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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Atypical antipsychotics are a major advance in the management of schizophrenia. The reevaluation of widely held risk/benefit assessments of the various atypical antipsychotics provides an opportunity to improve treatment patterns. The best available clinical trial evidence indicates that efficacy among the atypical antipsychotics (at equivalent doses) is very similar, but safety and tolerability profiles differ significantly. Atypical antipsychotics differ markedly in their potential to cause metabolic disturbances, including obesity, diabetes, dyslipidemia, and the metabolic syndrome; clozapine and olanzapine carry the greatest risks, atypical antipsychotics like risperidone and quetiapine have lower risks, and newer agents like ziprasidone and aripiprazole are associated with minimal metabolic risks. Results from the Atypical Antipsychotic Therapy and Metabolic Issues (AtAMI) survey define important opportunities for improving medical and psychiatric outcomes during atypical antipsychotic therapy. (See accompanying article by Newcomer et al) Additional educational and research efforts are required to increase understanding of common conditions such as the metabolic syndrome, increase awareness of uncommon but serious events like diabetic ketoacidosis, and pancreatitis, and identify appropriate strategies for monitoring the risks/benefits of atypical antipsychotic therapy. As clinicians refine practice patterns regarding the atypical antipsychotics, they may require additional knowledge and resources to fully incorporate risk/benefit considerations and optimize long-term psychiatric and medical outcomes.
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PMID:Atypical antipsychotics and metabolic dysregulation: evaluating the risk/benefit equation and improving the standard of care. 1535 15

Psychiatry is constantly faced with challenges related to the medical status of its patients and comorbid effects of pharmacologic treatment for psychiatric disorders. Other articles in this supplement review how obesity, diabetes, and dyslipidemia play a role in the treatment of schizophrenia, but these issues are by no means limited to schizophrenia. As the population of the United States becomes more obese and sedentary over time, risk factors for cardiovascular disease and diabetes are increasing in prevalence and affect the treatment of any psychiatric condition. As our understanding of how metabolic factors contribute to disease grows, it has become clear that a clustering of individual dysmetabolic factors, now known as metabolic syndrome, can contribute to significant morbidity and mortality and should be accounted for in the treatment of psychiatric conditions.
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PMID:Metabolic syndrome: epidemiology and consequences. 1560 Mar 80

Dyslipidemia is an increasing problem in most industrialized societies and is a risk factor for coronary heart disease (CHD). Imbalances in individual lipid components, including total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and serum triglycerides, have each been shown to contribute to this increased risk. Certain psychiatric patient populations, such as those afflicted with schizophrenia, are of particular concern. Psychiatric patients with schizophrenia are naturally at increased risk for dyslipidemia and obesity, in part due to poor diet and sedentary lifestyle, but these conditions can be exacerbated by some antipsychotic medications. Clozapine and olanzapine, for example, appear to be associated with hyperlipidemia, which may be associated with changes in body weight. Other, newer antipsychotic agents may exhibit less liability for weight gain and the development of dyslipidemia. This review is intended to briefly highlight the association between dyslipidemia and cardiovascular disease, the changes in serum lipids associated with some antipsychotic agents, and how these changes in serum lipids affect the monitoring of schizophrenia patients.
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PMID:Dyslipidemia and atypical antipsychotic drugs. 1560 Mar 82

The introduction of atypical antipsychotic drugs has provided a clear benefit for many schizophrenia patients, with less risk for the extrapyramidal side effects associated with conventional antipsychotics. However, some antipsychotics are associated with an increased risk of adverse metabolic outcomes, including weight gain, dyslipidemia, and hyperglycemia. Increases in adiposity and disturbances in glucose and lipid metabolism represent a serious health risk in a patient that may be predisposed to these metabolic conditions. The increased risk for diabetes with certain antipsychotics may be associated with the risk of treatment-induced weight gain. However, other mechanisms, including effects on central neurotransmitters and direct effects on glucose metabolism, may contribute to the development of disordered glucose metabolism. The purpose of this article is to review the association between antipsychotic medications and obesity, insulin resistance, and diabetes, including the mechanisms through which these changes might be effected.
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PMID:Abnormalities of glucose metabolism associated with atypical antipsychotic drugs. 1560 Mar 83

Olanzapine (Zyprexa, Eli Lilly & Co.) is an atypical antipsychotic medication with once-daily dosing that was originally developed for the treatment of schizophrenia. It has shown broad efficacy in the treatment of bipolar mixed and manic episodes, but is less effective in the treatment of bipolar depression. Double-blind studies have demonstrated a rapid onset of action in acute bipolar mania, significantly greater rates of response compared with placebo, and a remission rate of 88.3% in a 49-week open-label study. Diverse presentations of the illness responded well to olanzapine including patients with rapid-cycling bipolar disorder, mixed episodes, as well as psychotic and nonpsychotic manias. Olanzapine monotherapy improved symptoms of depression related to its sedating and appetite-enhancing profile, but core symptoms such as depressed mood did not improve significantly. However, in combination with fluoxetine, bipolar depressed patients responded without an increased risk of mania. Weight gain and sedation are prominent adverse effects, and it has been associated with atherogenic dyslipidemia and glucose intolerance.
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PMID:Use of olanzapine in the treatment of bipolar I disorder. 1585 3

Ziprasidone (Geodon), risperidone (Risperdal), and aripiprazole (Abilify) appear to be associated with a relatively low risk for hyperlipidemia, whereas quetiapine (Seroquel), olanzapine (Zyprexa), and clozapine (Clozaril) are associated with a relatively high risk for hyperlipidemia. Possible underlying causes of lipid dysregulation include weight gain, dietary changes, and glucose intolerance. Given the multiple cardiovascular risk factors reported for patients with schizophrenia, great care must be exercised to minimize the additional risk for hyperlipidemia when choosing antipsychotic therapy. It is recommended that a lipid panel be obtained at baseline for all patients with schizophrenia and annually thereafter for patients taking relatively low-risk agents or quarterly thereafter for patients taking relatively high-risk agents. Patients with persistent dyslipidemia should be referred for lipid-lowering therapy or switched to a less lipid-enhancing antipsychotic agent.
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PMID:Atypical antipsychotic therapy and hyperlipidemia: a review. 1586 22

Type 2 diabetes mellitus and obesity have reached epidemic proportions in many developing and developed nations, leading to talk of the "twin epidemics." The latest projections from the International Diabetes Federation suggest that 190 million people worldwide currently have type 2 diabetes. In addition, > or = 300 million people worldwide have impaired glucose tolerance (IGT). These statistics represent an epidemic of major proportions--possibly the largest epidemic in human history--in terms of glucose intolerance and cardiovascular disease (CVD) risk because individuals with IGT are at substantially higher risk for diabetes and CVD than are members of the general population. Along with IGT, the metabolic syndrome comprises other major CVD risk factors, including insulin resistance, central obesity, and dyslipidemia; insulin resistance has been implicated as the single most common cause of the syndrome. Although the exact prevalence of the metabolic syndrome is unknown, the syndrome is widespread among adults in developed nations, becoming more prevalent with age. Epidemiologic data suggest that in patients with schizophrenia or affective disorders, both diabetes and obesity are 1.5 to 2.0 times more prevalent than in the general population. Furthermore, because adverse effects of certain therapies for human immunodeficiency virus (HIV) infection and psychiatric disorders increase the risk for developing diabetes, obesity, and the metabolic syndrome, such therapies should be carefully chosen, particularly considering CVD risk. Appropriate therapy may be determined via screening of patients for levels of fasting blood glucose and lipids, as well as other CVD risk factors, before initiating use of second-generation antipsychotic agents or highly active antiretroviral therapy.
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PMID:Epidemiology of diabetes mellitus and associated cardiovascular risk factors: focus on human immunodeficiency virus and psychiatric disorders. 1590 89

Individuals with psychiatric disorders tend to have excessive morbidity. They typically have high rates of respiratory illnesses, infectious diseases, substance abuse (including smoking), obesity, diabetes mellitus, and cardiovascular disease (CVD). Persons with schizophrenia and affective disorders also have a high prevalence of risk factors for CVD, such as diabetes and obesity, which are on the order of 1.5 to 2.0 times higher than in the general population; this translates into increased mortality rates due to CVD. The use of certain psychotropics results in metabolic sequelae, such as obesity, dyslipidemia, glucose dysregulation, and the metabolic syndrome. These sequelae exacerbate the already elevated risk of CVD and diabetes in this group of people. Therefore, the use of psychotropic agents that result in, for example, excessive weight gain not only add another complication for physicians managing a patient with schizophrenia but also may have serious prognostic and cost implications with respect to treatment-related diabetes and coronary disease incidence. The recent American Diabetes Association (ADA) Consensus Panel concluded that some agents are associated with greater diabetes risk than others. The current review describes the prevalence of the metabolic syndrome in people with affective disorders and schizophrenic populations, its prognostic relevance, and its exacerbation among patients treated with particular psychotropic agents, including certain atypical antipsychotics, selective serotonin reuptake inhibitors, and mood stabilizers. The costs associated with the treatment of the metabolic syndrome, diabetes, and coronary heart disease in populations with schizophrenia are also described.
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PMID:Metabolic issues and cardiovascular disease in patients with psychiatric disorders. 1590 91

This study investigated the relationships between serum lipid profiles and schizophrenia and the effects of conventional or atypical antipsychotic drugs on serum lipid profiles. During a 1-year period, fasting blood samples for serum lipid profiles were collected from 126 schizophrenic patients and 59 healthy control subjects. The serum lipid profiles were detected by enzymatic determination. Patients were assessed for disease severity at baseline and endpoint at 3 weeks using the Positive and Negative Syndrome Scale. At baseline, patients with acute-phase schizophrenia had lower high-density lipoprotein (HDL) levels, higher low-density lipoprotein (LDL) levels, and higher ratios of total cholesterol/high-density lipoprotein (TC/HDL) and LDL/HDL than healthy control subjects. At endpoint, after a 3-week treatment with antipsychotics, the blood samples of the 97 schizophrenic patients were assessed again. Responders to antipsychotic treatment (n = 68) but not nonresponders (n = 29) had significantly increased TC, triglyceride (TG), and very low-density lipoprotein (VLDL) levels and decreased ratio of LDL/HDL. Experimental findings also showed significantly increased TC, TG, HDL, and VLDL levels and decreased ratio of LDL/HDL in responders taking atypical antipsychotic drugs (n = 32), but not in patients treated with conventional antipsychotic drugs (n = 36). In conclusion, this study identified strong associations between dyslipidemia and acute-phase schizophrenia and dyslipidemia and responders taking atypical antipsychotics; both associations would increase the risk of developing diabetes and coronary heart disease.
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PMID:Serum lipid profiles and schizophrenia: effects of conventional or atypical antipsychotic drugs in Taiwan. 1596 76

This study evaluated body mass index, body surface area, subcutaneous fat tissue, and coronary atherosclerosis by autopsy reports for people with schizophrenia who were deceased to evaluate the presence of cardiac atherosclerosis and its association with body weight. Included in the study were autopsy reports for 134 people with schizophrenia and 134 matched normal subjects who had died between January 1990 and December 2000 and whose family had donated brain tissue to Maryland Brain Collection. Cause of death due to cardiovascular disease was observed for 45.7% of people with schizophrenia and 42.3% of the control group (P = NS). Body weight, body mass index, body surface area, and subcutaneous fat were not significantly different between the 2 groups; however, a larger proportion of the schizophrenia group had high (33.3%) and low (20.9%) percentile body weight compared with controls (27.7% vs 10.0%). People with schizophrenia who were underweight had higher rates of cardiac death than the controls (37.7% vs 13%) (chi(2) = 5.79, P = .01); however, no difference was noted in the number of coronary arteries occluded. Twenty-three (48.9%) of 47 of the controls with abnormally high subcutaneous fat showed cardiac atherosclerosis, whereas only 15 (33.3%) of 45 of the schizophrenia group with abnormally high subcutaneous fat had atherosclerosis (P = NS). Overall, the percentage of deaths due to cardiovascular disease was not higher in people with schizophrenia; however, in normal controls, cardiovascular disease appears to be related more to weight than in people with schizophrenia. This may be related to intrinsic metabolic differences associated with schizophrenia, lifestyle differences, or effects of antipsychotic medications. Nonetheless, our study suggests that efforts for the prevention of coronary atherosclerosis in schizophrenia patients should go beyond weight control to target multiple risk factors such as smoking, dyslipidemia, and cardiac side effect of antipsychotic medications.
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PMID:Cardiovascular disease in relation to weight in deceased persons with schizophrenia. 1627 14


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