Comparative Characteristics of the Metabolic Syndrome Prevalence in Patients With Schizophrenia in Three Western Siberia Psychiatric Hospitals

Objective: The purpose of this study was to compare the prevalence of MetS and the associated sociodemographic, clinical, and pharmacotherapeutic characteristics of patients with schizophrenia in three psychiatric hospitals in the West Siberian region.Methods: Patients with a clinical diagnosis of schizophrenia (ICD-10: F20) and an age between 18 and 60 years were included in the study after giving informed consent. Metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. This research was carried out at three Western Siberian psychiatric hospitals in Kemerovo, Tomsk, and Omsk. The study population included respectively 94, 131, and 91 inpatients with schizophrenia. We carried out schizophrenia symptoms assessment by PANSS, antipsychotic therapy evaluation, anthropometry, and biochemical analysis. Statistical Analysis included the Shapiro–Wilk test, non-parametric Kruskal–Wallis H-test for independent samples, Mann–Whitney U-test for independent samples, the chi-square test, stepwise multiple regression analyses. The level of significance was p < 0.05.Results: The metabolic syndrome prevalence was higher among patients in Tomsk (36.6%), compared with Kemerovo (20.2%, p = 0.008) or Omsk (18.7%, p = 0.004), mainly due to the high prevalence of abdominal obesity, while men from Tomsk were more susceptible to this condition than men from other regions (p < 0.05). Patients from Omsk had the highest severity schizophrenia symptoms according to PANSS, and patients from Tomsk had the lowest severity of positive symptoms according to PANSS. Patients from Tomsk had the minimum duration of antipsychotic therapy compared with the patient from Kemerovo (p = 0.017) and from Omsk (p = 0.000019), but most patients from Tomsk received second-generation atypical antipsychotics, while patients from Omsk received mainly conventional antipsychotics (p = 0.0001). Multiple regression analysis showed that metabolic syndrome associated with schizophrenia duration and body mass index, although the association was not so strong (adjusted R2 = 0.2435, p < 0.0001).Discussion: The study illustrates that in different psychiatric hospitals within the same region, the prevalence of metabolic syndrome in patients with schizophrenia can vary significantly, which dictates the need to look for opportunities to minimize the risk of its occurrence, taking into account the experience of each hospital.

Severe Tachycardia Associated with Psychotropic Medications in Psychiatric Inpatients: A Study of Hospital Medical Emergency Team Activation

The use of antipsychotic medications is associated with side effects, but the occurrence of severe tachycardia (heart rate ≥ 130 per minute) is not well described. The aim of this study was to determine the frequency and strength of the association between antipsychotic use and severe tachycardia in an inpatient population of patients with mental illness, while considering factors which may contribute to tachycardia. We retrospectively analyzed data from 636 Medical Emergency Team (MET) calls occurring in 449 psychiatry inpatients in three metropolitan hospitals co-located with acute medical services, and used mixed-effects logistic regression to model the association between severe tachycardia and antipsychotic use. The median age of patients was 42 years and 39% had a diagnosis of schizophrenia or psychotic disorder. Among patients who experienced MET calls, the use of second-generation (atypical) antipsychotics was commonly encountered (70%), but the use of first-generation (conventional) antipsychotics was less prevalent (10%). Severe tachycardia was noted in 22% of all MET calls, and sinus tachycardia was the commonest cardiac rhythm. After adjusting for age, anticholinergic medication use, temperature >38 °C and hypoglycemia, and excluding patients with infection and venous thromboembolism, the odds ratio for severe tachycardia with antipsychotic medication use was 4.09 (95% CI: 1.64 to 10.2).

A Study of Metabolic Syndrome in Patients on Risperidone

Background: Novel antipsychotics are superior to conventional antipsychotics, as they significantly reduce both positive and negative symptoms of schizophrenia and have lower risk of extra pyramidal syndrome (EPS). However, these drugs cause significant metabolic side effects. Objective: This study was carried out to assess the hospital prevalence of metabolic syndrome (MetS) and metabolic profile related to use of oral risperidone which is one of the most commonly used atypical antipsychotics. Methods: A cross-sectional study was carried out on a period sample of 6 months, to study the hospital prevalence and profile of MetS in adult patients on oral risperidone. Data was collected from pharmacy dispensing records, patients’ case record files, and subsequently patients were contacted telephonically and called to participate in this study. Results: Hospital prevalence of MetS was found to be 12.1% (13 out of 107) by NCEP ATP III criteria and 14.9% (16 out of 107) by IDF criteria in patients (aged 20 to 40 years) on risperidone. Ninety one patients (85%) of the sample were found to be in Overweight category and Central Obesity was found in 82(76.6%) patients. Twenty three (21.4%) of the patients had increased triglyceride (TG) levels. Out of the 16 patients with MetS, 11(68.75%) of them had total duration of illness (TDI) of >4 years, 11(68.75%) were in 30-40 years age group, 13 (81.25%) of them had continued illness or they were in partial remission, 11 (68.75%) of them were already exposed to any antipsychotics other than risperidone, 6(37.5%) of them were having diabetes mellitus (DM) in one parents. Conclusion: This study reported the hospital prevalence of MetS as 14.9% (IDF criteria) in young adult patients on oral risperidone. The triglyceride levels and central obesity was also found to be higher in patients, who otherwise had low prevalence of MetS.

An Unusual Occurrence of Trifluoperazine-Induced Nystagmus in Persistent Hallucinatory Disorder—A Case Report

Trifluoperazine is a conventional antipsychotic whose use has been limited with the arrival of relatively new atypical antipsychotics. However, conventional antipsychotics are utilized in the management of psychiatric illnesses comorbid with metabolic disorders such as diabetes or dyslipidemia. Though trifluoperazine has been known to cause extrapyramidal symptoms, rarely ophthalmic symptoms manifest. Here, we discuss the rare occurrence of newly-emergent nystagmus in an individual with persistent hallucinatory disorder and comorbid diabetes mellitus treated with trifluoperazine.

Topiramate Adjunctive Therapy for Olanzapine Induced Weight Gain in Patients with Schizophrenia

In recent days, the prevailing use of second generation antipsychotics (SGA) or atypical antipsychotics over conventional antipsychotics have shifted the concern of physician from extra pyramidal side effects to the weight gain in the patients receiving treatment for schizophrenia. Among others atypical anti-psychotics, the phenomenology of Olanzapine related weight gain is highly recognized in the clinical practice. However, the exact mechanism by which Olanzapine exerts weight gain effect is largely not understood and is very likely to be multi-factorial. Among other several risk factors, factors such as 5HT2c polymorphisms and H1 receptor affinity have also been purposed. Similarly, various neuro-endocrinal factors related in maintaining energy homeostasis have also been observed to be affected by Olanzapine treatment. However no consisting findings are available to clearly explain the underlying psycho-pathology of disease spectrum in schizophrenia. However, though, recent finding from a clinical trial carried out in healthy male volunteers have suggested that the low baseline TSH profile predicts Olanzapine related weight gain and also interestingly relief by Topiramate adjuvant therapy. However, no such investigations were found in schizophrenia patient.

Tardive Dyskinesia with Atypical versus Conventional Antipsychotic Medications

This chapter provides a summary of a landmark study on schizophrenia and specifically examines a common side effect of antipsychotic medications: tardive dyskinesia. How does the incidence of tardive dyskinesia compare among users of atypical and conventional antipsychotics? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. Take home points include that the incidence of tardive dyskinesia was lower in the study group taking atypical antipsychotics than the group taking conventional antipsychotics, but not as low as previous studies had indicated.

Differentiated psychopharmacological treatment in three genetic subtypes of 22q11.2 deletion syndrome

IntroductionThe 22q11.2 deletion syndrome (22q11DS), mostly caused by the common deletion including the TBX- and COMT-genes (LCR22A-D), is highly associated with somatic anomalies. The distal deletion (distal of LCR22D) comprises the MAPK1-gene and is associated with specific heart defects. The rare central deletion (LCR22B-D) encompasses the CRKL-gene and shows predominantly urogenital anomalies. 22q11DS also differs in its neuropsychiatric profile: common deletion accompanied by schizophrenia-like psychoses and autism spectrum disorders, distal deletion by anxiety disorders, and central deletion by autistic-like behaviours.ObjectivesInvestigating genetic subtypes of 22q11DS.AimsAchieving a targeted pharmacological treatment based on genetic sub-typing.MethodsThirty-two patients with genetically proven 22q11DS, referred for detailed neuropsychiatric analysis.ResultsApart from two patients with distal deletion and one with central deletion, common 22q11.2 deletion was detected in 29 patients. Those with the common deletion were typified by a history of relapsing schizophrenia-like psychoses and partial non-response to conventional antipsychotics. In most patients, anxieties and mood instability were also manifest. The two patients with a distal deletion predominantly showed anxiety symptoms, while the behaviour of the patient with a central deletion was characterized by symptoms from the autism spectrum. Most patients with a common deletion could successfully be treated with clozapine or quetiapine, often combined with valproic acid. One patient with a distal deletion showed full remission upon treatment with citalopram (the second refused such a pharmacological intervention). The behaviour of the patient with central deletion improved upon contextual measures only.ConclusionsThe genetic subtype of 22q11DS enables targeting of treatment strategy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Predicting offense recidivism in Schizophrenia patients

IntroductionSchizophrenia increases the risk of offending. Recidivism rates are significant.AimIdentifying general and violent recidivism risk factors in schizophrenia patients.MethodsWe conducted a case control study. All included patients were admitted, at least once, to the forensic psychiatry department in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. A draw was performed to create the control group. Both groups were matched according to their first offenses’ types as well as to their ages. A multivariate analysis was performed.ResultsWe included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in urban poor neighbourhoods (P = 0.023; OR = 4.86), having been unemployed (P = 0.042; OR = 2.18) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.026; OR = 4.89) and cannabis use disorders (P = 0.018; OR = 6.01). A hospitalization shorter than 6 months increased the risk by 1.79 (P = 0.046). A combination of conventional antipsychotics (P = 0.023;OR = 4.81) and a poor adherence (P = 0.001; OR = 10.42) were considered as recidivism risk factors too.ConclusionsAll eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients’ families, society and the government should be taken.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Predicting offense recidivism in Schizophrenia patients

IntroductionSchizophrenia increases the risk of offending. Recidivism rates are significant.AimIdentifying general and violent recidivism risk factors in schizophrenia patients.MethodsWe conducted a case control study. All included patients were admitted, at least once, to the forensic psychiatry department in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. A draw was performed to create the control group. Both groups were matched according to their first offences’ types as well as to their ages. A multivariate analysis was performed.ResultsWe included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in urban poor neighbourhoods (P = 0.039; OR = 1.23), having been unemployed (P = 0.047; OR = 1.22) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.032; OR = 1.29) and cannabis use disorders (P = 0.005; OR = 1.34). A hospitalization shorter than 6 months increased the risk by 1.44 (P = 0.039). A combination of conventional antipsychotics (P = 0.003; OR = 1.36) and a poor adherence (P = 0.006; OR = 1.36) were considered as recidivism risk factors too.ConclusionsAll eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients’ families, society and the government should be taken.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Isolated rhabdomyolysis caused by olanzapine: About a clinical case

IntroductionAtypical anti-psychotics are increasingly prescribed, given their tolerance. Among these anti-psychotic olanzapine, known for its adverse metabolic effects. By against an adverse event type rhabdomyolysis with olanzapine appears uncommon (<1%) and few clinical cases have been reported in the literature.AimThe aim of our study is to illustrate with a clinical case the occurrence of an isolated rhabdomyolysis with olanzapine.Materiel and methodStarting from the study of the case of a patient with rhabdomyolysis with olanzapine we studied the literature data. Clinical vignette: it is about a patient aged 25 followed for bipolar disorder type I. He responded to the association olanzapine and valproic acid then to valproic acid only. His last hospitalization for manic relapse dating to September 9, 2015 occurred in a context of treatment discontinuation. Upon admission the patient underwent an oral treatment based olanzapine and valproic acid. A dosage of creatine phosphokinase (CPK) done systematically, on September 11 showed high levels of (CPK) to 973 (U/L) without clinical signs of neuroleptic malignant syndrome. The electrocardiogram and biological tests results were normal. Other etiologies can lead to elevated (CPK) were eliminated. The persistent elevation of CPK motivated the arrest of olanzapine. The evolution was marked by a return to normal CPK rates after 15 days. The olanzapine was replaced by haloperidol and vaproic acid maintained. The pharmacovigilance investigation conclude to the accountability of olanzapine in this rhabdomyolysis.ConclusionSecond generation, anti-psychotics are known for their better tolerance compared to conventional antipsychotics. However, they are not devoid of side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.