aspects of food intake appear to occur independent of sex. CONCLUSIONS The findings from this review indicate that the varying levels of AAP-related weight gain reflect changes in both appetite and feeding behaviors, which differ by type of AAP. However, inconsistencies exist among the studies (both human and rodent) that may reflect considerable differences in study design and methodology. Future studies examining underlying mechanisms of antipsychotic-induced weight gain are recommended in order to develop strategies addressing the serious metabolic side effect of AAPs.
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Crichton GE, Elias MF, Robbins MA. Association between depressive symptoms, use of antidepressant medication and the metabolic syndrome: the Maine-Syracuse Study. BMC Public Health 2016; 16:502. [PMID: 27287001 PMCID: PMC4902917 DOI: 10.1186/s12889-016-3170-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/29/2016] [Indexed: 12/26/2022] Open
Abstract
Background Both depression and the metabolic syndrome (MetS) are two major public health issues. The aim of this study was to examine associations between depressive symptoms, the use of antidepressant medications, and the prevalence of MetS. Methods Cross-sectional analyses were undertaken on 970 participants from the Maine-Syracuse Study. Depressive symptoms were measured using two self-reported depression scales, the Center for Epidemiological Studies Depression Scale (CES-D), and the Zung self-rating depression scale. Antidepressant medication use was also self-reported. MetS was defined according to the recent harmonized criteria. Results The risk of MetS were approximately 79 and 86 % higher for those in the highest quartile for the CESD and the Zung (CES-D: OR = 1.79, p = 0.003; Zung: OR = 1.71, p = 0.006), compared to those in the lowest quartile. With adjustment for socio-demographic variables, lifestyle factors and C-reactive protein (CRP), risk was attenuated, but remained statistically significant for the CES-D. In those who reported using antidepressant medication, the odds of having MetS were over 2-fold higher (OR = 2.22, p < 0.001, fully adjusted model), compared to those who did not use antidepressants. Both measures of depressed mood were also associated with low high density-lipoprotein (HDL) cholesterol levels. Antidepressant use was associated with elevated fasting plasma glucose concentrations, hypertension, and low HDL-cholesterol. Conclusion Depressive symptoms and the use of antidepressant medications are associated with the prevalence of MetS, and with some of the individual components of the syndrome.
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Affiliation(s)
- Georgina E Crichton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - Merrill F Elias
- Department of Psychology, University of Maine, Orono, ME, USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA
| | - Michael A Robbins
- Department of Psychology, University of Maine, Orono, ME, USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA
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Yang CY, Lo SC, Peng YC. Prevalence and Predictors of Metabolic Syndrome in People With Schizophrenia in Inpatient Rehabilitation Wards. Biol Res Nurs 2016; 18:558-66. [PMID: 27268516 DOI: 10.1177/1099800416653184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atypical antipsychotic medications increase the risk of developing metabolic syndrome (MetS) and cardiovascular diseases in people with schizophrenia. AIM To explore the prevalence of MetS and the predictors associated with the number of MetS components in people with chronic schizophrenia. METHODS We recruited 357 participants from 10 rehabilitation wards in northern Taiwan. The Beck Anxiety Inventory, Beck Depression Inventory-II, Health-Promoting Lifestyle Profile (HPLP), and modified Baecke physical activity questionnaire were used to evaluate the participants. MetS prevalence was calculated using the modified Adult Treatment Panel III criteria for Asians. RESULTS The prevalence of MetS in this sample was 37.8%. Multinomial logistic regression revealed that the HPLP-exercise score (odds ratio [OR] = 0.411, p = .002) and depressive symptoms (OR = 0.949, p = .040) were protective factors for ≥4 MetS components. The leisure physical activity level (OR = .536, p = .024) was a protective factor for three MetS components. Body mass index ≥24 kg/m(2) was the strongest risk factor for two MetS components (OR = 8.057, p < .001), three MetS components (OR = 11.287, p < .001), and ≥four MetS components (OR = 15.621, p < .001). Additionally, participants' age >40 (OR = 3.638, p = .012) was a risk factor for ≥four MetS components. CONCLUSION In this study, the prevalence of MetS was higher than that reported for patients utilizing community-based services in Taiwan. The important risk factors for MetS were being overweight and older than 40. The protective factors for MetS were a high HPLP-exercise score and leisure-based physical activities.
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Affiliation(s)
- Chiu-Yueh Yang
- Department of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Su-Chen Lo
- Department of Nursing, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ying-Chieh Peng
- Department of Nursing, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
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Remington G, Lee J, Agid O, Takeuchi H, Foussias G, Hahn M, Fervaha G, Burton L, Powell V. Clozapine’s critical role in treatment resistant schizophrenia: ensuring both safety and use. Expert Opin Drug Saf 2016; 15:1193-203. [DOI: 10.1080/14740338.2016.1191468] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- G. Remington
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - J. Lee
- Department of General Psychiatry 1, Institute of Mental Health, Singapore, Singapore
| | - O. Agid
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - H. Takeuchi
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - G. Foussias
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - M. Hahn
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - G. Fervaha
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - L. Burton
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - V. Powell
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Kan C, Kaar SJ, Eisa M, Jones L, Beckett J, Mustafa O, Ismail K. Diabetes management in psychiatric inpatients: time to change? Diabet Med 2016; 33:407-8. [PMID: 26104060 DOI: 10.1111/dme.12838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/26/2022]
Affiliation(s)
- C Kan
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience
| | - S J Kaar
- General Adult Psychiatry, South London and Maudsley NHS Foundation Trust
| | - M Eisa
- General Adult Psychiatry, Barnet, Enfield and Haringey NHS Trust
| | - L Jones
- General Adult Psychiatry, South London and Maudsley NHS Foundation Trust
| | - J Beckett
- General Adult Psychiatry, South London and Maudsley NHS Foundation Trust
| | - O Mustafa
- Department of Diabetes, King's College Hospital, King's Health Partners, London, UK
| | - K Ismail
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience
- Department of Diabetes, King's College Hospital, King's Health Partners, London, UK
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Cardiovascular Disease Mortality of Medicaid Clients with Severe Mental Illness and a Co-occurring Substance Use Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:284-292. [DOI: 10.1007/s10488-016-0722-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rathmann W, Pscherer S, Konrad M, Kostev K. Diabetes treatment in people with type 2 diabetes and schizophrenia: Retrospective primary care database analyses. Prim Care Diabetes 2016; 10:36-40. [PMID: 25937183 DOI: 10.1016/j.pcd.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/27/2015] [Accepted: 04/04/2015] [Indexed: 11/22/2022]
Abstract
AIMS Aim of this study were to compare outcomes (HbA1c, BMI) and antidiabetic treatment of type 2 diabetes patients with and without schizophrenia under real-life conditions in primary care practices in Germany. METHODS 1321 type 2 diabetes patients with and 1321 matched controls (age, sex, diabetes duration, diabetologist care, practice) without schizophrenia in 1072 general practices throughout Germany were retrospectively analyzed (Disease Analyser: 01/2009-12/2013). Antidiabetic treatment, HbA1c and BMI were compared using paired t-tests, McNemar tests and conditional logistic regression adjusting for macro- and microvascular comorbidity (ICD-10). RESULTS Mean age (±SD) of patients and controls was 67.4±13.2 years (males: 38.9%). Diabetes duration was 5.7±4.3 years, 6% were in diabetologist care. Private health insurance was less often found among patients with schizophrenia than controls (2.2% vs 6.3%; p<0.0001). There was no difference in the mean HbA1c values (cases: 7.1±1.4%; controls: 7.2±1.5%) (54.1 vs. 55.2 mmol/mol) (p=0.8797) and in the average BMI (32.4±6.6 vs. 31.0±5.0 kg/m(2); p=0.2072) between the two groups. Novel cost-intensive antidiabetic agents (DPP-4- or SGLT2-inhibitors, GLP-1 receptor agonists) were less often prescribed in cases (15.3 vs. 18.3%; p=0.0423). However, in multivariable logistic regression, schizophrenia (odds ratio, 95%CI: 1.101; 0.923-1.317) was not associated with prescription use of novel antidiabetic agents (reference: other antidiabetic agents) after adjusting for private health insurance (OR: 2.139; 1.441-3.177) and comorbidity. CONCLUSIONS There is no evidence that type 2 diabetes patients with schizophrenia have worse diabetes control than those without a severe mental illness in general practices.
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Affiliation(s)
- Wolfgang Rathmann
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
| | | | - Marcel Konrad
- Fresenius University of Applied Sciences, Idstein, Germany
| | - Karel Kostev
- Fresenius University of Applied Sciences, Idstein, Germany; IMS Health, Frankfurt, Germany.
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Gelberg HA, Kwan CL, Mena SJ, Erickson ZD, Baker MR, Chamberlin V, Nguyen C, Rosen JA, Shah C, Ames D. Meal replacements as a weight loss tool in a population with severe mental illness. Eat Behav 2015; 19:61-4. [PMID: 26172565 DOI: 10.1016/j.eatbeh.2015.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/08/2015] [Accepted: 06/24/2015] [Indexed: 11/17/2022]
Abstract
Weight gain and worsening metabolic parameters are often side effects of antipsychotic medications used by individuals with severe mental illness. To address this, a randomized, controlled research study of a behavioral weight management program for individuals with severe mental illness was undertaken to assess its efficacy. Patients unable to meet weight loss goals during the first portion of the year-long study were given the option of using meal replacement shakes in an effort to assist with weight loss. Specific requirements for use of meal replacement shakes were specified in the study protocol; only five patients were able to use the shakes in accordance with the protocol and lose weight while improving metabolic parameters. Case studies of two subjects are presented, illustrating the challenges and obstacles they faced, as well as their successes. Taking responsibility for their own weight loss, remaining motivated through the end of the study, and incorporating the meal replacement shakes into a daily routine were factors found in common with these patients. Use of meal replacements shakes with this population may be effective.
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Affiliation(s)
- Hollie A Gelberg
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
| | - Crystal L Kwan
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
| | - Shirley J Mena
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
| | - Zachary D Erickson
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
| | - Matthew R Baker
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
| | - Valery Chamberlin
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 16111 Plummer Street, North Hills, CA 91343, United States.
| | - Charles Nguyen
- Department of Veterans Affairs Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, United States.
| | - Jennifer A Rosen
- Department of Veterans Affairs Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, United States.
| | - Chandresh Shah
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 351 East Temple Street, Los Angeles, CA 90012, United States.
| | - Donna Ames
- Department of Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
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Richards L, Batscha CL, McCarthy VL. Lifestyle and Behavioral Interventions to Reduce the Risk of Metabolic Syndrome in Community-Dwelling Adults With Serious Mental Illness: Implications for Nursing Practice. J Psychosoc Nurs Ment Health Serv 2015; 54:46-55. [PMID: 26565415 DOI: 10.3928/02793695-20151109-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/13/2015] [Indexed: 11/20/2022]
Abstract
Adults with mental illness are at increased risk of being diagnosed with metabolic syndrome and consequently cardiovascular disease, diabetes, and stroke. The current article explores community-based interventions to decrease the risk of metabolic syndrome by changing health behaviors among adults with serious mental illness (SMI). Ovid Medline, PsycINFO, and CINAHL were searched for nonpharmacological studies of behavioral or lifestyle interventions addressing risk of metabolic syndrome among adults with SMI. Thirteen studies, seven with statistically significant results, were included in the review. Despite the well-known risks of metabolic syndrome, the majority of available studies had small samples with insufficient power. There was little consistency in methods or outcome measures. Studies that were client-directed and involved peer and staff support appeared most useful in changing health behaviors and improving quality of life. Further research is needed to guide nursing practice in implementing effective methods to reduce the risk of metabolic syndrome in community-dwelling adults with SMI.
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Kisely S, Ehrlich C, Kendall E, Lawrence D. Using Avoidable Admissions to Measure Quality of Care for Cardiometabolic and Other Physical Comorbidities of Psychiatric Disorders: A Population-Based, Record-Linkage Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:497-506. [PMID: 26720507 PMCID: PMC4679130 DOI: 10.1177/070674371506001105] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Quality of care for comorbid physical disorders in psychiatric patients can be assessed by the number of avoidable admissions for ambulatory care sensitive (ACS) conditions. These are admissions for physical conditions that, with appropriate primary care, should not require inpatient treatment. Avoidable admissions for ACS conditions feature prominently in Australia's National Health Performance Framework and have been used to assess health care provision for marginalized groups, such as Indigenous patients or those of lower socioeconomic status. They have not been applied to people with mental illness. METHODS A population-based, record-linkage analysis was used to measure ACS admissions for physical disorder in psychiatric patients of state-based facilities in Queensland, Australia, during 5 years. RESULTS There were 77 435 males (48.0%) and 83 783 females (52%) (total n = 161 218). Among these, 13 219 psychiatric patients (8.2%) had at least 1 ACS admission, the most common being for diabetes (n = 6086) and angina (n = 2620). Age-standardized rates were double those of the general population. Within the psychiatric group, and after adjusting for confounders, those who had ever been psychiatric inpatients experienced the highest rates of ACS admissions, especially for diabetes. CONCLUSIONS In common with other marginalized groups, psychiatric patients have increased ACS admissions. Therefore, this measure could be used as an indicator of difficulties in access to appropriate primary care in Canada, given the availability of similar administrative data.
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Affiliation(s)
- Steve Kisely
- Professor, Departments of Psychiatry and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Professor, The University of Queensland School of Medicine, Queensland, Australia
| | - Carolyn Ehrlich
- Research Fellow, Population and Social Health Research Program, Griffith University, Queensland, Australia
| | - Elizabeth Kendall
- Professor, Population and Social Health Research Program, Griffith University, Queensland, Australia
| | - David Lawrence
- Professor, Centre for Child Health Research, The University of Western Australia, Perth, Australia
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Grover S, Nebhinani N, Padmavati R, Chadda RK, Tirupati S, Pallava A. Metabolic syndrome in antipsychotic naïve patients with schizophrenia: pooled analysis of data from three Indian studies. Early Interv Psychiatry 2015; 9:357-62. [PMID: 24438348 DOI: 10.1111/eip.12117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 12/07/2013] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to assess the prevalence of metabolic syndrome (MS) and subthreshold MS in antipsychotic naïve patients with schizophrenia by pooling the data from three different centres in India. METHODS One hundred thirty-seven antipsychotic naïve patients with schizophrenia were evaluated for MS using common criteria for clinical diagnosis. RESULTS Twenty-six patients (19%) met consensus criteria. Additionally, 56 patients (40.9%) fulfilled one criterion and 32 patients (23.3%) fulfilled two criteria of MS out of five criteria. CONCLUSION One-fifth of antipsychotic naïve patients with schizophrenia had MS and another two-third had at least one metabolic abnormality. Awareness of such a high risk is vitally important for rational selection of antipsychotic medications as well as effective implementation of preventive measures.
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Affiliation(s)
- Sandeep Grover
- Postgraduate Institute of Medical Education and Research, Chandigarh
| | | | | | | | - Srinivasan Tirupati
- Hunter New England Area Health Service, The University of Newcastle, Newcastle, NSW, Australia
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Hellings JA, Jadhav M, Jain S, Jadhav S, Genovese A. Low Dose Loxapine: Neuromotor Side Effects and Tolerability in Autism Spectrum Disorders. J Child Adolesc Psychopharmacol 2015; 25:618-24. [PMID: 26485086 DOI: 10.1089/cap.2014.0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE New and repurposed drugs are urgently needed to treat individuals with autism spectrum disorders (ASD). Loxapine (LOX) in low doses of 5-15 mg/day resembles an atypical antipsychotic (Stahl 2002 ). Our recent open pilot study of LOX found significant behavioral improvements and overall weight neutrality in 16 adolescents and adults with ASD. The present study examined an outpatient sample for LOX neuromotor tolerability. METHODS Consecutive outpatients with Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision (DSM-IV-TR) ASD diagnoses receiving LOX were examined for tardive dyskinesia (TD) and extrapyramidal side effects (EPS) using the Dyskinesia Identification System: Condensed User Scale (DISCUS), and for akathisia using the Barnes Akathisia Rating Scale. Data were also then retrospectively extracted from clinic charts regarding age, gender, diagnoses, LOX doses, treatment duration, concomitant medications, and LOX dosage reductions. RESULTS Thirty-four subjects (25 male, 9 female) participated. Mean age was 23.4 years at LOX initiation (range 8-52). Thirteen subjects (38.2%) received loxapine for ≥5 years. Mean LOX dose was 8.9 mg/day (range 5-30 mg) and mean duration was 4.2 years (range 0.8-13). Fourteen subjects (41.2%) received concomitant atypical antipsychotics. Benztropine was prescribed in 5 of 34 subjects (14.7%). Three subjects manifested tics at baseline, but lower final DISCUS scores. Subject 26, with Prader-Willi syndrome, manifested TD. Apart from LOX 5 mg daily he received paroxetine 40 mg daily, which reduces LOX metabolism significantly. Akathisia objective scores were positive in 6 subjects (17.6%): Subject 2 scored 3 (pacing was present also at baseline); subjects 6, 7, and 11 each scored 1; and subjects 18 and 23 each scored 2. Six of 9 subjects (66.7%) with expressive language were positive for subjective akathisia. CONCLUSIONS Low dose LOX was well tolerated, with lower than expected TD rates. This confirms clinical resemblance to an atypical antipsychotic. Individuals with neuromuscular problems including Prader-Willi Syndrome receiving LOX require close monitoring. Further study of LOX in ASD is warranted.
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Affiliation(s)
- Jessica A Hellings
- 1 Department of Psychiatry, The Ohio State University Nisonger Center , Columbus, Ohio.,2 Department of Psychiatry, University of Kansas Medical Center , Kansas City, Kansas
| | - Mandar Jadhav
- 2 Department of Psychiatry, University of Kansas Medical Center , Kansas City, Kansas.,3 Ross University School of Medicine , Miramar, Florida
| | - Seema Jain
- 1 Department of Psychiatry, The Ohio State University Nisonger Center , Columbus, Ohio.,4 The Ohio State University College of Medicine , Columbus, Ohio
| | - Sneha Jadhav
- 2 Department of Psychiatry, University of Kansas Medical Center , Kansas City, Kansas
| | - Ann Genovese
- 2 Department of Psychiatry, University of Kansas Medical Center , Kansas City, Kansas
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