Beyond the "Hype" on the association between metabolic syndrome and atypical antipsychotics - The confounding effects of cohort, typical antipsychotics, severe mental illness, comedications, and comorbid substance use
"Primarily, studies of an observational nature have been conducted and have provided useful information. However, using observational data to compare outcomes associated with antipsychotic polypharmacy may result in biased estimates . Because the type of treatment (monotherapy or polypharmacy) was not randomly assigned in these prior studies, patients with specific characteristics, such as disease severity, could have been more likely to have been treated with polypharmacy. "
[Show abstract][Hide abstract] ABSTRACT: To compare the rate of relapse as a function of antipsychotic treatment (monotherapy vs. polypharmacy) in schizophrenic patients over a 2-year period.
Using data from a multicenter cohort study conducted in France, we performed a propensity-adjusted analysis to examine the association between the rate of relapse over a 2-year period and antipsychotic treatment (monotherapy vs. polypharmacy).
Our sample consisted in 183 patients; 50 patients (27.3%) had at least one period of relapse and 133 had no relapse (72.7%). Thirty-eight (37.7) percent of the patients received polypharmacy. The most severely ill patients were given polypharmacy: the age at onset of illness was lower in the polypharmacy group (p = 0.03). Patients that received polypharmacy also presented a higher general psychopathology PANSS subscore (p = 0.04) but no statistically significant difference was found in the PANSS total score or the PANSS positive or negative subscales. These patients were more likely to be given prescriptions for sedative drugs (p < 0.01) and antidepressant medications (p = 0.03). Relapse was found in 23.7% of patients given monotherapy and 33.3% given polypharmacy (p = 0.16). After stratification according to quintiles of the propensity score, which eliminated all significant differences for baseline characteristics, antipsychotic polypharmacy was not statistically associated with an increase of relapse: HR = 1.686 (0.812; 2.505).
After propensity score adjustment, antipsychotic polypharmacy is not statistically associated to an increase of relapse. Future randomised studies are needed to assess the impact of antipsychotic polypharmacy in schizophrenia.
[Show abstract][Hide abstract] ABSTRACT: The author's work builds on D.G. Lowe's (1987) theory of
perceptual groupings. Minimal processing is applied to an image to
extract edges. The edges are then represented as well-defined
two-dimensional patterns that the authors call interesting patterns. No
attempt is made to infer three-dimensional structure from the patterns,
and they are matched against two-dimensional models which are
projections of characteristic views of three-dimensional objects. The
patterns are built up from modular building blocks called triples
Computer Vision, 1990. Proceedings, Third International Conference on; 01/1991
[Show abstract][Hide abstract] ABSTRACT: Leptin dysregulation has been implicated in the body weight gain and metabolic dysfunction observed with the second generation antipsychotic drugs (SGAD) olanzapine and clozapine.
This study quantified the frequency of subjects with abnormal correlation between leptin and the body mass index controlling for gender (defined as being out of the upper or lower 95% confidence interval in the regression line when combining each group with the drug-free subjects) after prolonged treatment with olanzapine (n=126), clozapine (n=62), first generation antiypsychotics (n=91), other SGAD (n=22), other psychotropic drugs (n=65) and drug-free subjects (n=229).
None of the analysis was significant (p>0.05). In fact, in 17 out of 20 comparisons, the drug-free group had numerically higher frequencies of outliers than the corresponding treatment group. There were 28 outliers (4.7% of the total sample). In agreement with previous studies, cross-sectional analysis did not report gross alterations in serum leptin levels during olanzapine or clozapine administration.
Longitudinal studies should focus on leptin regulation early on treatment, on the frequency of abnormal leptin receptor sensitivity and/or specific polymorphisms in the leptin allele and on several confounding factors in order to design personalized preventive and therapeutic measures.
Schizophrenia Research 10/2008; 106(2-3):315-9. DOI:10.1016/j.schres.2008.08.031 · 3.92 Impact Factor
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