Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Commentary
3 (
3
); 284-285

Commentary

Department of Psychiatry, College of Medicine,Mansoura University, Egypt
Address for correspondence: Dr. Mostafa Amr, Department of Neuroscience, College of Medicine in Al-Ahsa, King Faisal University, Al Ahsa, Saudi Arabia, Hofuf, Saudi Arabia. E-mail: mostafapsy@yahoo.com

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

In recent years, metabolic syndrome (MS) has been identified as an important health risk in patients with schizophrenia and related disorders, and has often been related to the use of second-generation antipsychotics, particularly clozapine and olanzapine. MS, which is a constellation of cardiovascular risk factors including diabetes, hypertension, obesity, and dyslipidemia, is potentially reversible and may explain the higher incidence of cardiovascular disease in patients with serious mental illness.[1]

In 2005, McEvoy et al.[2] found that the age-adjusted prevalence of metabolic syndrome in patients with schizophrenia was 40.9%, based on the criteria from the third report of the National Cholesterol Education Program's Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (NCEP ATP III).

Among the second generation antipsychotic drugs (SGA), olanzapine and clozapine are associated with excessive body weight gain, hyperglycemia, dyslipidemia and probably a pro-coagulant state.[2]

At present, it is not clear whether the metabolic syndrome has a single cause as it appears that it can be precipitated by multiple underlying risk factors. The most important of these underlying risk factors are abdominal obesity and insulin resistance.[3]

Several expert consensus guidelines have, therefore, called for routine monitoring of weight, lipids, and glucose for patients taking second-generation antipsychotics.[4]

Commonly used proxy or anthropometric measures such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), hip circumference, and waist-to-stature ratio (WSR) have been proposed to define obesity in epidemiological studies. In 2001, NCEP ATP III adopted waist circumference (WC) as the best surrogate for visceral adipose tissue (VAT). VAT as measured by WC has been shown to have a stronger association with cardiometabolic risk factors than general adiposity as measured by body mass index (BMI).[5]

However, WC cut-off values for detecting diabetes, other metabolic abnormalities, and cardiovascular disease (CVD) were proposed for different populations, with higher values for Europeans and lower values for Asians.[6] Comparability of findings within the same ethnicity, however, is limited, which may be due to variations in the age range of the study population and the statistical methods applied.

Moreover, the usefulness of anthropometric measures in predicting obesity-related metabolic side effects such as insulin resistance (IR) associated with antipsychotic agents in patients with schizophrenia is still uncertain. One study found that both BMI and WC significantly predicted abnormalities in glucose homeostasis measured by a frequently sampled intravenous glucose tolerance test (FSIVGTT) in patients with schizophrenia taking olanzapine, risperidone, ziprasidone, or first-generation antipsychotics.[7]

This article has put forward a sincere effort to examine the relative importance of BMI and WC as markers of dyslipidemia and insulin resistance in schizophrenia patients stabilized on second generation antipsychotics in the Indian population.[8] Further studies would profit from examination of relevant neurobiological and pathophysiologic pathways involved in antipsychotic-induced weight gain, especially the role of individual genetic factors and drug-related pharmacogenetic factors as there is emerging evidence to suggest that there are individual differences between different SGAs with regard to cardiac and metabolic side effect profiles.

At present, we recommend monitoring VAT by measuring WC along with monitoring of fasting glucose, lipid levels, and blood pressure for patients with schizophrenia being treated with Olanzepine.

References

  1. . Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) JAMA. 2001;285:2486-97.
    [Google Scholar]
  2. , , , , , , . Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res. 2005;80:19-32.
    [Google Scholar]
  3. , , , , . Prevalence of baseline serum glucose and lipid testing in users of second-generation antipsychotic drugs: A retrospective, population-based study of Medicaid claims data. J Clin Psychiatry. 2008;69:316-22.
    [Google Scholar]
  4. , , . Metabolic monitoring for patients treated with antipsychotic medications. Can J Psychiatry. 2006;51:492-501.
    [Google Scholar]
  5. , , , , , , . Association between simple anthropometric indices and cardiovascular risk factors. Int J Obes Relat Metab Disord. 2001;25:1689-97.
    [Google Scholar]
  6. , , , . Metabolic syndrome--A new world-wide definition.A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23:469-80.
    [Google Scholar]
  7. , , , , , , . Adiposity and insulin sensitivity derived from intravenous glucose tolerance tests in antipsychotic-treated patients. Neuropsychopharmacology. 2007;32:2561-9.
    [Google Scholar]
  8. , , , , , . Anthropometric parameters as indicators of metabolic derangements in schizophrenia patients stabilized on olanzapine in an Indian rural population. Journal of Neurosciences in Rural Practice. 2012;3:277-82.
    [Google Scholar]

    Fulltext Views
    491

    PDF downloads
    225
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections