Psychotropic-Induced Weight Gain: Liability, Mechanisms and Treatment Approaches. In: Mcelroy SL, Allison DB, Bray GA, editors. Obesity and Mental Disorders. Informa Healthcare; 2006. pp. 307-54. [DOI: 10.3109/9780849374517.014]

Aripiprazole: pharmacology and evidence in bipolar disorder

Aripiprazole is a psychotropic agent with a novel pharmacologic profile. The purpose of this article is to review the pharmacology, efficacy and safety of aripiprazole in bipolar disorder. The authors conducted a PubMed search of all English-language articles published between January 1995 and February 2007. The key search term was 'aripiprazole' combined with: 'randomized controlled trial', 'pharmacology', 'pharmacokinetics', 'pharmacodynamics', 'depression', 'mania', 'maintenance' and 'bipolar disorder'. Abstracts and proceedings from national and international psychiatric meetings were also reviewed. The search was augmented with a manual review of relevant article reference lists. This review is limited to pivotal registration, as well as acute and maintenance, randomized controlled trials in bipolar disorder. Aripiprazole is established as efficacious in acute mania and in the maintenance treatment of bipolar disorder. Aripiprazole has a favorable safety and tolerability profile, with minimal propensity for clinically significant weight gain and metabolic disruption. Extrapyramidal side effects, such as akathisia, are reported and may be treatment limiting in some cases. The hazard risk for tardive dyskinesia in the bipolar population is unknown. Aripiprazole constitutes an alternative mood-stabilizing pharmacologic avenue in bipolar disorder; its comparative efficacy in long-term recurrence prevention and bipolar depression is a future research vista.

Genetics of antipsychotic treatment emergent weight gain in schizophrenia

Classic and modern antipsychotics can induce substantial weight gain causing diabetes, lipid abnormalities and psychological distress. Treatment emergent weight gain varies within the broad class of antipsychotics; however, an individual's propensity to develop weight gain largely depends on genetic factors. The first part of this review highlights current ideas and concepts related to antipsychotic-induced weight gain, including principles on energy homeostasis. The second part summarizes genetic findings emphasizing studies published after 2003 as prior studies have been reviewed in detail elsewhere. Candidate gene studies have produced significant findings in the 5-hydroxytryptamin 2C (5HT2C) and adrenergic alpha2a (ADRalpha2a) receptor genes, as well as in the leptin, guanine nucleotide binding protein (GNB3) and synaptomal-associated protein 25kDa (SNAP25) genes. Results from genome-wide association and linkage studies point to several chromosomal regions (e.g., 12q24) and some specific genes (e.g., promelanin concentrating hormone [PMCH], polycyctic kidney and hepatic disease 1 [PKHD1], peptidylglycine alpha-amidating monooxygenase [PAM]). However, more efforts are needed before risk prediction and personalized medicine can be made available for antipsychotic-induced weight gain.