Preclinical and Clinical Sex Differences in Antipsychotic-Induced Metabolic Disturbances: A Narrative Review of Adiposity and Glucose Metabolism

Castellani, L; Costa-Dookhan, Kenya A.; McIntyre, William Brett; Wright, David C.; Flowers, Stephanie A.; Hahn, Margaret; Ward, Kristen M.

doi:10.20900/jpbs.20190013

Cited by 22 publications

(15 citation statements)

References 138 publications

(253 reference statements)

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“…In a recent review, Castellani et al (48) found that the majority of clinical studies indicated that women on AP gained more weight than men, and were more at risk for metabolic syndrome. The pathway to metabolic side-effects induced especially by second generation AP remains incompletely understood.…”

Section: Metabolic Effectsmentioning

confidence: 99%

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

Seeman

2021

Front. Psychiatry

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Background: Animal and human experiments have confirmed sex differences in the expression of hepatic enzymes that metabolize antipsychotic drugs and that may, in this way, be partly responsible for the clinical sex/gender differences observed in the efficacy and tolerability of antipsychotic treatment.Aim: The aim of this mini review is to synthesize the literature on the pharmacodynamics of male/female differential response to antipsychotic drugs.Method: Relevant search terms were used to search for pre-clinical and human trials and analysis of antipsychotic differential drug response and occurrence/severity of adverse effects in women and men.Results: The search found that sex influences drug response via the amount of a given drug that enters the brain and the number of neurotransmitter receptors to which it can bind. Consequently, sex partly determines the efficacy of a specific drug and its liability to induce unwanted effects. There are other factors that can overshadow or enhance the dimorphic effect of sex, for instance, the host's age, hormonal status, diet and life style as well as the molecular structure of the drug and its dose, and the method of its administration. Most of all, the host's individual genetics affects each step of a drug's pharmacodynamics.Conclusion: On average, women's psychotic symptoms respond to antipsychotic drugs at doses lower than men's. This means that many women may be de facto overdosed and, thus, experience unnecessary adverse effects. That being said, factors such as genetics and age probably determine drug response and tolerability to a greater degree than do biological sex or gender social roles.

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Section: Metabolic Effectsmentioning

confidence: 99%

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

Seeman

2021

Front. Psychiatry

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“…Female sex has also been related to more extensive weight gain following antipsychotic drug treatment (17), whereas male sex has been linked to lower HDL-C and higher triglyceride (TG) levels following drug treatment (18,19). One proposed mechanism underlying these sex differences in metabolic co-morbidities is the influence of sex hormones on regulating food intake, energy expenditure, and drug metabolism (20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Effect of Serum Lipids and Body Mass Index on Psychotic Symptoms, a Cross-Sectional Study of First-Episode Psychosis Patients

et al. 2021

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Background: Schizophrenia is a disorder with considerable heterogeneity in course and outcomes, which is in part related to the patients' sex. Studies report a link between serum lipids, body mass index (BMI), and therapeutic response. However, the role of sex in these relationships is poorly understood. In a cross-sectional sample of first-episode psychosis (FEP) patients, we investigated if the relationship between serum lipid levels (total cholesterol, HDL-C, LDL-C, and triglycerides), BMI, and symptoms differs between the sexes.Methods: We included 435 FEP patients (males: N = 283, 65%) from the ongoing Thematically Organized Psychosis (TOP) study. Data on clinical status, antipsychotics, lifestyle, serum lipid levels, and BMI were obtained. The Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS) were used to assess psychotic and depressive symptoms. General linear models were employed to examine the relationship between metabolic variables and symptomatology.Results: We observed a female-specific association between serum HDL-C levels and negative symptoms (B = −2.24, p = 0.03) and between triglycerides levels (B = 1.48, p = 0.04) and BMI (B = 0.27, p = 0.001) with depressive symptoms. When controlling for BMI, only the association between serum HDL-C levels and negative symptoms remained significant. Moreover, the HDL-C and BMI associations remained significant after controlling for demography, lifestyle, and illness-related factors.Conclusion: We found a relationship between metabolic factors and psychiatric symptoms in FEP patients that was sex-dependent.

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“…Research with a larger population is needed to see the effect and mechanism of increasing body weight on gender. 14 This study has several limitations. First, the influence of independent variables (such as patients' demographic data and nutritional intake of patients before therapy) towards weight gain cannot be analyzed since this study was conducted retrospectively.…”

Section: Discussionmentioning

confidence: 92%

Atypical Antipsychotic Induced Weight Gain in Schizophrenic Patients

Herlina

Perwitasari

Dania

et al. 2021

ijcp

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Atypical antipsychotics are widely prescribed and have the potential to cause weight gain, which may result in the development of metabolic syndrome. Also, it is important to monitor the use of atypical antipsychotic for metabolic disturbance. The purpose of this study is to determine the side effects of atypical antipsychotics in increasing body weight in schizophrenia patients after 4 weeks of use. Furthermore, a retrospective design was conducted and data were collected based on consecutive sampling in 80 adult psychiatric inpatients (20 women and 60 men) with initial diagnoses of schizophrenia and with the same daily nutrition. The patients were hospitalized from January to March 2019, within the term (over 4 weeks) of initiation atypical antipsychotic. The patient body weight was collected before and 4 weeks after the treatment of atypical antipsychotic. The results showed that patients (20 women and 60 men) receiving atypical antipsychotic had a mean age of 35.6 years and a percentage of 70% women and 56% men had a weight gain of 1–5 kg over 4 weeks. The mean weight observed among our subjects increased from 57.55±10.743 kg to 59.83±12.205 kg after initiating treatment (p=0.001). However, the dual combination of atypical antipsychotics risperidone and clozapine are the most widely atypical antipsychotic used with a percentage equal to 91.25%, 3.75% clozapine, and 5% risperidone. Furthermore, it can be concluded that atypical antipsychotics use for at least 4 weeks can cause weight gain in schizophrenic patients. Pharmacist and doctors are recommended to monitor the metabolic side effects due to the atypical antipsychotic use. Keywords: Atypical antipsycotic, schizophrenia, weight gain Antipsikotik Atipikal Menginduksi Peningkatan Berat Badan pada Pasien Skizofrenia AbstrakAntipsikotik atipikal banyak diresepkan dan berpotensi menyebabkan kenaikan berat badan yang dapat menyebabkan sindrom metabolik. Ada kebutuhan klinis yang mendesak untuk memantau penggunaan antipsikotik atipikal terhadap gangguan metabolisme. Penelitian ini bertujuan untuk mengetahui efek samping antipsikotik atipikal dalam meningkatkan berat badan pada pasien skizofrenia setelah pemakaian 4 minggu. Melalui desain retrospektif, data dikumpulkan dengan consecutive sampling pada 80 pasien rawat inap psikiatri dewasa (20 wanita dan 60 pria) dengan diagnosis awal skizofrenia dan dengan pengaturan nutrisi harian yang sama. Pasien dirawat di rumah sakit sejak Januari 2019 sampai dengan Maret 2019, dalam jangka menengah (lebih dari 4 minggu) pemberian antipsikotik atipikal. Data berat badan pasien dicatat sebelum dan 4 minggu sesudah pemakaian antipsikotik atipikal. Pasien (20 wanita dan 60 pria) yang menerima antipsikotik atipikal memiliki usia rata-rata 35,6 tahun, semua pasien dengan persentase 70% wanita dan 56% pria memiliki kenaikan berat badan 1–5 kg selama periode 4 minggu. Berat rata-rata yang diamati di antara subyek meningkat dari 57,55±10,743 kg menjadi 59,83±12,205 kg setelah memulai pengobatan (p=0,001). Antipsikotik atipikal yang paling banyak digunakan adalah kombinasi antipsikotik atipikal risperidon clozapin dengan persentase sebesar 91,25%, clozapin 3,75%, risperidon 5%. Kami menyimpulkan bahwa penggunaan antipsikotik atipikal selama setidaknya 4 minggu dapat menyebabkan penambahan berat badan pada pasien skizofrenia. Apoteker dan dokter direkomendasikan untuk memantau efek samping metabolik akibat penggunaan antipsikotik atipikal.Kata kunci: Antipsikotik atipikal, peningkatan berat badan, skizofrenia

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Preclinical and Clinical Sex Differences in Antipsychotic-Induced Metabolic Disturbances: A Narrative Review of Adiposity and Glucose Metabolism

Cited by 22 publications

References 138 publications

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

Sex-Specific Effect of Serum Lipids and Body Mass Index on Psychotic Symptoms, a Cross-Sectional Study of First-Episode Psychosis Patients

Atypical Antipsychotic Induced Weight Gain in Schizophrenic Patients

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