There is a growing concern regarding the propensity of second generation antipsychotics (SGAs) to induce weight gain and metabolic adverse effects. Recent consensus guidelines have recommended assessment and monitoring procedures to appropriately detect and manage these adverse effects. This study addresses the appreciation and readiness of clinicians to implement management guidelines for these adverse effects. Respondents indicated awareness of the risks of treatment with SGAs. The extent of monitoring for metabolic adverse effects was low and inconsistent across measures and in frequency of evaluation. Ongoing efforts are needed to support and encourage change in clinician practice.
"Another study conducted by Buckley et al.  showed that 82% of psychiatrists thought that the risk for such abnormalities among their patients who were receiving antipsychotic medications was higher than in the general population. With regard to discussing informed consent, our study showed that only a minority of psychiatrists (1.2%) actually used a document to explain the risk of elevated blood glucose to patients when they were taking antipsychotics, similar to the results of Buckley et al. . "
[Show abstract][Hide abstract] ABSTRACT: There is growing concern about the metabolic abnormalities in patients with schizophrenia.
The aim of this study was to assess the attitudes of psychiatrists toward metabolic adverse events in patients with schizophrenia.
A BRIEF QUESTIONNAIRE WAS CONSTRUCTED TO COVER THE FOLLOWING BROAD AREAS: the psychiatrists' recognition of the metabolic risk of antipsychotic therapy, pattern of monitoring patients for physical risks, practice pattern for physical risks, and knowledge of metabolic disturbance. In March 2012, the questionnaire was mailed to 8,482 psychiatrists who were working at hospitals belonging to the Japan Psychiatric Hospitals Association.
The overall response rate was 2,583/8,482 (30.5%). Of the respondents, 85.2% (2,200/2,581) reported that they were concerned about prescribing antipsychotics that have a risk of elevating blood sugar; 47.6% (1,201/2,524) stated that their frequency of monitoring patients under antipsychotic treatment was based on their own experiences; and only 20.6% (5,22/2,534) of respondents answered that the frequency with which they monitored their patients was sufficient to reduce the metabolic risks.
Psychiatrists practicing in Japan were generally aware and concerned about the metabolic risks for patients being treated with antipsychotics. Although psychiatrists should monitor their patients for metabolic abnormalities to balance these risks, a limited number of psychiatrists answered that the frequency with which they monitored patients to reduce the metabolic risks was sufficient. Promotion of the best practices of pharmacotherapy and monitoring is needed for psychiatrists treating patients with schizophrenia.
PLoS ONE 01/2014; 9(1):e86826. DOI:10.1371/journal.pone.0086826 · 3.23 Impact Factor
"The adverse effects of long term weight gain have not escaped regulatory bodies. A number of clinical practice guidelines , ,  and other studies – all recommend choosing psychotropics least likely to cause weight gain, or switching to those less likely to cause weight gain – if weight gain occurs. This is because the CATIE trial data does provide some evidence that patients who stayed on medications with high propensity to induce weight gain, showed greater weight gain than those who switched from these medications to other drugs that were less likely to cause weight gain . "
[Show abstract][Hide abstract] ABSTRACT: Psychotropic medication use is associated with weight gain. While there are studies and reviews comparing weight gain for psychotropics within some classes, clinicians frequently use drugs from different classes to treat psychiatric disorders.
To undertake a systematic review of all classes of psychotropics to provide an all encompassing evidence-based tool that would allow clinicians to determine the risks of weight gain in making both intra-class and interclass choices of psychotropics.
We developed a novel hierarchical search strategy that made use of systematic reviews that were already available. When such evidence was not available we went on to evaluate randomly controlled trials, followed by cohort and other clinical trials, narrative reviews, and, where necessary, clinical opinion and anecdotal evidence. The data from the publication with the highest level of evidence based on our hierarchical classification was presented. Recommendations from an expert panel supplemented the evidence used to rank these drugs within their respective classes. Approximately 9500 articles were identified in our literature search of which 666 citations were retrieved. We were able to rank most of the psychotropics based on the available evidence and recommendations from subject matter experts. There were few discrepancies between published evidence and the expert panel in ranking these drugs.
Potential for weight gain is an important consideration in choice of any psychotropic. This tool will help clinicians select psychotropics on a case-by-case basis in order to minimize the impact of weight gain when making both intra-class and interclass choices.
PLoS ONE 06/2012; 7(6):e36889. DOI:10.1371/journal.pone.0036889 · 3.23 Impact Factor
"This issue should be stressed in the literature as well as in educational activities. Having elaborate guidelines (Marder et al., 2004; De Nayer et al., 2005; De Hert et al., 2006b) as such is not sufficient to change daily clinical practice, as is recently demonstrated in two surveys on screening for metabolic side effects (Newcomer et al., 2004; Buckley et al., 2005). Recent guidelines propose a switch to an antipsychotic with a safer metabolic profile when confronted with severe dyslipidaemia or other metabolic side effects, but this strategy has not been evaluated systematically. "
[Show abstract][Hide abstract] ABSTRACT: Mortality rates in patients with schizophrenia are double compared with the general population, with cardiovascular disease causing 50% of the excess. Lowering low-density lipoprotein cholesterol is recognized as a primary target for the prevention of cardiovascular mortality. The effects of lipid-lowering treatment were evaluated in patients with schizophrenia. Forty-six patients with schizophrenia and with severe dyslipidaemia were identified. All were treated with antipsychotics. Patients were screened for cardiovascular risk factors and examined at baseline when statin therapy was initiated. The effects of lipid-lowering medication on lipid profile, glucose homeostasis and components of metabolic syndrome were evaluated at 3 months follow-up. After 3 months of statin therapy, a significant decrease in triglycerides, total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and, in associated ratios, low-density lipoprotein/high-density lipoprotein, cholesterol/high-density lipoprotein was observed. No significant changes occurred in high-density lipoprotein cholesterol, body mass index, waist circumference or glucose homeostasis. The only component of metabolic syndrome affected by statin therapy has been the serum triglyceride level. Statins proved effective in the management of dyslipidaemia in patients with schizophrenia treated with antipsychotics. More complex treatment may be required for associated metabolic disturbances.
International Clinical Psychopharmacology 02/2007; 22(1):43-9. DOI:10.1097/YIC.0b013e3280113d3b · 2.46 Impact Factor
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