Assessment of Long Term Metabolic Effects of Atypical Antipsychotics in Schizophrenia Patients

Abstract

Background and aims. Patients with schizophrenia have a shorter life expectancy than normal population partially due to the metabolic side effects of antipsychotic treatment. The aim of this study is to evaluate the long-term evolution of the metabolic syndrome in chronic schizophrenia patients on fixed second generation antipsychotics (SGA). Material and method. The components of metabolic syndrome were evaluated repeatedly in a minimum 6 months and maximum 2 years follow-up period. The presence of metabolic syndrome (MetS) and metabolic risk scores (cMetS) according to National Cholesterol Education Program Adult Treatment Panel III were calculated and compared in time. In the prevalence, incidence and normalization logistic regression studies included all the known risk factors together with the follow-up period. Finally, all these rates were compared depending on the type of SGA. Results. Only cMetS, waist circumference and diastolic blood pressure presented significant increase in the follow-up period which was in average 385.5 days. The prevalence of MetS at base-line was 39.4%, which increased to 48.5% after the follow-up period. The calculated incidence of 30% was associated with a 23.1% rate of normalization. Logistic regression studies revealed as independent risk factors the age and base-line cMetS/weight for incidence and for normalization. In the aripiprazole group the normalization rate exceeded the incidence rate (33.3% vs 20%). Conclusions. The results emphasize the highly dynamic character of the metabolic syndrome even in chronic schizophrenia patients with fixed SGA regimen. The normalization of MetS is a possibility that should not ignored. The age and weight continue to remain independent risk factors, thus close monitoring in elderly and strict weight control plan are necessary. Aripiprazole showed better safety profile, but more extensive studies are required for definitive conclusions.

NOS1AP Gene Variants and Their Role in Metabolic Syndrome: A Study of Patients with Schizophrenia

“…Later onset of schizophrenia has also been associated with MetS in a number of articles [ 10 , 76 ]; however, the mechanisms behind this phenomenon remain unclear. Additionally, MetS patients in the present paper were more often treated with second-generation antipsychotics, which is consistent with the literature on the ability of these drugs to cause metabolic disorders [ 8 , 16 , 17 , 18 ]. A second limitation is that we studied a group of chronic patients with schizophrenia who had been receiving long-term antipsychotic treatment, but we cannot be sure that the patients adhered to the treatment regimen in the long term.…”

“…The trend of transition in the treatment of the vast majority of patients from first-generation antipsychotics to atypical antipsychotics has changed the spectrum of adverse effects observed in the patients from extrapyramidal to metabolic symptoms [ 16 ]. The prevalence of MetS in patients receiving antipsychotic therapy increased by 9.1% during a 1-year treatment period [ 17 ]. Over a 6–10-year follow-up period, 136 lethal outcomes were recorded in 1686 individuals receiving atypical antipsychotics, where 43 lethal outcomes were associated with cardiovascular diseases [ 18 ].…”

Gut Microbiota Markers for Antipsychotics Induced Metabolic Disturbance in Drug Naïve Patients with First Episode Schizophrenia – A 24 Weeks Follow-up Study

“…We also observed a negative correlation between the Christensenellaceae family and the levels of the triglyceride. Previous studies have shown the comorbidity between metabolic syndrome and SZ [3][4][5], and common genes may underlie such observed comorbidity [30]. Large-scale genomic studies have shown that there are a handful of pleiotropic genes associated with triglyceride, BMI and SZ [6].…”

“…Epidemiological studies have reported that the prevalence of obesity, type 2 diabetes (T2D), and hypercholesterolemia in SZ patients is 3–5 times higher than in general population [3,4]. A recent study estimated the overall rate of metabolic syndrome to 32.5% in SZ patients [3], and this rate is increased during treatment [5]. Large-scale genomic studies have revealed putative common genetic bases between SZ and metabolic disorders/traits – including cardiovascular diseases, T2D, levels of blood glucose, insulin and lipoproteins and body mass index (BMI) [6,7].…”