Is antipsychotic polypharmacy associated with metabolic syndrome even after adjustment for lifestyle effects?: a cross-sectional study

Abstract

BackgroundAlthough the validity and safety of antipsychotic polypharmacy remains unclear, it is commonplace in the treatment of schizophrenia. This study aimed to investigate the degree that antipsychotic polypharmacy contributed to metabolic syndrome in outpatients with schizophrenia, after adjustment for the effects of lifestyle.MethodsA cross-sectional survey was carried out between April 2007 and October 2007 at Yamanashi Prefectural KITA hospital in Japan. 334 patients consented to this cross-sectional study. We measured the components consisting metabolic syndrome, and interviewed the participants about their lifestyle. We classified metabolic syndrome into four groups according to the severity of metabolic disturbance: the metabolic syndrome; the pre-metabolic syndrome; the visceral fat obesity; and the normal group. We used multinomial logistic regression models to assess the association of metabolic syndrome with antipsychotic polypharmacy, adjusting for lifestyle.ResultsSeventy-four (22.2%) patients were in the metabolic syndrome group, 61 (18.3%) patients were in the pre-metabolic syndrome group, and 41 (12.3%) patients were in visceral fat obesity group. Antipsychotic polypharmacy was present in 167 (50.0%) patients. In multinomial logistic regression analyses, antipsychotic polypharmacy was significantly associated with the pre-metabolic syndrome group (adjusted odds ratio [AOR], 2.348; 95% confidence interval [CI], 1.181-4.668), but not with the metabolic syndrome group (AOR, 1.269; 95%CI, 0.679-2.371).ConclusionsThese results suggest that antipsychotic polypharmacy, compared with monotherapy, may be independently associated with an increased risk of having pre-metabolic syndrome, even after adjusting for patients' lifestyle characteristics. As metabolic syndrome is associated with an increased risk of cardiovascular mortality, further studies are needed to clarify the validity and safety of antipsychotic polypharmacy.

Prevalence of polymorphisms in the ANKK1, DRD2, DRD3 genes and metabolic syndrome in refractory schizophrenia

“…Some studies that have investigated the association of this polymorphism with schizophrenia found an increased frequency of this allele (Ins) in this group of patients 17 - 18 . A study conducted in 2010 found that significant weight gain was confirmed after 6 weeks of treatment with risperidone or olanzapine in the population of patients with the -141C Del allele.…”

Metabolic syndrome in bipolar disorder and schizophrenia: dietary and lifestyle factors compared to the general population

“…While affective symptomatology within bipolar disorder is undoubtedly key, this has been less studied within schizophrenia, but is currently gaining interest (46). It is also important to point out the high percentage of patients in general that were receiving antidepressants as part of our investigation (~59%) as polypharmacy has also been implicated as a risk factor for metabolic syndrome (47). Additionally long standing research has shown a relationship between depression and cardiovascular disease (48).…”

Polypharmacy for schizophrenia

“…[27] A treatment that maximized the antipsychotic effects of these medications but did not expose patients to metabolic risk would be ideal. Polypharmacy approaches overall have been shown to contribute towards the risk of metabolic syndrome[28, 29]. Often tolerability issues drive the need to combine antipsychotics.…”