Early treatment-related changes in diabetes and cardiovascular disease risk markers in first episode psychosis subjects

Abstract

Objective-To examine prospective changes in cardiovascular disease (CVD) and type-2 diabetes risk factors in young adult first episode psychotic (FEP) patients treated with second generation antipsychotic medications.Methods-At baseline, fasting serum and anthropometric measures were obtained from 45 FEP patients and 41 healthy adults (controls) of similar age, ethnicity and sex; sixteen of the FEP patients remained on the same antipsychotic medication and were available for a second blood draw at 24 weeks of treatment. Serum was assayed for glucose, insulin, triglycerides, total cholesterol and high and low density lipoproteins (HDL, LDL), adiponectin, leptin, interleukin 6, E-selectin and VCAM-1. Wilcoxon nonparametric tests were used to compare risk markers between the FEP and control group at baseline and to evaluate pre-post treatment changes within the FEP group.Results-At baseline, the distributions of risk marker values were similar between the two groups and the percentages of FEP patients and healthy controls who were overweight/obese, dyslipidemic, hyperglycemic, and hyperinsulinemic did not differ. At 24 weeks, compared to baseline, FEP patients showed significant increases in BMI (p=0.0002), glucose (p=0.0449), insulin (p=0.0161), cholesterol (p=0.0129), leptin (p=0.0215), and E-selectin (p=0.0195), and a decrease in adiponectin (p=0.0371).Conclusions-Among patients with first episode psychosis, 6-month treatment with second generation antipsychotics is associated with the exacerbation of pre-existing and emergence of new CVD and diabetes risk factors.

Which comes first: atypical antipsychotic treatment or cardiometabolic risk?

“…Atypical antipsychotics are also known to exacerbate pre-existing and emerging cardiovascular disease and diabetes risk factors in patients with schizophrenia (23,24). What is the mechanism of this induction of cardiometabolic risk and disease?…”

“…treatment gain weight and subsequently develop downstream complications (23,37), which brings them a few steps closer to diabetes and cardiovascular disease (Figs 1 and 4). Others exposed to certain antipsychotics, especially clozapine and olanzapine, may experience downstream effects prior to or even without gaining weight (38).…”

Metabolic Syndrome Associated with Schizophrenia and Atypical Antipsychotics

“…The ADA guidelines recommended frequency of lipid monitoring is clearly insufficient to identify patients who develop dyslipidemia during antipsychotic drug treatment because it can occur from a few months to several months of antipsychotic drug treatment [32,33]. We suggest monitoring fasting lipids 3, 6, and 12 months after initiation of an antipsychotic drug and then annually.…”

“…This is the time when patients receiving antipsychotic drug treatment may develop glucose metabolism impairment [32,33]. Therefore, we recommend monitoring on a quarterly basis during the first year.…”

Metabolic Consequences of Antipsychotic Therapy: Preclinical and Clinical Perspectives on Diabetes, Diabetic Ketoacidosis, and Obesity

“…No changes in glucose uptake were observed in the clamp experiment, but enhanced excursions of meal-induced plasma insulin and glucose were found. Experience of treating first episode psychosis with SGAs mirrors human volunteer studies with reports of clinically meaningful increases in fasting plasma concentrations of glucose and insulin (De Hert et al 2008;Graham et al 2008). The minority of studies where glycemic markers were measured in children/ adolescents do not reveal substantial metabolic disturbances (De Hert et al 2011a).…”