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Which comes first: atypical antipsychotic treatment or cardiometabolic risk?
Acta Psychiatr Scand. 2009 Mar; 119(3):171-9.AP

Abstract

OBJECTIVE

To provide an overview for practicing clinicians on the pharmacological basis of cardiometabolic risk induced by antipsychotic drugs in patients with serious mental illness, to propose hypotheses to explain these risks and to give tips for managing cardiometabolic risk during antipsychotic treatment.

METHOD

A MEDLINE search using terms for atypical antipsychotics (including individual drug names), metabolic, cardiovascular, weight gain and insulin resistance, cross-referenced with schizophrenia was performed on articles published between 1990 and May 2008.

RESULTS

Strong evidence exists for significant cardiometabolic risk differences among several antipsychotic agents. Histamine H1 and serotonin 5HT2C antagonism are associated with risk of weight gain, but receptor targets for dyslipidemia and insulin resistance have not yet been identified. Convincing data indicate that hypertriglyceridemia and insulin resistance may occur in the absence of weight gain with certain antipsychotics.

CONCLUSION

Although lifestyle and genetics may contribute independent risks of cardiometabolic dysfunction in schizophrenia and other serious mental illness, antipsychotic treatment also represents an important contributor to risk of cardiometabolic dysfunction, particularly for certain drugs and for vulnerable patients. Mental health professionals must learn to recognize the clinical signposts indicating antipsychotic-related cardiometabolic problems to forestall progression to type II diabetes, cardiovascular events and premature death.

Authors+Show Affiliations

Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA 92008, USA. smstahl@neiglobal.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19178394

Citation

Stahl, S M., et al. "Which Comes First: Atypical Antipsychotic Treatment or Cardiometabolic Risk?" Acta Psychiatrica Scandinavica, vol. 119, no. 3, 2009, pp. 171-9.
Stahl SM, Mignon L, Meyer JM. Which comes first: atypical antipsychotic treatment or cardiometabolic risk? Acta Psychiatr Scand. 2009;119(3):171-9.
Stahl, S. M., Mignon, L., & Meyer, J. M. (2009). Which comes first: atypical antipsychotic treatment or cardiometabolic risk? Acta Psychiatrica Scandinavica, 119(3), 171-9. https://doi.org/10.1111/j.1600-0447.2008.01334.x
Stahl SM, Mignon L, Meyer JM. Which Comes First: Atypical Antipsychotic Treatment or Cardiometabolic Risk. Acta Psychiatr Scand. 2009;119(3):171-9. PubMed PMID: 19178394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Which comes first: atypical antipsychotic treatment or cardiometabolic risk? AU - Stahl,S M, AU - Mignon,L, AU - Meyer,J M, PY - 2009/1/31/entrez PY - 2009/1/31/pubmed PY - 2009/4/25/medline SP - 171 EP - 9 JF - Acta psychiatrica Scandinavica JO - Acta Psychiatr Scand VL - 119 IS - 3 N2 - OBJECTIVE: To provide an overview for practicing clinicians on the pharmacological basis of cardiometabolic risk induced by antipsychotic drugs in patients with serious mental illness, to propose hypotheses to explain these risks and to give tips for managing cardiometabolic risk during antipsychotic treatment. METHOD: A MEDLINE search using terms for atypical antipsychotics (including individual drug names), metabolic, cardiovascular, weight gain and insulin resistance, cross-referenced with schizophrenia was performed on articles published between 1990 and May 2008. RESULTS: Strong evidence exists for significant cardiometabolic risk differences among several antipsychotic agents. Histamine H1 and serotonin 5HT2C antagonism are associated with risk of weight gain, but receptor targets for dyslipidemia and insulin resistance have not yet been identified. Convincing data indicate that hypertriglyceridemia and insulin resistance may occur in the absence of weight gain with certain antipsychotics. CONCLUSION: Although lifestyle and genetics may contribute independent risks of cardiometabolic dysfunction in schizophrenia and other serious mental illness, antipsychotic treatment also represents an important contributor to risk of cardiometabolic dysfunction, particularly for certain drugs and for vulnerable patients. Mental health professionals must learn to recognize the clinical signposts indicating antipsychotic-related cardiometabolic problems to forestall progression to type II diabetes, cardiovascular events and premature death. SN - 1600-0447 UR - https://www.unboundmedicine.com/medline/citation/19178394/Which_comes_first:_atypical_antipsychotic_treatment_or_cardiometabolic_risk L2 - https://doi.org/10.1111/j.1600-0447.2008.01334.x DB - PRIME DP - Unbound Medicine ER -