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Prevalence of metabolic syndrome among patients with Schizophrenia in Palestine
Waleed M Sweileh, Sa’ed H Zyoud, Salah A Dalal, Sami Ibwini, Ansam F Sawalha, Iyad Ali
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-235
Abstract: We recruited 250 patients with schizophrenia from 4 psychiatric primary healthcare centers in Northern Palestine. The MS prevalence was assessed based on National Cholesterol Education Program Adult Treatment Panel III Adapted criteria.The overall MS prevalence was 43.6%, with 39% in male and 55.9% in female patients. On average, the study patients had 2.3?±?1.3 metabolic abnormalities. Univariate analysis showed that MS was significantly higher with older age, female gender, longer duration of the illness, smoking, abdominal obesity, high systolic and diastolic blood pressure, high triglycerides, low HDL-C, and high fasting plasma glucose. Multiple logistic regression analysis showed that only systolic blood pressure, high triglycerides, high fasting plasma glucose, and low HDL-C were significant predictors of MS in schizophrenic patients.MS is common among Arab patients with schizophrenia. Patients with schizophrenia should receive regular monitoring and adequate treatment of cardio-metabolic risk factors.Schizophrenia is a mental disorder that affects approximately one percent of the various populations throughout the world [1-3]. Patients with schizophrenia are reported to have shorter life span compared to the general population [4-6]. The most commonly reported cause of excess mortality among patients with schizophrenia is cardiovascular diseases [7,8]. Cardiovascular morbidity and mortality among patients with schizophrenia has been linked to high prevalence of metabolic syndrome [9]. Metabolic syndrome (MS), also known as syndrome X or insulin resistance syndrome is a cluster of interrelated metabolic risk factors that appear to directly promote the development of atherosclerotic cardiovascular disease [10-13]. Furthermore, metabolic abnormalities not only have an impact on physical health but also on a poorer quality of life [14], non-compliance [15] and a lower functional outcome [16].Three definitions of MS have been proposed by the National Cholesterol E
Metabolic Disturbances in Schizophrenia Patients With Positive, Negative and Cognitive Symptoms
P. Uma Devi,S Murugam
JK Science : Journal of Medical Education & Research , 2009,
Abstract: Elevated cholesterol, triglycerides and glucose are known independent risk factors for coronary heartdisease. This study examines the status of cholesterol, triglycerides and glucose of schizophrenia patientswith positive, negative and cognitive symptoms and to investigate the association between these levels andobesity. This was a prospective observational study involving samples of patients who met establishedcriteria for schizophrenia and were admitted to the mental health care center, Coimbatore. Glucose, totalcholesterol and triglycerides levels increased when schizophrenia patients are treated with anti-psychoticdrugs. Although mean changes in glucose and cholesterol levels remained within clinically normal ranges,about one patient in eight studied developed abnormally high glucose, and also one in five patients assessedhas abnormal cholesterol levels. The obesity and metabolic disorders observed in the patients were higherthan the prevalence in the control group and confirms that there are deregulations of metabolic pathwaysin schizophrenic patients. The rate of obesity and metabolic disorders observed in this study were higherthan the prevalence in the control group sugesting that more attention should be paid to the metaboliccondition of psychiatric patients.
Psychiatrists' Attitudes toward Metabolic Adverse Events in Patients with Schizophrenia  [PDF]
Norio Sugawara, Norio Yasui-Furukori, Manabu Yamazaki, Kazutaka Shimoda, Takao Mori, Takuro Sugai, Yutaro Suzuki, Toshiyuki Someya
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086826
Abstract: Background There is growing concern about the metabolic abnormalities in patients with schizophrenia. Aims The aim of this study was to assess the attitudes of psychiatrists toward metabolic adverse events in patients with schizophrenia. Method A brief questionnaire was constructed to cover the following broad areas: the psychiatrists' recognition of the metabolic risk of antipsychotic therapy, pattern of monitoring patients for physical risks, practice pattern for physical risks, and knowledge of metabolic disturbance. In March 2012, the questionnaire was mailed to 8,482 psychiatrists who were working at hospitals belonging to the Japan Psychiatric Hospitals Association. Results The overall response rate was 2,583/8,482 (30.5%). Of the respondents, 85.2% (2,200/2,581) reported that they were concerned about prescribing antipsychotics that have a risk of elevating blood sugar; 47.6% (1,201/2,524) stated that their frequency of monitoring patients under antipsychotic treatment was based on their own experiences; and only 20.6% (5,22/2,534) of respondents answered that the frequency with which they monitored their patients was sufficient to reduce the metabolic risks. Conclusions Psychiatrists practicing in Japan were generally aware and concerned about the metabolic risks for patients being treated with antipsychotics. Although psychiatrists should monitor their patients for metabolic abnormalities to balance these risks, a limited number of psychiatrists answered that the frequency with which they monitored patients to reduce the metabolic risks was sufficient. Promotion of the best practices of pharmacotherapy and monitoring is needed for psychiatrists treating patients with schizophrenia.
Metabolic Profiling of CSF: Evidence That Early Intervention May Impact on Disease Progression and Outcome in Schizophrenia  [PDF]
Elaine Holmes equal contributor,Tsz M Tsang equal contributor,Jeffrey T.-J Huang equal contributor,F. Markus Leweke equal contributor,Dagmar Koethe,Christoph W Gerth,Brit M Nolden,Sonja Gross,Daniela Schreiber,Jeremy K Nicholson,Sabine Bahn
PLOS Medicine , 2006, DOI: 10.1371/journal.pmed.0030327
Abstract: Background The identification of schizophrenia biomarkers is a crucial step towards improving current diagnosis, developing new presymptomatic treatments, identifying high-risk individuals and disease subgroups, and assessing the efficacy of preventative interventions at a rate that is not currently possible. Methods and Findings 1H nuclear magnetic resonance spectroscopy in conjunction with computerized pattern recognition analysis were employed to investigate metabolic profiles of a total of 152 cerebrospinal fluid (CSF) samples from drug-na?ve or minimally treated patients with first-onset paranoid schizophrenia (referred to as “schizophrenia” in the following text) and healthy controls. Partial least square discriminant analysis showed a highly significant separation of patients with first-onset schizophrenia away from healthy controls. Short-term treatment with antipsychotic medication resulted in a normalization of the disease signature in over half the patients, well before overt clinical improvement. No normalization was observed in patients in which treatment had not been initiated at first presentation, providing the first molecular evidence for the importance of early intervention for psychotic disorders. Furthermore, the alterations identified in drug-na?ve patients could be validated in a test sample set achieving a sensitivity and specificity of 82% and 85%, respectively. Conclusions Our findings suggest brain-specific alterations in glucoregulatory processes in the CSF of drug-na?ve patients with first-onset schizophrenia, implying that these abnormalities are intrinsic to the disease, rather than a side effect of antipsychotic medication. Short-term treatment with atypical antipsychotic medication resulted in a normalization of the CSF disease signature in half the patients well before a clinical improvement would be expected. Furthermore, our results suggest that the initiation of antipsychotic treatment during a first psychotic episode may influence treatment response and/or outcome.
Risk of metabolic syndrome in patients with schizophrenia: comparative study with population of bank employees in Russia  [PDF]
Martynikhin, Ivan,Tanyanskiy, Dmitry,Solntsev, Vladislav,Sokolian, Nina
Archives of Psychiatry and Psychotherapy , 2013,
Abstract: Aim. This study is dedicated to evaluation of the prevalence of metabolic syndrome and its components in patients with schizophrenia in Russia.Methods. 138 patients with schizophrenia who received antipsychotic medication and 138 mental healthy subjects from 1,561 bank employees cohort matched to schizophrenic patients by sex, age and body mass index were enrolled to the study. Fasting blood plasma levels of glucose, lipids, insulin, cortisol, prolactin concentrations were determined.Results. In comparison with control group, patients had significantly higher frequency of metabolic syndrome and abdominal type of obesity (according to NCEP ATP III and IDF criteria). In spite of lesser levelof plasma glucose and total cholesterol, plasma insulin and triglycerides concentrations were higher in patients with schizophrenia. High density lipoprotein cholesterol concentration was lower in patients while arterial blood pressure level didn’t differ between groups. Cortisol and prolactin levels were elevated in the patient group, but these hormones neither correlated with metabolic syndrome nor with any metabolic parameters studied.Discussion. The study conducted in Russia revealed the increased frequency of metabolic syndrome in schizophrenic patients in comparison with mental healthy cohort. The main disorders found in the patient group were abdominal obesity, insulin resistance and dyslipidemia.Conclusion. Results obtained in this study should be taken into account when developing of medical treatment of patients with schizophrenia.
Relationships between Brain Structure and Metabolic Changes in Schizophrenia Patients Treated with Olanzapine: A Voxel-Based Morphometric Study  [PDF]
Genevieve Letourneau,Lahcen Ait Bentaleb,Benjamin Stip,David Luck,Emmanuel Stip
Schizophrenia Research and Treatment , 2011, DOI: 10.1155/2011/862350
Abstract: Introduction. Second-generation antipsychotics treatment is associated with weight gain and metabolic disturbances. Although much research has been done on the topic, the precise mechanisms underlying such side effects are still not well understood. Method. We followed over 16 weeks a group of 17 schizophrenia patients who were treated with olanzapine and monitored biometric, clinical, and metabolic data, including ghrelin and leptin levels. All patients had a structural cerebral magnetic resonance imaging examination during the first week of their followup and at the end of the study. Results. We found positive and negative significant correlations between grey matter volumes of several brain regions and variations of body weight as well as of ghrelin and leptin levels. The right frontal operculum, bilateral precuneus, and bilateral hippocampal regions were found to be significantly associated with those changes. Conclusion. Our results suggest associations between brain structure and metabolic variations in schizophrenia patients taking olanzapine.
Fatty Acid Desaturase Gene Polymorphisms and Metabolic Measures in Schizophrenia and Bipolar Patients Taking Antipsychotics  [PDF]
Kyle J. Burghardt,Kristen N. Gardner,Joshua W. Johnson,Vicki L. Ellingrod
Cardiovascular Psychiatry and Neurology , 2013, DOI: 10.1155/2013/596945
Abstract: Atypical antipsychotics have become a common therapeutic option in both schizophrenia and bipolar disorder. However, these medications come with a high risk of metabolic side effects, particularly dyslipidemia and insulin resistance. Therefore, identification of patients who are at increased risk for metabolic side effects is of great importance. The genetics of fatty acid metabolism is one area of research that may help identify such patients. Therefore, in this present study, we aimed to determine the effect of one commonly studied genetic polymorphism from both fatty acid desaturase 1 (FADS1) and FADS2 gene on a surrogate measure of insulin resistance and lipid levels in a metabolically high-risk population of patients largely exposed to atypical antipsychotics. This study used a cross-sectional design, fasting blood draws, and genetic analysis to investigate associations between polymorphisms, haplotypes, and metabolic measures. A total of 320 subjects with schizophrenia ( ) or bipolar disorder ( ) were included in this study. The mean age of the population was 42.5 years and 45% were male. A significant association between FADS1 and FADS2 haplotypes was found with insulin resistance while controlling for confounders. Further investigation is required to replicate this finding. 1. Background The use of antipsychotics, particularly the atypical antipsychotics (AAPs), is considered the standard of care in schizophrenia symptom management and is becoming a common therapeutic choice in the management of bipolar disorder [1–3]. The fact that AAPs are commonly used in both of these populations may be due to the overlapping symptomatology that is seen as well as the genetic overlap that has been identified in several disease linkage studies [4–7]. Although many studies support the use of AAPs in the severely mentally ill, these medications come with a high risk of metabolic side effects. This risk requires careful monitoring and management as the cardiometabolic side effects have been shown to increase the cost of care, decrease adherence, and, most severely, have negative consequences on length and quality of life [8–11]. Therefore, investigation into lifestyle, diet, and genetic factors that may increase or attenuate the risk of metabolic side effects in patients taking AAPs is important and of high interest. One current line of research within the area of AAP metabolic side effects concentrates on fatty acid metabolism and its influence on metabolic measures. Fatty acids (FAs) serve many important physiological functions including energy reserves,
An economic evaluation of aripiprazole vs olanzapine adapted to the Italian setting using outcomes of metabolic syndrome and risk for diabetes in patients with schizophrenia
Giorgio L Colombo,Mauro Caruggi,Sergio Di Matteo,Alessandro Rossi
Neuropsychiatric Disease and Treatment , 2008,
Abstract: Giorgio L Colombo1, Mauro Caruggi2, Sergio Di Matteo1, Alessandro Rossi31S.A.V.E. Studi Analisi Valutazioni Economiche, Milano, Italy; 2Università degli Studi dell’Insubria, Varese, Italy; 3Università de L’Aquila, ItalyObjective: To evaluate the cost-effectiveness of aripiprazole and olanzapine in patients with schizophrenia.Methods: Data from a double-blind, randomized study demonstrating the efficacy of aripiprazole and olanzapine were used to observe new incidence of metabolic syndrome (26-week therapy) and to model the risk of developing diabetes over 5 years of therapy. Cumulative incidence of metabolic syndrome was compared using Kaplan–Meier estimates; diabetes risk was estimated using a validated, general population risk-prediction model. Economic assessment was conducted from the third-party payer perspective by evaluating pharmacotherapy costs of treating schizophrenia and medical costs associated with treating adverse metabolic effects in a hypothetical cohort of 1000 patients. Resource utilization and costs were derived from the underlying study and published data, using a 3% rate to discount costs and benefits.Results: For the patients switched from olanzapine to aripiprazole, treatment with aripiprazole was a dominant cost-saving strategy. Use of aripiprazole avoided 184 events of metabolic syndrome over 26 weeks of treatment, contributing to a real-world (RW) cost savings of €2.53 per patient and a total savings of approximately €465.52 over a 5-year period. For the same cohort, the risk-prediction model indicated that 34 occurrences of diabetes could be avoided over 5 years, corresponding to a RW cost savings of €56.86 per patient and a total saving of approximately €1,933.24. These savings reflect avoided costs in treating adverse metabolic events and comparable costs in the acquisition of aripiprazole.Conclusions: Maintenance aripiprazole therapy offers medical and economic benefits over olanzapine, reflected by reduced incidence of metabolic syndrome and diabetes and associated lower costs.Keywords: schizophrenia, cost-consequences, apripiprazole, olanzapine, metabolic syndrome, diabetes
Relationships between Brain Structure and Metabolic Changes in Schizophrenia Patients Treated with Olanzapine: A Voxel-Based Morphometric Study  [PDF]
Genevieve Letourneau,Lahcen Ait Bentaleb,Benjamin Stip,David Luck,Emmanuel Stip
Schizophrenia Research and Treatment , 2011, DOI: 10.1155/2011/862350
Abstract: Introduction. Second-generation antipsychotics treatment is associated with weight gain and metabolic disturbances. Although much research has been done on the topic, the precise mechanisms underlying such side effects are still not well understood. Method. We followed over 16 weeks a group of 17 schizophrenia patients who were treated with olanzapine and monitored biometric, clinical, and metabolic data, including ghrelin and leptin levels. All patients had a structural cerebral magnetic resonance imaging examination during the first week of their followup and at the end of the study. Results. We found positive and negative significant correlations between grey matter volumes of several brain regions and variations of body weight as well as of ghrelin and leptin levels. The right frontal operculum, bilateral precuneus, and bilateral hippocampal regions were found to be significantly associated with those changes. Conclusion. Our results suggest associations between brain structure and metabolic variations in schizophrenia patients taking olanzapine. 1. Introduction Second-generation antipsychotics, such as olanzapine and clozapine, are associated with weight gain [1] and various metabolic disturbances [2]. These adverse effects are associated with a significant increase of morbidity among the affected patients [3]. Metabolic changes have been associated with an important increase of appetite [4] but might as well be secondary to other mechanisms, all of which are still poorly understood despite the important amount of research that has already been produced on the topic. It has also been described that weight gain secondary to antipsychotic therapy was also associated with better clinical response [5], which can raise new questions and new hypothesis as for the mechanisms of weight gain. Over the last years, the involvement of neuropeptides and hormones, such as ghrelin and leptin, in the appetite and eating behavior mechanisms has been studied. Ghrelin is an orexigenic signalling hormone, especially produced in the stomach and released in the blood stream, circulating in the whole body [6]. Ghrelin secretion is regulated by food intake, and its concentration rises during fasting and lowers after meals [7]. The rise of ghrelin levels could play a role in the meal initiation [8]. Levels of plasma ghrelin show a negative correlation with BMI and are high in thin or anorexic people and low in obese people [9]. Ghrelin is the endogenous ligand for a Growth Hormone secretagogue receptor (GHS-R), which means that it stimulates Growth Hormone (GH) release.
Prevalence of metabolic syndrome in patients with schizophrenia, and metabolic changes after 3 months of treatment with antipsychotics - results from a German observational study
Susanne Kraemer, Anette Minarzyk, Thomas Forst, Daniel Kopf, Hans-Peter Hundemer
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-173
Abstract: MetS-prevalence (AHA/NHLB-definition) was assessed and Clopper-Pearson 95% confidence intervals (CIs) were calculated. Factors associated with MetS were explored through univariate and multivariate logistic regressions (both visits).MetS-prevalence was 44.3% (CI 39.8;48.9) at baseline and 49.6% (CI 45.0;54.2) at month-3. Previously unmedicated patients showed the lowest baseline MetS-prevalence (24.7%, CI 18.3;32.1). MetS-prevalence was not significantly different, regardless if patients previously received typical or atypical antipsychotics. Increased MetS-risk was associated with somatic comorbidity and non-smoking at both visits, and with non-psychiatric co-medication, male sex, and increased C-reactive protein at month-3.At baseline, MetS was most prevalent in patients with previous antipsychotic medication. Limited metabolic changes were observed 3 months after switch/initiation of antipsychotic therapy.ClinicalTrials.gov Identifier: n.a.Several studies have reported increased mortality in patients with schizophrenia. Besides higher risks for cancer, respiratory and cerebrovascular disorders, and of death from suicide or homicide, the main cause is cardiovascular disease [1-7]. Even before antipsychotic medication became available in the 1950s, abnormal responses to insulin and diabetes-like glucose tolerance curves [8,9] were observed in psychiatric patients. Planansky and Heilizer [10] reported weight gain already in 1959 in patients treated with chlorpromazine. Thakore et al. [11] found higher BMI (body mass index), WHR (waist/hip ratio), and a threefold amount of intra-abdominal fat (IAF) in untreated schizophrenia patients compared to healthy controls. Further factors associated with schizophrenia, like unhealthy diet patterns [12], smoking [13], lower levels of physical activity and cardiorespiratory fitness [14], and poor living conditions certainly contribute to the finding that these patients, including those on antipsychotics, may have a higher risk t
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