The metabolic effects of antipsychotic medication

Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 08/2006; 51(8):480-91.
Source: PubMed


To review current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and type 2 diabetes mellitus (T2DM) and to examine the relation of adiposity to medical risk.
We identified relevant publications through a search of MEDLINE from the years 1975 to 2006, using the following primary search parameters: "diabetes or hyperglycemia or glucose or insulin or lipids" and "antipsychotic." Meeting abstracts and earlier nonindexed articles were also reviewed. We summarized key studies in this emerging literature, including case reports, observational studies, retrospective database analyses, and controlled experimental studies.
Treatment with different antipsychotic medications is associated with variable effects on body weight, ranging from modest increases (for example, less than 2 kg) experienced with amisulpride, ziprasidone, and aripiprazole to larger increases during treatment with agents such as olanzapine and clozapine (for example, 4 to 10 kg). Substantial evidence indicates that increases in adiposity are associated with decreases in insulin sensitivity in individuals both with and without psychiatric disease. The effects of increasing adiposity, as well as other effects, may contribute to increases in plasma glucose and lipids observed during treatment with certain antipsychotics.
Treatment with certain antipsychotic medications is associated with metabolic adverse events that can increase the risk for metabolic syndrome and related conditions such as prediabetes, T2DM, and cardiovascular disease.

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    • "Schizophrenia is associated with an increased risk of type 2 diabetes and cardiovascular disease, which contributes to a lower life expectancy in these patients [1] [2] [3]. Anti-psychotic drugs are related to a significant weight gain, which may be one underlying risk factor for the increased diabetes risk and higher cardiovascular morbidity in schizophrenia [4] [5]. Patients with schizophrenia may also have less access to general healthcare with less opportunity for cardiovascular risk screening and prevention than in the non-psychiatric population [6]. "
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    ABSTRACT: 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. 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). 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. 55.2mmol/mol) (p=0.8797) and in the average BMI (32.4±6.6 vs. 31.0±5.0kg/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. 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. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · Apr 2015
    • "Obesity is a major public health concern and individuals with serious mental illnesses are at increased risk for overweight and obesity compared with the general public (Allison et al., 2009; Dickerson et al., 2006; Sicras, Rejas, Navarro, Serrat, & Blanca, 2008. Factors associated with obesity include poor dietary intake (Casagrande et al., 2011), lack of physical activity (Okoro et al., 2014), and psychiatric medications that contribute to weight gain (Newcomer & Haupt, 2006). A high incidence of obesity-related conditions such as cardiovascular disease and early mortality has led to the recognition that weight loss programs are needed for people in recovery. "
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    ABSTRACT: This purpose of this study was to evaluate the Nutrition and Exercise for Wellness and Recovery (NEW-R) weight loss intervention. Using a pretest/posttest design, 18 participants recruited from a community-based mental health program were assessed at baseline, immediately following the intervention (8 weeks), and at 6-month follow-up. The intervention was delivered by an occupational therapist and occupational therapy graduate students and consisted of 8 weekly sessions lasting 2 hr. Outcomes included changes in weight, and levels of knowledge about nutrition and exercise. Participants lost an average of 3 pounds at immediate postintervention, and lost an average of 10 pounds at the 6-month follow-up. Participants also demonstrated significant increases in their knowledge about nutrition and physical activity. The results of this study provide preliminary support for the impact of the NEW-R intervention on weight loss and knowledge about diet and exercise. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Apr 2015 · Psychiatric Rehabilitation Journal
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    • "An increasing number of reports suggest that the prevalence rate of MS among antipsychotics-naı¨ve patients with schizophrenia is higher than in the general population [25e27]. Also, despite the relationship between antipsychotics use and MS found in other reports [12] [28] [29], the use of antipsychotics (FGA, SGA, or FGA þ SGA) in our study was not found to have significant association with MS in our regression model. Therefore, it may be that the high prevalence rate of MS Table 5 Ten-year risk of coronary artery disease. "
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    ABSTRACT: The prevalence rate of metabolic syndrome (MS) and coronary artery disease (CAD) has been found to be high in patients with chronic schizophrenia. Current evidence shows that CAD is underdiagnosed in this group. Our study evaluated the prevalence of MS and the risk of CAD in patients with chronic schizophrenia in a chronic care mental hospital in southern Taiwan. We included all patients with the diagnosis of schizophrenia or schizoaffective disorder. We collected all laboratory, physical examination, psychiatric interview, and chart review data. We also evaluated the risk of CAD in these patients using the Framingham point system. There was no significant age difference in the MS prevalence rate in these patients. The young patients with schizophrenia in our study tended to have a higher prevalence of MS than the general population. In addition, female patients had a higher prevalence rate of MS than males. Based on the Framingham point system, we found the 10-year risk of CAD to be higher among the patients with schizophrenia than in the general population. Our study highlights the importance of the high risk of MS in both younger and older patients with schizophrenia, without a significant relationship to the use of antipsychotics. More complete cohort studies are needed to confirm these findings. Psychiatrists may want to establish more specific and detailed clinical guidelines for patients with chronic schizophrenia with comorbid physical diseases, especially MS and CAD.
    Full-text · Article · Nov 2014 · The Kaohsiung journal of medical sciences
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