Physical Health Monitoring of Patients With Schizophrenia

Marder, Stephen R.; Essock, Susan M.; Miller, Alexander L.; Boyer, Robert; Casey, Dympna; Davis, John M.; Kane, John M.; Lieberman, Jeffrey A.; Schooler, Nina R.; Covell, Nancy H.; Stroup, T. Scott; Weissman, Ellen M.; Wirshing, Donna A.; Hall, Catherine S.; Pogach, Leonard; Pi‐Sunyer, Xavier; Bigger, J. Thomas; Friedman, Alan Warren; Kleinberg, David L.; Yevich, Steven J.; Davis, Bonnie M.; Shon, Steven P.

doi:10.1176/appi.ajp.161.8.1334

Cited by 728 publications

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“…Risk for CVD and overall mortality due to CVD is elevated in patients suffering from schizophrenia compared to the general population, with mortality rates in this population being at least two times higher than in general population and CVD being responsible for as much as 50% of the excess mortality [16,17]. Recently, there has been an increased awareness of the physical needs of patients with mental illness and several psychiatric clinics, including ours, have set up physical health screening [11,18]. Such screening has unmasked a substantial degree of pathology, especially metabolic disturbances considered as CVD risk factors, including diabetes mellitus [10,11,15].…”

Section: Introductionmentioning

confidence: 99%

Abnormal glucose metabolism in patients treated with antipsychotics

Scheen

Hert

2007

Diabetes & Metabolism

151

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Second-generation (atypical) antipsychotic medications are of great benefit to a wide variety of people with psychiatric disorders, especially patients with schizophrenia. However, one constellation of adverse effects is an increased risk of obesity, diabetes, and metabolic syndrome. Increasing numbers of reports concerning impaired glucose tolerance, diabetes, and ketoacidosis have raised concerns about a possible association between abnormal glucose metabolism and treatment with atypical antipsychotics, although the question is still debated because of the presence of many confounding factors. A close relationship between drug-induced weight gain and risk of diabetes has been reported, emphasizing the role of insulin resistance. However, some cases of diabetes developed independently of weight gain, rather rapidly and possibly progressing to ketoacidosis, thus arguing for a severe impairment of insulin secretion. Another debated question is whether diabetes risk is a class action or a differential action. Although not fully scientifically proven yet, available evidence suggests that clozapine and olanzapine have a higher propensity to induce diabetes and metabolic syndrome compared with other atypical antipsychotic drugs, risperidone and quetiapine. Despite more limited available data, amisulpride, aripiprazole and ziprazidone showed less likelihood of precipitating diabetes. Interestingly, reversibility of drugrelated diabetes has been reported with aripiprazole. The choice of atypical antipsychotic medication for a specific patient depends on many factors, but the likelihood of developing diabetes should become an important consideration. When prescribing an atypical antipsychotic, a commitment to careful baseline screening and follow-up monitoring is essential in order to mitigate the risk of developing diabetes and associated complications.Keywords: antipsychoticsa; schizophrenia ; diabetes ; impaired glucose tolerance ; metabolic syndrome ; review RésuméLes antipsychotiques de seconde génération, appelés aussi antipsychotiques atypiques, ont apporté une aide précieuse dans la prise en charge de nombreux patients psychiatriques, en particulier ceux avec schizophrénie. Cependant, ils semblent associés à une constellation d'effets indésirables métaboliques, avec un risque accru d'obésité, de diabète et de syndrome métabolique. Un nombre croissant de publications à propos de cas de diminution de tolérance au glucose, de diabète et d'acidocétose chez des patients traités avec des antipsychotiques atypiques plaident pour une association causale possible entre une anomalie du métabolisme du glucose et le traitement par antipsychotique atypique, même si la question reste controversée suite à la présence de nombreux facteurs confondants. Une relation étroite entre la prise de poids induite par la médication et le risque accru de diabète a été rapportée, insistant sur le rôle de l'insulinorésistance. Pourtant, certains cas de diabète se développent indépendamment de toute prise pondérale, avec une évolution...

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Section: Introductionmentioning

confidence: 99%

Abnormal glucose metabolism in patients treated with antipsychotics

Scheen

Hert

2007

Diabetes & Metabolism

151

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“…Patients with schizophrenia have other physical health problems that might be related to the BH response. For example, patients with schizophrenia are at increased risk of cardiovascular disease diabetes, hyerplipidemia, and hypertension (Hennekens et al, 2005;Marder et al, 2004). Perhaps one of these health problems (or their pharmacologic treatment) might explain the increase in the BH response in patients.…”

Section: Discussion Of Breath Hold Resultsmentioning

confidence: 99%

Chronic smoking and the BOLD response to a visual activation task and a breath hold task in patients with schizophrenia and healthy controls

et al. 2008

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Many psychiatric patient groups smoke heavily, but little is known regarding the effects of this habit on functional brain imaging results. The present report assesses the effect of chronic smoking on the blood-oxygen-level-dependent (BOLD) response to a simple visual activation (VA) task and a breath hold (BH) task in patients with schizophrenia. Eight healthy controls and twelve patients with schizophrenia were studied. Half of each group had never smoked and the other half of each group had smoked for more than 10 pack years. Responses to the VA task were assessed in the visual cortex and responses to the BH task were assessed in gray matter generally. There were four fMRI dependent measures: (1) median percent signal change; (2) activation volume (in voxels); (3) time-to-peak of the impulse response function (IRF); and (4) time-to-trough of the IRF. All measures were tested as dependent variables in an ANCOVA with diagnosis and smoking status as crossed factors and age as a covariate. Heavy smokers had 22% larger percent signal change for the VA task and 50% larger percent signal change for the BH task. Patients had a 40% larger percent signal change for the breathhold task. Other statistically significant effects of smoking history on activation volume and the timing of the brain responses were noted. If replicated, the results may have important implications for fMRI studies comparing groups with markedly different smoking habits, such as studies comparing patients with schizophrenia, 60-90% of whom smoke, and healthy controls, who smoke with a much lower frequency.

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“…Marder et al (9) recommended that the patient's body mass index (BMI) should be recorded before medication initiation or change and at every visit for the first 6 months. The patient should be weighed (and the BMI recorded) at least quarterly when he stabilizes, and more often if he is overweight.…”

Section: Weight Gainmentioning

confidence: 99%

“…Consensus guidelines have been published which elaborate on the differences in risk between agents and provide specific monitoring recommendations (9,19,20). However, a recent study showed that the rate of screening for metabolic side effects of atypical antipsychotics is still low (21).…”

Section: Diabetes Mellitusmentioning

confidence: 99%

“…The intervals were not substantially affected by the inhibitor. As suggested in a recent paper (9), in the absence of increased risk factors for QTc interval prolongation or cardiac arrhythmias, ziprasidone can be prescribed without ECG monitoring. However, patients who are to be treated with this drug should receive a baseline ECG before treatment is initiated if any of the following cardiac risk factors are present: known heart disease, a personal history of syncope, a family history of sudden death at under age 40 years (especially if both parents had sudden death), or congenital long QTc syndrome.…”

Section: Prolongation Of Qtc Intervalmentioning

confidence: 99%

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Side effects of atypical antipsychotics: a brief overview

2008

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Patients with schizophrenia suffer from increased rates of multiple medical problems, due to their lifestyle (high smoking prevalence, high-fat diet), inherent neglect of personal care, and barriers to treatment of physical illness (1). A further important contributor to adverse health outcomes is the side effect profile of antipsychotic medications. Since the introduction of the second generation or atypical antipsychotics (AAP), these agents have been widely prescribed for the management of patients with schizophrenia, bipolar disorders, other psychotic disorders or conditions with severe behavioral disturbance. The increasing use of AAP is in part due to their lower propensity to induce extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotics. Now, more than 15 years after the first atypical antipsychotic entered the market, psychiatrists have gradually come to realize that while extrapyramidal symptoms and tardive dyskinesia occur less frequently with atypical agents, these medications may present a different set of adverse effects. The quality of available evidence for the association of specific antipsychotics with particular side effects varies considerably. In this article, we review the recent findings concerning weight gain, diabetes mellitus (DM), hyperlipidemia, QTc interval prolongation, myocarditis, sexual side effects, extrapyramidal side effects and cataract in patients receiving AAP. WEIGHT GAINForty to sixty-two percent of people with schizophrenia are overweight or obese. Obesity increases these patients' risk for cardiovascular morbidity and mortality. In addition, excessive weight and obesity can have important effects on an individual's adjustment in the community, adherence to prescribed medication, ability to participate in rehabilitation efforts, and self-image (2).Treatment with first-and second-generation antipsychotics can contribute to weight gain (3-5). A meta-analysis by Allison and Casey (4) provided an estimate of the mean weight gain in patients receiving standard doses of antipsychotics over a 10-week period: the mean increases were 4.45 kg with clozapine, 4.15 kg with olanzapine, 2.92 kg with sertindole, 2.10 kg with risperidone, and 0.04 kg with ziprasidone. Data on quetiapine have been variable, but it seems that the weight gain liability on this drug may be similar to that of risperidone (6). Weight gain with olanzapine at the commonly used dose of 15mg/day may exceed 10 kg during the first year of treatment (7). On the other hand, weight gain seems to be dose-dependent: Rondanelli et al (8) reported no change in weight in elderly patients who received 1.4 mg/day risperidone or 4.4 mg/day olanzapine or 75 mg/day quetiapine over a 12-month period.Marder et al (9) recommended that the patient's body mass index (BMI) should be recorded before medication initiation or change and at every visit for the first 6 months. The patient should be weighed (and the BMI recorded) at least quarterly when he stabilizes, and more often if he is overweight. BMI monito...

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Physical Health Monitoring of Patients With Schizophrenia

Cited by 728 publications

References 68 publications

Abnormal glucose metabolism in patients treated with antipsychotics

Abnormal glucose metabolism in patients treated with antipsychotics

Chronic smoking and the BOLD response to a visual activation task and a breath hold task in patients with schizophrenia and healthy controls

Side effects of atypical antipsychotics: a brief overview

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