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The metabolic syndrome during atypical antipsychotic drug treatment: mechanisms and management.
Metab Syndr Relat Disord. 2004 Fall; 2(4):290-307.MS

Abstract

The frequency of obesity, insulin resistance, type 2 diabetes mellitus and other components of metabolic syndrome appear to be significantly elevated in some psychiatric patients. This is a notable example of genetic/environment interaction. Considering the genetic contribution, evidence of insulin resistance in persons with schizophrenia was reported in the pre-pharmacological era. High insulin, glucose, and cortisol levels are observed in first episode psychosis. The frequency of type 2 diabetes mellitus is significantly increased in persons with schizophrenia and bipolar disorder and in their first-degree relatives. Finally, a link exists between schizophrenia and enzymes involved in glycolysis and between antipsychotic drug-induced weight gain and serotonin receptor polymorphism. Important environmental factors are poor dietary habits, smoking, lack of physical exercise, and drug treatment, mostly with antipsychotic drugs (APDs) and perhaps with mood stabilizers. The APDs probably induce metabolic dysfunction by producing sudden appetite increase and weight gain in predisposed subjects. However, direct drug effects on glucose and lipid metabolism independent from body weight change have been proposed. Excessive weight gain is mainly observed with clozapine, olanzapine, chlorpromazine, and thioridazine and is less consistently noted with risperidone or quetiapine. Two recently introduced APDs, ziprasidone and aripiprazole, display a neutral effect on weight and metabolism. Subjects at high risk must be identified early during APD treatment so that provide lifestyle counseling and pharmacological assistance can be provided. The immediate research agenda for the APDs is to improve the animal models of drug-induced metabolic dysfunction; to clarify mechanisms other than weight gain and appetite stimulation; and to test pharmacological agents in randomized, double-blind studies to prevent or reverse metabolic syndrome in selected patients.

Authors+Show Affiliations

Department of Physiology, Los Andes University Medical School, Mérida, Venezuela.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18370698

Citation

Baptista, Trino, et al. "The Metabolic Syndrome During Atypical Antipsychotic Drug Treatment: Mechanisms and Management." Metabolic Syndrome and Related Disorders, vol. 2, no. 4, 2004, pp. 290-307.
Baptista T, De Mendoza S, Beaulieu S, et al. The metabolic syndrome during atypical antipsychotic drug treatment: mechanisms and management. Metab Syndr Relat Disord. 2004;2(4):290-307.
Baptista, T., De Mendoza, S., Beaulieu, S., Bermúdez, A., & Martinez, M. (2004). The metabolic syndrome during atypical antipsychotic drug treatment: mechanisms and management. Metabolic Syndrome and Related Disorders, 2(4), 290-307. https://doi.org/10.1089/met.2004.2.290
Baptista T, et al. The Metabolic Syndrome During Atypical Antipsychotic Drug Treatment: Mechanisms and Management. Metab Syndr Relat Disord. 2004;2(4):290-307. PubMed PMID: 18370698.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The metabolic syndrome during atypical antipsychotic drug treatment: mechanisms and management. AU - Baptista,Trino, AU - De Mendoza,Soaira, AU - Beaulieu,Serge, AU - Bermúdez,Andrés, AU - Martinez,Maritza, PY - 2008/3/29/pubmed PY - 2008/3/29/medline PY - 2008/3/29/entrez SP - 290 EP - 307 JF - Metabolic syndrome and related disorders JO - Metab Syndr Relat Disord VL - 2 IS - 4 N2 - The frequency of obesity, insulin resistance, type 2 diabetes mellitus and other components of metabolic syndrome appear to be significantly elevated in some psychiatric patients. This is a notable example of genetic/environment interaction. Considering the genetic contribution, evidence of insulin resistance in persons with schizophrenia was reported in the pre-pharmacological era. High insulin, glucose, and cortisol levels are observed in first episode psychosis. The frequency of type 2 diabetes mellitus is significantly increased in persons with schizophrenia and bipolar disorder and in their first-degree relatives. Finally, a link exists between schizophrenia and enzymes involved in glycolysis and between antipsychotic drug-induced weight gain and serotonin receptor polymorphism. Important environmental factors are poor dietary habits, smoking, lack of physical exercise, and drug treatment, mostly with antipsychotic drugs (APDs) and perhaps with mood stabilizers. The APDs probably induce metabolic dysfunction by producing sudden appetite increase and weight gain in predisposed subjects. However, direct drug effects on glucose and lipid metabolism independent from body weight change have been proposed. Excessive weight gain is mainly observed with clozapine, olanzapine, chlorpromazine, and thioridazine and is less consistently noted with risperidone or quetiapine. Two recently introduced APDs, ziprasidone and aripiprazole, display a neutral effect on weight and metabolism. Subjects at high risk must be identified early during APD treatment so that provide lifestyle counseling and pharmacological assistance can be provided. The immediate research agenda for the APDs is to improve the animal models of drug-induced metabolic dysfunction; to clarify mechanisms other than weight gain and appetite stimulation; and to test pharmacological agents in randomized, double-blind studies to prevent or reverse metabolic syndrome in selected patients. SN - 1557-8518 UR - https://www.unboundmedicine.com/medline/citation/18370698/The_metabolic_syndrome_during_atypical_antipsychotic_drug_treatment:_mechanisms_and_management_ L2 - https://www.liebertpub.com/doi/10.1089/met.2004.2.290?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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