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

Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophrenia.This study aimed to identify the incidence of metabolic syndrome and its reversal in a non-preselected cohort of chronic psychotic patients in routine practice in one year follow-up and to find variables to describe development and reversal of metabolic syndrome. This cohort study was conducted as part of a disease management program and patients were included if they had two complete assessments in a one year follow-up. We conducted two logistic regressions to find variables to describe the development of metabolic syndrome and the reversal of metabolic syndrome. At the time of the first assessment 35% (n=92) of the 260 included patients had metabolic syndrome. Within one year 21 patients developed metabolic syndrome and 30 patients had it reversed. This was an incidence of 13% (21/168) and a reversal of 33% (30/92). Smoking, family history of cardiovascular diseases, and duration of disease >6 years was associated with a higher risk of developing metabolic syndrome as well as abdominal obesity and dyslipidemia. Patients with abdominal obesity had a smaller chance of reversing metabolic syndrome. Other variables included in the logistic regression such as receiving cardiovascular/antidiabetic drug treatment or duration of disease >6 years did not alter the risk of reversing the metabolic syndrome. Our study showed that the natural course of metabolic syndrome is dynamic. A considerable number of patients developed or reversed the metabolic syndrome in one year follow-up.
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PMID:The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year. 1939 13

Schizophrenic patients have a life expectancy 20% shorter than general population, mainly due to cardiovascular disease. Several risk factors for cardiovascular disease are modifiable, and some, like blood glucose and lipids, and weight, can be worsened by antipsychotic drugs, mainly second generation ones. This article reviews the concept of metabolic syndrome and its relationship with schizophrenia and antipsychotic drugs. It also reviews the relationship between obesity, abdominal fat and schizophrenia, and the influence that second generation antipsychotics may have on weight. Antipsychotics are differentiated according to their liability of inducing weight gain, possible physiopathological mechanisms for weight gain are mentioned, and main pharmacological treatments to revert or prevent this situation are discussed. Some parameters for the periodic monitoring of the constitutive elements of metabolic syndrome to be used by psychiatrist in patients taking second generation antipsychotics are suggested.
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PMID:[Metabolic syndrome induced by antipsychotic drugs. The problem of obesity]. 1942 16

To report a case of rapidly worsening hypertriglyceridemia in a geriatric patient that occurred 2 weeks after treatment with risperidone. The patient is a 70-year-old morbidly obese woman admitted to an inpatient psychiatric unit for exacerbation of schizophrenia. She had a pre-existing metabolic syndrome at baseline with a baseline triglyceride level of 188 mg/dL (>150 mg/dL), high-density lipoprotein of 34 mg/dL (<50 mg/dL), and fasting blood glucose of 100 mg/dL. She was started on risperidone and rapidly developed worsening hypertriglyceridemia after 2 weeks of being on the medication without any associated weight gain. Two weeks after admission, a repeat fasting lipid profile revealed serum triglycerides of 395 mg/dL with a direct low-density lipoprotein of 79 mg/dL, high-density lipoprotein of 21 mg/dL, and total serum cholesterol of 155 mg/dL. The hypertriglyceridemia improved when the medication was stopped. We postulate that the worsening hypertriglyceridemia was due to the effects of risperidone. An objective causality assessment revealed that the adverse drug event was probable. There have been numerous reports in the literature of hypertriglyceridemia without weight gain associated with atypical antipsychotics. None of the published cases had reported a rapidly occurring hypertriglyceridemia within 2 weeks of starting an atypical antipsychotic. It is possible that baseline obesity and baseline metabolic disorder may be risk factors for worsening hypertriglyceridemia in patients started on atypical antipsychotics. Clinicians treating elderly patients with risperidone should be aware of the potential for rapidly developing hypertriglyceridemia and monitor such patients accordingly. We caution clinicians to be aware that hypertriglyceridemia can worsen rapidly after initiation of atypical antipsychotics even in the first 2 weeks of treatment. Further studies are needed to see whether pre-existing metabolic syndrome is a possible risk factor for developing rapid hypertriglyceridemia in patients started on atypical antipsychotic drugs.
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PMID:Rapidly worsening hypertriglyceridemia during treatment with risperidone. 1945 18

Antipsychotics are classified in two groups, the first generation (conventional, typical) and the second generation (modern, atypical). In the treatment of schizophrenia and psychoses antipsychotics of the second generation are the preferred choice due to their effectiveness and side effects profile. First and second generation antipsychotics are commonly used to treat acute mania. Moreover, second generation antipsychotics are used in the maintenance-treatment of bipolar disorder. Several second generation antipsychotics have been shown to be effective in the treatment of acute bipolar depression and as an augmentation-strategy in combination with an antidepressant in the treatment of unipolar depression. In clinical practice there is a big off-label use of antipsychotics, for example in the treatment of personality disorders. In addition to the oral dosage form, there exist two parenteral dosage forms of antipsychotics: quick-acting and long-acting injections. The side effects profile for first generation antipsychotics is characterized by extrapyramidal-motoric side effects. Second generation antipsychotics are, with respect to their effectiveness and side effects, very heterogeneous. Some substances present in the second generation grouping can lead to, in particular, an increased risk for weight gain and metabolic syndrome.
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PMID:[Antipsychotics]. 1949 35

It seems that the efficacy of aripiprazole for treating schizophrenia is mediated through a combination of partial agonism at dopamine D2 and serotonin 5-HT1A receptors and antagonism at serotonin 5-HT2A receptors. Aripiprazole has also received approval for the treatment of bipolar disorder as adjunctive therapy or monotherapy (manic or mixed episodes) as well as an augmentation therapy of major depressive disorder (MDD) by the US FDA. The overall safety and tolerability of aripiprazole is favorable compared to other atypical antipsychotics across the approved indications. Aripiprazole showed a minimal propensity for clinically significant weight gain and metabolic disruption. However, extrapyramidal side effects, such as akathisia, are reported and may limit its clinical use in some cases, particularly in patients with bipolar disorder and MDD. This review focuses on the tolerability and safety of aripiprazole across a broad spectrum of psychiatric disorders while taking into consideration results from registrational studies as well as findings from studies in the naturalistic setting. In conclusion, whereas the comparative safety and tolerability of aripiprazole has not been systematically evaluated in comparator studies, tolerability and safety issues commonly associated with atypical antipsychotics such as weight gain and metabolic syndrome are less prominent with aripiprazole.
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PMID:A review of the safety and tolerability of aripiprazole. 1950 66

Olanzapine is a second-generation antipsychotic that may cause weight gain and metabolic syndrome in some cases. The peroxisome proliferator-activated receptor (PPAR)-gamma is an important gene in the progress of type II diabetes and metabolic syndrome. In recent studies the polymorphism of the PPAR-gamma has been studied in type II diabetes mellitus, polycystic ovary syndrome, and insulin resistance syndrome. It is aimed to evaluate the association between polymorphism of PPAR-gamma gene and olanzapine-induced weight gain. Our study comprised 95 unrelated subjects who strictly met Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for schizophrenia, and all were of Turkish origin. All patients were evaluated with rating scales, and genetic analyses were performed. We found statistically significant differences between pretreatment and posttreatment body mass index and weight change in Pro12Ala polymorphism of PPAR-gamma2. Our results suggest that genetic polymorphism of PPAR might be important in olanzapine-induced weight gain and that genetic variance of people might be considered in antipsychotic medication selection.
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PMID:The association of olanzapine-induced weight gain with peroxisome proliferator-activated receptor-gamma2 Pro12Ala polymorphism in patients with schizophrenia. 1962 37

Over the past 15 years, novel pharmacologic treatments for the management of HIV/AIDS and severe mental illness have changed the prognosis and quality of life for millions of patients throughout the world. In HIV-infected patients, highly active antiretroviral therapy (HAART) has altered this epidemic in many countries and simpler, better-tolerated treatment regimens have resulted in many patients with HIV living longer and with an improved quality of life. In patients with severe mental illness, second generation antipsychotics (SGAs) or atypical antipsychotics have provided hope for many patients and families struggling with schizophrenia and bipolar disorder. Despite these advances in treatment, metabolic abnormalities, specifically the metabolic syndrome (MetS), are occurring at a greater incidence in both persons with HIV and persons with severe mental illness (SMI). Furthermore, patients with severe mental illness are becoming HIV-infected, and higher prevalence rates of severe mental illness are seen in HIV patients than the general population. This review examines the prevalence of metabolic abnormalities within each population and the impact of HAART and SGAs on the development of MetS. Overviewed are possible mechanisms for the development of MetS in these patients, standard monitoring protocols, and potential treatments for managing these metabolic issues. Finally, recommendations for monitoring and managing the intersecting, growing population of HIV/AIDS patients with severe mental illness are provided.
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PMID:Metabolic syndrome and associated cardiovascular risk factors in the treatment of persons with human immunodeficiency virus and severe mental illness. 1964 20

Schizophrenia affects about 1% of the world's population. Those with schizophrenia are at elevated risk of a variety of physical health conditions, including diabetes, coronary heart disease, hypertension and osteoporosis. Osteoporosis secondary to antipsychotic-induced hyperprolactinaemia (i.e. raised prolactin levels) has received little attention, when compared with reports on metabolic syndrome for instance. A recent study established that schizophrenia and prolactin-raising antipsychotic medication is directly associated with hip fractures. This is important and concerning as osteoporotic fractures are associated with much morbidity and mortality. This paper reviews the literature on antipsychotic-induced hyperprolactinaemia and its subsequent effects on bone mineral density.
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PMID:Antipsychotic-induced hyperprolactinaemia in patients with schizophrenia: considerations in relation to bone mineral density. 1982 78

This naturalistic study attempted to determine the prevalence of prolonged QTc interval in a relatively large population of inpatients hospitalized with chronic schizophrenia, and to explore QTc relationship with demographic variables, metabolic parameters and prescribed treatments. All inpatients from a Spanish long-term psychiatric hospital were cross-sectionally investigated to determine the prevalence of QTc prolongation and metabolic syndrome. The sample with a DSM-IV diagnosis of schizophrenia included 171 Caucasian inpatients, all of Spanish origin. A prolonged QTc interval was defined as >450 ms in men and >470 ms in women. The relationships between QTc and other continuous variables were assessed using a linear regression model with QTc as the dependent variable. Only 10 patients (6%) had a prolonged QTc interval; one case was possibly explained by hypokalemia. Three patients (2%) had a QTc > 500 ms. Gender, old age (> or = 50 years old), current smoking, systolic blood pressure, HDL cholesterol and history of arrhythmia were found to have significant effects on QTc interval in a linear regression analysis. After controlling for significant variables, the mean QTc interval was not significantly influenced by antipsychotic dose, type of antipsychotic treatment, the use of depot antipsychotics, or the number of different antipsychotics prescribed. Our study focused on long-term schizophrenia inpatients with frequent antipsychotic polypharmacy and high antipsychotic doses, and suggested that after excluding the case with hypokalemia length of QTc was associated with history of arrhythmias and with metabolic factors, while the effects of antipsychotic compound or class were not so evident.
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PMID:QTc interval in a sample of long-term schizophrenia inpatients. 1989 25

Switching to a different second-generation antipsychotic (SGA) with a lower risk of weight gain is recommended for overweight or obese psychiatric patients undergoing SGA treatment. However, there have been no complete reports regarding the long-term metabolic effects of switching to amisulpride. In this open-label 1-year study, we investigated the effects on body weight and other metabolic profiles when psychiatric patients treated with another SGA were switched to amisulpride treatment. Forty-six schizophrenia or schizoaffective inpatients with a body mass index greater than 27 kg/m were enrolled in the switch group. These patients were cross-titrated to amisulpride treatment and followed up for 1 year prospectively. Another 46 inpatients matched with the baseline body mass index of those in the switch group were enrolled as the control group retrospectively. The results showed that the switch group had greater weight loss than the control group (7.80 +/- 6.67 vs 2.60 +/- 6.23 kg, respectively; repeated-measure analysis of variance, P < 0.0005). During the treatment course, the amisulpride-treated patients showed significantly decreased fasting triglyceride, total cholesterol, glucose, and insulin resistance levels; decreased diastolic blood pressure and pulse rate; and a significant increase in high-density lipoprotein cholesterol levels after switching to amisulpride (all with a P < 0.05). The prevalence of metabolic syndrome in amisulpride-treated patients also decreased significantly from 65.2% to 30.4% (McNemar test, P < 0.0005). These findings suggest that switching to amisulpride could be an effective treatment of overweight or obese psychiatric patients treated previously with other SGAs.
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PMID:Improved body weight and metabolic outcomes in overweight or obese psychiatric patients switched to amisulpride from other atypical antipsychotics. 1991 Jul 16


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