Recent Onset Cardiometabolic Effects amongst Patients Started on Psychotropics: A Cohort Study

Abstract

Introduction: Mortality rates in schizophrenia patients due to cardiovascular events are reported to be more than the general population. Dyslipidaemia, obesity, diabetes, and hypertension are some of the common illnesses these patients are vulnerable to develop. The drugs which are used to treat schizophrenia and other related disorders i.e. antipsychotics causes increase in weight, dyslipidaemia and insulin resistance in some patients. Some agent’s i.e. Second Generation Antipsychotics (SGA) cause more of the above mentioned symptoms and than others agent’s i.e. First Generation Antipsychotics (FGA). The novelty of the study includes the emergence of Metabolic syndrome (MetS) in drug naïve or drug free patients who were prescribed trifluoperazine and olanzapine and comparative study of them. Aim: To assess the emergence of MetS in drug naïve patients of schizophrenia after the administration of trifluoperazine-FGA and olanzapine-SGA. Materials and Methods: A cohort study was conducted from May 2019 to March 2021, in the Department of Psychiatry, Shyam Shah Medical College, and Rewa, Madhya Pradesh, India. Study was started after the clearance from institutional ethical committee. The study included 41 drug naïve indoor and outdoor patients, diagnosed as schizophrenia according to International Classification of Diseases 10 Diagnostic Criteria for Research (ICD 10 DCR). The patients were divided into two groups, one group was prescribed FGA trifluoperazine and other was prescribed SGA olanzapine. Twenty patients were prescribed olanzapine and 21 patient’s trifluoperazine. Metabolic parameters were taken before onset of drug treatment therapy, after two and four months respectively. The patients were given medications for four months. The changes in metabolic parameters i.e., waist circumference, blood pressure, Fasting Blood Sugar (FBS), triglycerides, and Low HDL (High Density Lipoprotein) were compared using unpaired student’s t-test and repeated measure Analysis of Variance (ANOVA) with p-value <0.05 considered as significant. Results: It was found that out of total 41 patient, 4 patients (19.4%) and 12 patients (60%) patients prescribed trifluoperazine and olanzapine respectively developed Mets after four months of antipsychotic medication. Also, there was a significant change in various parameters of MetS in both groups as seen in repeated measure ANOVA. Conclusion: SGA cause significantly more changes in the metabolic parameters and compared to the FGA, increasing the likelihood of developing MetS and associated disorders like cerebrovascular accidents and diabetes mellitus type-II.