Newcomer JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry. 68 (suppl 1): 20-27

Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 02/2007; 68 Suppl 1(Suppl 1):20-7.
Source: PubMed


Compared with the general population, persons with schizophrenia have up to a 20% shorter lifespan, with cardiovascular disease as the leading cause of death. In addition, persons with schizophrenia have increased prevalence of the metabolic syndrome (obesity, insulin resistance, dyslipidemia, impaired glucose tolerance, and hypertension), increased prevalence of risk factors such as smoking, poverty, and poor nutrition, and reduced access to medical care. Results from the recent Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) provide further evidence of the metabolic risk associated with different atypical antipsychotics. Based on this study and a growing number of other randomized clinical trials, clozapine and olanzapine treatment can produce substantial mean changes in weight and an increased risk of associated metabolic disturbances. Risperidone and quetiapine treatment can produce intermediate changes in mean weight in comparison to treatment with other atypical antipsychotics, with discrepant results with respect to metabolic risk. Aripiprazole and ziprasidone treatment induced the lowest mean changes in weight gain and had no effect on risk for adverse metabolic changes, among currently available atypical agents. Considerable evidence indicates that mentally ill patients often do not receive adequate recognition of, monitoring of, or care for their medical illnesses. There is a critical need for psychiatrists and primary care professionals to increase awareness of and attention to the physical health problems of persons with mental illness, including appropriate management of metabolic adverse events associated with psychiatric medications.

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    • "For both psychosis and depression, a number of explanations have been proposed, including lifestyle and dietary habits (i.e. sedentary behavior, sleep dysregulation, and increased appetite) [28] [29], alterations of the hypothalamic–pituitary–adrenal axis (HPA) [30] [31], vulnerability to a genotypic peculiar form of MetS [32] [33] [34] [35] and direct action of antidepressant and antipsychotic drugs on lipid and carbohydrate metabolism [36] [37] [38] [39] [40] [41]. "
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    ABSTRACT: Objective: Several studies indicate increased prevalence of metabolic syndrome (MetS) among patients with psychiatric disorders as well as among individuals with gender dysphoria (GD) treated by cross-sex hormonal treatment. However, the MetS prevalence among hormone treated GD individuals suffering from psychiatric problems has not been detected. Methods: From a sample of 146 GD patients we selected 122 metabolically healthy individuals in order to investigate the prevalence of MetS after the beginning of the cross-sex hormonal treatment in a 2 year follow-up assessment. Furthermore, we assessed differences in MetS prevalence between hormone treated GD patients with and without concomitant psychiatric problems. Results: When treated with hormone therapy, GD patients reported changes in several parameters which are clustered in MetS, with statistically significant differences compared to baseline. Glyco-insulinemic alterations were more pronounced in male to female patients (MtFs). However, weight gain, waist circumference increases, blood pressure increases, and lipid alterations were similar in MtFs and female to male patients (FtMs). 14.8% of the sample at year 1 and 17.2% at year 2 developed MetS. Among patients with concomitant psychiatric problems, 50% at year 1 and 55% at year 2 developed MetS against 8% at year 1 and 10% at year 2 of patients without concomitant psychiatric problems. Conclusion: This study indicates that sex hormones induce MetS in a relatively low proportion of healthy GD individuals and especially during the first year of hormonal treatment. Most importantly, concomitant psychiatric problems are associated with considerably greater MetS prevalence in hormone treated GD individuals.
    Journal of Psychosomatic Research 02/2015; 78(4). DOI:10.1016/j.jpsychores.2015.02.001 · 2.74 Impact Factor
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    • "Also, moving from a organisational facility to a foster family has been shown to increase the probability of being prescribed antipsychotics(Bygdnes & Kristiansen, 2007). An additional problem related to the use of antipsychotic medications is the under-treatment of the physical problems they cause (Newcomer, 2007). Finally, the deinstitutionalisation(Dorvil & Guttman, 1997)of the members of this population, who rarely cook for themselves(Wirshing, Smith, Erickson, Mena, & Wirshing, 2006), transferred the food control from the institutions, which played a negligible role in the obesity problematic(Fox, Burkhart, & Rotatori, 1983), to the foster families. "

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    • "Second-generation antipsychotics (SGAs) have been increasingly used for patients with schizophrenia due to their increased efficacy and reduced risk of extrapyramidal side effects compared with firstgeneration antipsychotics (Leucht et al., 2009). Among SGAs, clozapine and olanzapine had great liability to induce weight gain and metabolic adverse reactions (Allison et al., 1999; Newcomer, 2007). These "
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    ABSTRACT: Second-generation antipsychotics (SGAs) have been associated with an increased liability for weight gain and metabolic side effects. Among SGAs, clozapine and olanzapine had great liability to induce weight gain and metabolic adverse reactions. Leptin, adiponectin, and total ghrelin play important roles in energy homeostasis and are suggested to be biomarkers of metabolic disturbances. The purpose of the present study was to investigate the differential effects of antipsychotics (olanzapine and clozapine) on the levels of adipocytokines (leptin and adiponectin) and total ghrelin. Three hundred and thirty-three patients with schizophrenia under clozapine or olanzapine monotherapy were recruited. Control participants were recruited from a healthy community population based on a health investigation (N=119). Fasting blood samples for glucose, cholesterol, triglycerides, leptin, adiponectin, and total ghrelin were analyzed. There were significant differences in the levels of cholesterol, triglycerides, and glucose between these three groups. Post hoc comparisons showed that the olanzapine group had the highest levels of cholesterol and triglycerides. The levels of leptin, adiponectin, and total ghrelin were also significantly different between the three groups after controlling age and body mass index (BMI). Post hoc comparisons showed that the olanzapine group had the lowest levels of adiponectin and total ghrelin. The present study found that the uses of olanzapine and clozapine were associated with changes in adipocytokines and total ghrelin, even after adjusting potential confounding factors. Olanzapine had greater influences on adiponectin and total ghrelin than clozapine. The changes in adipocytokines and total ghrelin were a direct effect of antipsychotics on hormonal pathways of energy homeostasis, rather than the result of weight gain. Copyright © 2014. Published by Elsevier Inc.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 12/2014; 58. DOI:10.1016/j.pnpbp.2014.12.001 · 3.69 Impact Factor
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