Schizophrénie, diabète et antipsychotiques

Gury, C.

doi:10.1016/s0013-7006(04)95452-8

Cited by 16 publications

(9 citation statements)

References 50 publications

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“…Clinically significant laboratory abnormalities were generally isolated, with the exception of elevations in creatine kinase (Meltzer, 1976;Terao et al, 1999) and glucose (Gury, 2004), which were to be expected in this population. Creatine kinase abnormalities were seen in eight (7.1%) donepezil-and seven (6.3%) placebo-treated patients, and glucose abnormalities in four (3.5%) donepezil-and nine (7.9%) placebo-treated patients.…”

Section: Safety and Tolerabilitymentioning

confidence: 60%

Efficacy and Safety of Donepezil in Patients with Schizophrenia or Schizoaffective Disorder: Significant Placebo/Practice Effects in a 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial

Keefe

Malhotra

Meltzer

et al. 2007

Neuropsychopharmacol

136

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Altered expression of central muscarinic and nicotinic acetylcholine receptors in hippocampal and cortical regions may contribute to the cognitive impairment exhibited in patients with schizophrenia. Increasing cholinergic activity through the use of a cholinesterase inhibitor (ChEI) therefore represents a possible strategy for cognitive augmentation in schizophrenia. We examined the efficacy and safety of the ChEI donepezil as cotreatment for mild to moderate cognitive impairment in schizophrenia or schizoaffective disorder in a prospective, 12-week, placebo-controlled, double-blind, parallel-group study. In total, 250 patients (18-55 years) with schizophrenia or schizoaffective disorder who were clinically stabilized on risperidone, olanzapine, quetiapine, ziprasidone, or aripiprazole, alone or in combination, were enrolled at 38 outpatient psychiatric clinics in the United States. Patients were randomized to donepezil 5 mg q.d. for 6 weeks then 10 mg q.d. for 6 weeks, or placebo administered as oral tablets. The primary outcome measure was the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) neurocognitive battery composite score. In the intent-to-treat sample (donepezil, n ¼ 121; placebo, n ¼ 124), both treatments showed improvement in the composite score from baseline to week 12. At week 12, cognitive improvement with donepezil was similar to that with placebo (last-observation-carried-forward effect size, 0.277 vs 0.411; p ¼ 0.1182) and statistically significantly inferior for the observed-cases analysis (0.257 vs 0.450; p ¼ 0.044). There was statistically significant improvement in the Positive and Negative Syndrome Assessment Scale negative symptoms score for placebo compared with donepezil, while total and positive symptom scores were similar between both treatments. Statistically significant improvements in positive symptoms score and Clinical Global Impression-Improvement for donepezil compared with placebo were noted at Week 6. Treatment-emergent adverse events (AEs) were observed for 54.5% of donepezil-and 61.3% of placebo-treated patients; most AEs were rated as mild to moderate in severity. Donepezil was safe and well-tolerated but was not effective compared with placebo as a cotreatment for the improvement of cognitive impairment in this patient population. A significant and surprisingly large placebo/practice effect was observed among placebotreated patients, and is a serious consideration in future clinical trial study designs for potential cognitive enhancing compounds in schizophrenia.

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Section: Safety and Tolerabilitymentioning

confidence: 60%

Efficacy and Safety of Donepezil in Patients with Schizophrenia or Schizoaffective Disorder: Significant Placebo/Practice Effects in a 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial

Keefe

Malhotra

Meltzer

et al. 2007

Neuropsychopharmacol

136

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“…Long before the introduction of antipsychotic drugs, researchers reported an increased prevalence of hyperglycemia and/or T2DM in schizophrenic patients 33. Then, an increase of diabetes prevalence was reported in patients treated with antipsychotics after the introduction of the first neuroleptics in the 1950s, and the same alarms occurred in the 1990s when AAPs were applied in clinical practice 34. Persistent reports have linked AAPs with impaired glucose metabolism, exacerbation of existing type 1 and 2 diabetes, new-onset T2DM, and diabetic ketoacidosis.…”

Section: Clinical Evidence For Aaps-induced Mets and Nafldmentioning

confidence: 99%

<p>Atypical antipsychotics-induced metabolic syndrome and nonalcoholic fatty liver disease: a critical review</p>

Zhuang

2019

NDT

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The atypical antipsychotics (AAPs) have been used as first-line drugs in psychiatric practice for a wide range of psychotic disorders, including schizophrenia and bipolar mania. While effectively exerting therapeutic effects on positive and negative symptoms, as well as cognitive impairments in schizophrenia patients, these drugs are less likely to induce extrapyramidal symptoms compared to typical antipsychotics. However, the increasing application of them has raised questions on their tolerability and adverse effects over the endocrine, metabolic, and cardiovascular axes. Specifically, AAPs are associated to different extents, with weight gain, metabolic syndrome (MetS), and nonalcoholic fatty liver disease (NAFLD). This article summarized clinical evidence showing the metabolic side effects of AAPs in patients with schizophrenia, and experimental evidence of AAPs-induced metabolic side effects observed in animals and cell culture studies. In addition, it discussed potential mechanisms involved in the APPs-induced MetS and NAFLD.

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“…In particular, elderly psychotic patients have a reduced life expectancy compared with healthy seniors, which is associated with a low rate of treatment for hypertension, dyslipidemia and diabetes (Gury, 2004;Marder et al, 2004;Sokal et al, 2004;Hennekens et al, 2005;Lefebvre et al, 2006;Nasrallah et al, 2006). The concurrent decline in cognitive function and functional abilities further compromises health outcomes (Harvey et al, 1998;Friedman et al, 2001;Harvey, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…The pharmacological treatment of older persons with schizophrenia and other psychotic disorders is similar to that of younger patients (Thorpe, 1997; Alexopoulos et al ., 2004; Lehman et al ., 2004a; White et al ., 2006; Limosin, 2009), but several specific factors should be taken into consideration. In particular, elderly psychotic patients have a reduced life expectancy compared with healthy seniors, which is associated with a low rate of treatment for hypertension, dyslipidemia and diabetes (Gury, 2004; Marder et al ., 2004; Sokal et al ., 2004; Hennekens et al ., 2005; Lefebvre et al ., 2006; Nasrallah et al ., 2006). The concurrent decline in cognitive function and functional abilities further compromises health outcomes (Harvey et al ., 1998; Friedman et al ., 2001; Harvey, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, second generation antipsychotics such as risperidone, olanzapine, quetiapine and aripiprazole have been preferred over classical antipsychotics because of their lower incidence of extrapyramidal, anticholinergic and cardiac side-effects and a greater efficacy in reducing negative and neurocognitive symptoms (Alexopoulos et al ., 2004; Jeste et al ., 2005). However, these medications have a propensity to cause weight gain and metabolic disorders, and elderly people with psychotic disorders have more somatic comorbidities, which cause greater difficulty in their treatment (Wirshing et al ., 2003; Gury, 2004; Jeste et al ., 2005; Ruetsch et al ., 2005). Data on tolerance of atypical antipsychotics in elderly patients suffering from schizophrenia and other psychotic disorders are still scarce, particularly concerning the dose adaptation in aging schizophrenic patients with altered renal or hepatic function (Rosenheck et al ., 2006).…”

Section: Introductionmentioning

confidence: 99%

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Health management of older persons with chronically medicated psychotic disorders: the results of a survey in France

Arbus

Clément

Bougerol

et al. 2012

International Psychogeriatrics

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Schizophrénie, diabète et antipsychotiques

Cited by 16 publications

References 50 publications

Efficacy and Safety of Donepezil in Patients with Schizophrenia or Schizoaffective Disorder: Significant Placebo/Practice Effects in a 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial

Efficacy and Safety of Donepezil in Patients with Schizophrenia or Schizoaffective Disorder: Significant Placebo/Practice Effects in a 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial

<p>Atypical antipsychotics-induced metabolic syndrome and nonalcoholic fatty liver disease: a critical review</p>

Health management of older persons with chronically medicated psychotic disorders: the results of a survey in France

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