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Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents. The prevalence of obesity, insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia, and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population. Risk reduction studies for persons with obesity, diabetes, and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction. In the landmark multi-center randomized-controlled trial study, the Diabetes Prevention Project (DPP), a cognitive/behavioral intervention, was more successful in producing weight loss and preventing diabetes than the drugs metformin, troglitazone or placebo. This pilot study examined the effectiveness of a cognitive/behavioral group intervention, modified after the DPP program, in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system. Outcome measures included body weight, body mass index, waist-hip ratios, and fasting glucose levels. Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33. The group that received the cognitive/behavioral group intervention lost more weight than the treatment as usual group. The CB group participants lost an average of 5.4 lb or 2.9% of body weight, and those in the control group lost 1.3 lb or 0.6% body weight. The range of weight loss for the treatment group was from 1 to 20 lb. This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder.
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PMID:A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics. 1650 43

Individuals with schizophrenia have higher rates of diabetes mellitus as compared with the general population, but little is known about their diabetic self-care. This grounded theory study was conducted to develop a theory of self-care for individuals with comorbid schizophrenia/schizoaffective disorder and diabetes. Twenty-six interviews were conducted among 11 respondents with varying degrees of ability to care for these coexisting illnesses. Respondents identified psychiatric symptoms as a major barrier to diabetic self-care. The resulting theory of Evolving Self-Care describes the process by which respondents developed self-care health beliefs over time to help them successfully manage their psychiatric disorder and diabetes. Categories include mastering mental illness, accommodating diabetes, and striving for health. When providing care to patients with schizophrenia/schizoaffective disorder and diabetes, advanced registered nurse practitioners are encouraged to provide education about the negative consequences of psychosis on diabetes self-care.
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PMID:Evolving self-care in individuals with schizophrenia and diabetes mellitus. 1654 42

Diabetes mellitus (DM) is more common among individuals with schizophrenia/schizoaffective disorders than among the general population. Eleven mental health consumers diagnosed with comorbid schizophrenia/schizoaffective disorder and DM participated in a grounded theory study that examined their approaches to diabetic self-care. The resulting model, Evolving Self-Care, describes the process by which respondents developed health beliefs about the self-care of dual illnesses. One subcategory of the model, Doing My Best, was further analyzed to examine the social context of respondents' diabetic self-care. Limited financial resources and material deprivation interfered with access to the resources necessary for adequate diabetic self-care. Mental health providers are encouraged to provide treatment and patient education that are consistent with the real world living situations of individuals with schizophrenia. Policymakers at the federal and state levels need to address the impact of financing of mental health services on the overall health of vulnerable individuals with serious mental illnesses.
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PMID:Doing my best: poverty and self-care among individuals with schizophrenia and diabetes mellitus. 1767 17

We report a case of a 29-year-old man with schizoaffective disorder in which diabetes mellitus and hypertriglyceridemia developed with quetiapine (Seroquels). We reviewed the literature on the relationship between antipsychotic therapy and development of metabolic disorders and found serious concerns. This case demonstrates the importance of a careful monitoring of glucose and other metabolic parameters in patients receiving atypical antipsychotics.
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PMID:Metabolic abnormalities associated with atypical antipsychotics: a case report and alert. 1738 Oct 36

Schizophrenic patients who are treated with antipsychotics, especially second generation antipsychotics, such as clozapine and olanzapine, manifest an increase in cholesterol and triglycerides as well as other changes associated with diabetes or the metabolic syndrome. Previous studies have shown that polymorphisms in several genes that regulate lipid metabolism can influence the levels of these lipids and response to drug treatment. We have investigated in an exploratory study whether polymorphisms in the apolipoprotein C-III (ApoC3), apolipoprotein A-V gene (ApoA5) and lipoprotein lipase genes influence differential lipid response to treatment with three second generation antipsychotics-olanzapine, clozapine and risperidone-or treatment with a first generation antipsychotic. A total of 189 patients with schizophrenia or schizoaffective disorder who were being treated with a single antipsychotic were studied in a cross-sectional study design in which fasting serum cholesterol and triglycerides and selected single-nucleotide polymorphosms (SNPs) in the three lipid metabolism genes were assessed. The treatment with antipsychotic monotherapy makes drug haplotype ascertainment less complex. Our analyses showed several nominally significant drug x gene and drug x haplotype interactions. The rarer C allele or the ApoA5_1131 (T/C) SNP was associated with higher cholesterol levels in patients treated with first generation antipsychotics and lower cholesterol levels in patients treated with olanzapine or clozapine. The rarer C allele of the ApoA5_SW19 (G/C) SNP was associated with higher cholesterol in risperidone-treated patients. An ApoA5 CG haplotype was associated with decreased cholesterol in olanzapine- or clozapine-treated patients and higher cholesterol in patients treated with first generation antipsychotics. The presence of the rarer T allele of the ApoC3_1100 (C/T) SNP or the presence of the ApoC3 TG haplotype was associated with decreased triglyceride levels in patients treated with olanzapine or clozapine and a nonsignificant trend for increased triglycerides in patients treated with first generation antipsychotics. The presence of the ApoC3 CC haplotype was associated with increased triglycerides in patients treated with olanzapine or clozapine. The overall magnitude of the effects was not large. These results provide a potential initial step toward a pharmacogenetic approach to selection of antipsychotic treatment which may help minimize the side effect of increases in serum lipids.
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PMID:Allelic variation in ApoC3, ApoA5 and LPL genes and first and second generation antipsychotic effects on serum lipids in patients with schizophrenia. 1772 53

Acetazolamide (AZD), a sulfa-like moiety, is a potent, nonspecific inhibitor of carbonic anhydrase (CA) enzymes and has been demonstrated to decrease lipogenesis in adipose cells in in vitro cell culture studies. In contrast, topiramate (a sulfamate moiety) appears to inhibit specific (CA) enzymes II and V. Four placebo-controlled trials with topiramate have demonstrated positive results in weight loss. There is only anecdotal evidence that AZD may cause weight loss. The following case is of a 49-year-old African-American woman with a long history of schizoaffective disorder, hypertension, diabetes type II, stress incontinence, and obesity (body mass index, 45.5 kg/m2). Previous trials of topiramate demonstrated temporary but significant weight loss before AZD use. A 4 week washout period occurred before starting AZD, 250 mg twice daily. Significant weight loss of 11.5 lbs was seen over 4 weeks. During washout periods of either topiramate or AZD, her total mean weight was approximately 2 to 7 lbs higher than when she was treated with AZD. Although tolerance and side effects may limit the use of AZD as a safe and effective strategy for medication-related weight gain, the pharmacology may provide research insights into the causes and treatments of obesity.
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PMID:Is acetazolamide similar to topiramate for reversal of antipsychotic-induced weight gain? 1809 Aug 83

Metabolic adverse effects such as hyperglycemia, alterations in insulin sensitivity, and weight gain are known to be potential complications of atypical antipsychotic therapy. In certain cases, hyperglycemia may be so profound that diabetic ketoacidosis (DKA) or hyperosmolar coma may result. Aripiprazole, approved by the United States Food and Drug Administration in 2002, appears to have fewer metabolic adverse effects than other atypical antipsychotics. We describe a 44-year-old man with no personal or family history of diabetes mellitus who was prescribed aripiprazole for schizoaffective disorder. Two weeks after starting this therapy, the patient developed DKA, which was corrected with insulin therapy and aggressive hydration. According to the Naranjo adverse drug reaction probability scale, aripiprazole was the probable trigger of his DKA. An exhaustive search for other causes of DKA was unrevealing. Administration of aripiprazole or any other atypical antipsychotic should be terminated when impaired glucose tolerance is suspected. Vigilance regarding the potential adverse effects of this class of drugs, including new agents such as aripiprazole, is crucial to preventing potentially life-threatening complications of hyperglycemia.
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PMID:Diabetic ketoacidosis associated with aripiprazole. 1875 91

Olanzapine treatment has been associated with clinically meaningful weight increases, hypertriglyceridemia, insulin resistance, and diabetes mellitus. There are few options for olanzapine responders who fail other antipsychotic agents. Aripiprazole is a potent (high-affinity) partial agonist at D2 and 5-HT1A receptors and a potent antagonist at 5-HT2A receptor and is associated with less weight gain than olanzapine. We report the results of a 10-week placebo-controlled, double-blind crossover study that examined 15 mg/d aripiprazole's effects on weight, lipids, glucose metabolism, and psychopathology in overweight and obese schizophrenia and schizoaffective disorder subjects treated with a stable dose of olanzapine. During the 4 weeks of aripiprazole treatment, there were significant decreases in weight (P = 0.003) and body mass index (P = 0.004) compared with placebo. Total serum cholesterol (P = 0.208), high-density lipoprotein cholesterol (HDL-C; P = 0.99), HDL-2 (P = 0.08), HDL-3 (P = 0.495), and low-density lipoprotein cholesterol (P = 0.665) did not change significantly comparing aripiprazole treatment to placebo treatment. However, total serum triglycerides (P = 0.001), total very low-density lipoprotein cholesterol (VLDL-C; P = 0.01), and VLDL-1C and VLDL-2C (P = 0.012) decreased significantly during the aripiprazole treatment phase. The VLDL-3C tended lower during aripiprazole, but the decrease was not significant (P = 0.062). There was a decrease in C-reactive protein comparing aripiprazole treatment to placebo, although it did not reach significance (P = 0.087). The addition of aripiprazole to a stable dose of olanzapine was well tolerated and resulted in significant improvements on several outcome measures that predict risk for medical morbidity.
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PMID:Aripiprazole added to overweight and obese olanzapine-treated schizophrenia patients. 2063 76

Rapid weight gain among patients with mental disorders can further compound psychological distress and negatively influence compliance. Weight gain associated with treatment with atypical antipsychotic medication has been widely recognized as a risk factor for the development of diabetes type II and cardiovascular diseases. This paper describes a 33-year old female patient treated for schizoaffective disorder. Within two months after introducing quetiapine the patient experienced considerable weight gain amounting to 19 kg. The replacement of antipsychotic during inpatient psychiatric care resulted in weight loss.
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PMID:Weight gain--as possible predictor of metabolic syndrome. 2144 10

To facilitate the development of a therapeutic alliance in genetic counseling, it is important that the counselor understands how families might perceive the condition that constitutes the reason for the referral. Through training and professional practice, genetic counselors develop a thorough understanding of families' perceptions of the conditions that are common indications for genetic counseling. But, for referral indications that are less frequent, like serious mental illnesses, genetic counselors may feel less confident in their understanding of the family's experience, or in their ability to provide psychosocial support when serious mental illness is reported in a family history. This may impede the establishment of a therapeutic alliance. As research shows that most referrals for genetic counseling related to serious mental illness are for female first-degree family members of affected individuals, we sought to explore how this group perceives serious mental illness. To provide a frame of reference with which genetic counselors may be more familiar, we explored how women perceived serious mental illness compared to other common complex disorders in their family. We conducted semi-structured interviews with women who had a child with a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder) and a first-degree relative with another common complex disorder (diabetes, heart disease, cancer). Interviews were transcribed and subjected to thematic analysis. Saturation was reached when nine women had participated. Serious mental illness was perceived as being more severe and as having a greater impact on the family than diabetes, heart disease, or cancer. Themes identified included guilt, stigma, and loss. Some of the most important issues that contribute to mothers' perceptions that serious mental illness is more severe than other common complex disorders could be effectively addressed in genetic counseling. Developing a heightened awareness of how family members experience a relative's mental illness may help genetic counselors to be better able to provide psychosocial support to this group, whether serious mental illness constitutes the primary reason for referral or appears in the family history during counseling for a different referral reason.
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PMID:Mothers' perspectives on their child's mental illness as compared to other complex disorders in their family: insights to inform genetic counseling practice. 2208 36


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