Weight gain and metabolic disturbances associated with the atypical antipsychotics.

2002 ◽  
Vol 33 (3) ◽  
pp. 341-344 ◽  
Author(s):  
Rafael A. Rivas-Vazquez ◽  
Jose Rey
Keyword(s):  
Weight Gain ◽  
Atypical Antipsychotics ◽  
Metabolic Disturbances

The impact of weight gain associated with atypical antipsychotic use in schizophrenia

2004 ◽  
Vol 16 (3) ◽  
pp. 113-123 ◽  
Author(s):  
Pierre Chue ◽  
Raphael Cheung
Keyword(s):  
Weight Gain ◽  
Weight Management ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Current Data ◽  
Antipsychotic Treatment ◽  
Metabolic Disturbances ◽  
Obesity And Diabetes ◽  
The Impact ◽  
Selection Of

Background:Atypical antipsychotics offer clear advantages in the management of schizophrenia, compared with conventional neuroleptics, but weight gain is a significant adverse effect with some of these agents.Objective:To review the literature on weight gain associated with atypical antipsychotic treatment in schizophrenia.Methods:Relevant sources were identified from Medline searches to February 2003 using combinations of keywords including ‘schizophrenia’, ‘antipsychotics’, ‘weight gain’, ‘adverse events’, ‘obesity’, and ‘diabetes’.Results:Most atypical antipsychotics induce some weight gain, but the magnitude of the effect varies markedly. The greatest increases are seen with clozapine and olanzapine: risperidone has a slight effect, comparable with that of conventional neuroleptics, while ziprasidone and aripiprazole appear from current data to have little effect. In addition, atypical antipsychotics have been associated with metabolic disturbances, particularly glucose dysregulation and dyslipidemia. These effects tend to be more marked with olanzapine and clozapine than with other agents. Weight gain associated with atypical antipsychotics imposes substantial morbidity, in addition to that associated with schizophrenia itself. Furthermore, weight gain can significantly impair patients' quality of life, and leads to non-adherence with treatment. Effective weight management should include the selection of an appropriate atypical antipsychotic and for effective weight management, as well both diet and exercise, formal weight management programs tailored to the needs of schizophrenic patients may be useful, and some patients may benefit from weight-reducing drugs.Conclusions:Weight gain associated with atypical antipsychotics is a common problem that requires effective management. The selection of an agent with a low risk of weight gain, such as risperidone or ziprasidone, is central to such management.

scholarly journals Atypical Antipsychotics and Metabolic Syndrome: From Molecular Mechanisms to Clinical Differences

2021 ◽  
Vol 14 (3) ◽  
pp. 238
Author(s):  
Marco Carli ◽  
Shivakumar Kolachalam ◽  
Biancamaria Longoni ◽  
Anna Pintaudi ◽  
Marco Baldini ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Weight Gain ◽  
Atypical Antipsychotics ◽  
Molecular Mechanisms ◽  
Psychotic Disorders ◽  
Partial Agonist ◽  
Hepatic Glucose Production ◽  
Glucose Production ◽  
Therapeutic Drug ◽  
Metabolic Disturbances

Atypical antipsychotics (AAPs) are commonly prescribed medications to treat schizophrenia, bipolar disorders and other psychotic disorders. However, they might cause metabolic syndrome (MetS) in terms of weight gain, dyslipidemia, type 2 diabetes (T2D), and high blood pressure, which are responsible for reduced life expectancy and poor adherence. Importantly, there is clear evidence that early metabolic disturbances can precede weight gain, even if the latter still remains the hallmark of AAPs use. In fact, AAPs interfere profoundly with glucose and lipid homeostasis acting mostly on hypothalamus, liver, pancreatic β-cells, adipose tissue, and skeletal muscle. Their actions on hypothalamic centers via dopamine, serotonin, acetylcholine, and histamine receptors affect neuropeptides and 5′AMP-activated protein kinase (AMPK) activity, thus producing a supraphysiological sympathetic outflow augmenting levels of glucagon and hepatic glucose production. In addition, altered insulin secretion, dyslipidemia, fat deposition in the liver and adipose tissues, and insulin resistance become aggravating factors for MetS. In clinical practice, among AAPs, olanzapine and clozapine are associated with the highest risk of MetS, whereas quetiapine, risperidone, asenapine and amisulpride cause moderate alterations. The new AAPs such as ziprasidone, lurasidone and the partial agonist aripiprazole seem more tolerable on the metabolic profile. However, these aspects must be considered together with the differences among AAPs in terms of their efficacy, where clozapine still remains the most effective. Intriguingly, there seems to be a correlation between AAP’s higher clinical efficacy and increase risk of metabolic alterations. Finally, a multidisciplinary approach combining psychoeducation and therapeutic drug monitoring (TDM) is proposed as a first-line strategy to avoid the MetS. In addition, pharmacological treatments are discussed as well.

Psychosis

2019 ◽  
pp. 150-151
Author(s):  
David L. Brody
Keyword(s):  
Young Adults ◽  
Weight Gain ◽  
Drug Abuse ◽  
Side Effects ◽  
Sleep Deprivation ◽  
Outpatient Treatment ◽  
Atypical Antipsychotics ◽  
Psychiatric Service ◽  
Safety First ◽  
Cognitive Side Effects

New onset hallucinations and delusions are rare after isolated concussion and should trigger a search for other causes: Schizophrenia (relatively common in young adults), drug abuse, alcohol or drug withdrawal, and delirium due to infection or sleep deprivation should be considered. Importantly, if the psychosis is dangerous or potentially dangerous, think about safety first. This may require inpatient admission to a psychiatric service. If outpatient treatment is required, atypical antipsychotics should be used in as low a dose as possible to minimize cognitive side effects. Aripiprazole (Abilify) is associated with less weight gain than other atypical antipsychotics. Risperidone (Risperdal) is the least expensive. Quetiapine (Seroquel), or rarely Clozaril, are the best choices when parkinsonism is a comorbidity.

Do Atypical Antipsychotics Cause Weight Gain in Nursing Home Dementia Residents?

2004 ◽  
Vol 19 (9) ◽  
pp. 809-812 ◽  
Author(s):  
Samuel L. Gurevitz ◽  
Terry Costakis ◽  
John Leiter
Keyword(s):  
Nursing Home ◽  
Weight Gain ◽  
Atypical Antipsychotics

scholarly journals Lurasidone compared to other atypical antipsychotic monotherapies for adolescent schizophrenia: a systematic literature review and network meta-analysis

2019 ◽  
Vol 29 (9) ◽  
pp. 1195-1205
Author(s):  
Celso Arango ◽  
Daisy Ng-Mak ◽  
Elaine Finn ◽  
Aidan Byrne ◽  
Antony Loebel
Keyword(s):  
Weight Gain ◽  
Literature Review ◽  
Atypical Antipsychotic ◽  
Systematic Literature Review ◽  
Atypical Antipsychotics ◽  
Meta Analysis ◽  
Similar Efficacy ◽  
Binary Outcomes ◽  
Schizophrenia Spectrum Disorders ◽  
Credible Intervals

AbstractThis network meta-analysis assessed the efficacy and tolerability of lurasidone versus other oral atypical antipsychotic monotherapies in adolescent schizophrenia. A systematic literature review identified 13 randomized controlled trials of antipsychotics in adolescents with schizophrenia-spectrum disorders. A Bayesian network meta-analysis compared lurasidone to aripiprazole, asenapine, clozapine, olanzapine, paliperidone extended-release (ER), quetiapine, risperidone, and ziprasidone. Outcomes included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Severity (CGI-S), weight gain, all-cause discontinuation, extrapyramidal symptoms (EPS), and akathisia. Results were reported as median differences for continuous outcomes and odds ratios (ORs) for binary outcomes, along with 95% credible intervals (95% CrI). Lurasidone was significantly more efficacious than placebo on the PANSS (− 7.95, 95% CrI − 11.76 to − 4.16) and CGI-S (− 0.44, 95% CrI − 0.67 to − 0.22) scores. Lurasidone was associated with similar weight gain to placebo and statistically significantly less weight gain versus olanzapine (− 3.62 kg, 95% CrI − 4.84 kg to − 2.41 kg), quetiapine (− 2.13 kg, 95% CrI − 3.20 kg to − 1.08 kg), risperidone (− 1.16 kg, 95% CrI − 2.14 kg to − 0.17 kg), asenapine (− 0.98 kg, 95% CrI − 1.71 kg to − 0.24 kg), and paliperidone ER (− 0.85 kg, 95% CrI − 1.57 kg to − 0.14 kg). The odds of all-cause discontinuation were significantly lower for lurasidone than aripiprazole (OR = 0.28, 95% CrI 0.10–0.76) and paliperidone ER (OR = 0.25, 95% CrI 0.08–0.81) and comparable to other antipsychotics. Rates of EPS and akathisia were similar for lurasidone and other atypical antipsychotics. In this network meta-analysis of atypical antipsychotics in adolescent schizophrenia, lurasidone was associated with similar efficacy, less weight gain, and lower risk of all-cause discontinuation compared to other oral atypical antipsychotics.

scholarly journals Short-term Increase in Risk of Overweight and Concomitant Systolic Blood Pressure Elevation in Treatment Naïve Persons Starting INSTI-based Antiretroviral Therapy

2019 ◽  
Author(s):  
Ronald Galdamez ◽  
José A García ◽  
Marta Fernández ◽  
Catalina Robledano ◽  
Vanessa Agulló ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Gain ◽  
Ldl Cholesterol ◽  
University Hospital ◽  
Strand Transfer ◽  
Metabolic Disturbances ◽  
Short Term ◽  
Metabolic Markers ◽  
Blood Pressure Elevation ◽  
Treatment Naïve

Abstract Background Integrase strand transfer inhibitors (INSTI) have been associated with weight gain, but their effect on short-term overweight/obesity incidence, blood pressure(BP) and metabolic markers change has not been described in treatment-naïve people with HIV(PWH). Methods Medical records of treatment-naïve persons starting ART at the HIV Clinic of University Hospital of Elche(Spain), between January 2007 and July 2019 were retrospectively reviewed. Standard procedures included measurements of weight, BP and metabolic assessment. Data at baseline, 48, 72, and 96 weeks post ART initiation were analysed. We used Cox mixed-effects model to generate predictions of BMI over time and Generalized Additive Mixed Models(GAMM) to relax the linearity assumptions and generate 95% confidence intervals in the multivariable adjust. Results Among 219 (median age 44.0 years, IQR=37.0-53.5; 46 females) participants. Baseline weight mean(SD) was 70.4(13.7)kg without difference between regimens; 66% had a BMI <25 kg/mt2. The incidence of overweight/obesity was significantly greater in persons starting INSTI-based regimens: 15(36.6%) of 41 patients treated with INSTI vs 30(28.9%) of 104 treated with other ART regimens(HR 2.3, 95%CI, 1.2–4.4;p=0.011). In contrast to other ART regimens, patients treated with INSTI showed a significant increase in systolic BP(SBP) (adjusted increase 7.0 mmHg, 95%CI, 0.3–13.7;p=0.039) that was correlated with weight gain (r=0.13, 95%CI, 0.10-0.16;p<0.001). Patients who reached overweight/obesity in INSTI-based ART showed a significant increase in LDL cholesterol. Conclusions INSTI-based ART was associated in the short-term with a greater risk of overweight/obesity and SBP elevation. Patients developing overweight/obesity increased LDL cholesterol with no other metabolic disturbances.

scholarly journals Study of Effects of Modafinal Add-on Therapy on Excessive Day time drowsiness and weight gain in patients on atypical Antipsychotics

2008 ◽  
Vol 30 (1) ◽  
pp. 24-31
Author(s):  
T. P. Sudhakar ◽  
G. Prasada Rao ◽  
P. Lakshmi Prasuna ◽  
K. John Vijay Sagar
Keyword(s):  
Weight Gain ◽  
Atypical Antipsychotics

scholarly journals Psychotropic drug-induced genetic-epigenetic modulation of CRTC1 gene is associated with early weight gain in a prospective study of psychiatric patients

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Aurélie Delacrétaz ◽  
Anaïs Glatard ◽  
Céline Dubath ◽  
Mehdi Gholam-Rezaee ◽  
Jose Vicente Sanchez-Mut ◽  
...  
Keyword(s):  
Weight Gain ◽  
Side Effects ◽  
Prospective Study ◽  
Psychotropic Drugs ◽  
Energy Homeostasis ◽  
Psychiatric Patients ◽  
Metabolic Disturbances ◽  
Drug Induced ◽  
Metabolic Side Effects ◽  
Early Weight Gain

Abstract Background Metabolic side effects induced by psychotropic drugs represent a major health issue in psychiatry. CREB-regulated transcription coactivator 1 (CRTC1) gene plays a major role in the regulation of energy homeostasis and epigenetic mechanisms may explain its association with obesity features previously described in psychiatric patients. This prospective study included 78 patients receiving psychotropic drugs that induce metabolic disturbances, with weight and other metabolic parameters monitored regularly. Methylation levels in 76 CRTC1 probes were assessed before and after 1 month of psychotropic treatment in blood samples. Results Significant methylation changes were observed in three CRTC1 CpG sites (i.e., cg07015183, cg12034943, and cg 17006757) in patients with early and important weight gain (i.e., equal or higher than 5% after 1 month; FDR p value = 0.02). Multivariable models showed that methylation decrease in cg12034943 was more important in patients with early weight gain (≥ 5%) than in those who did not gain weight (p = 0.01). Further analyses combining genetic and methylation data showed that cg12034943 was significantly associated with early weight gain in patients carrying the G allele of rs4808844A>G (p = 0.03), a SNP associated with this methylation site (p = 0.03). Conclusions These findings give new insights on psychotropic-induced weight gain and underline the need of future larger prospective epigenetic studies to better understand the complex pathways involved in psychotropic-induced metabolic side effects.

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