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April 01, 2007
Research Update on Metabolic Syndrome (Including Diabetes, Heart-Attack & Stroke Risks) and Schizophrenia
Read more... Schizophrenia Med Side-effects
People with schizophrenia have a higher risk of metabolic syndrome (also referred to as syndrome X or the dysmetabolic syndrome) than the general population. Metabolic syndrome is a cluster of related symptoms that puts the individual at increased risk of diabetes and cardiovascular disease such as heart-attack and stroke. Metabolic syndrome generally includes some or all of the following: elevated blood pressure, abdominal obesity, diabetes or "prediabetes" (impaired glucose tolerance, impaired fasting glucose or insulin resistance), dyslipidemia (high levels of triglycerides and/or HDL - the "bad" cholesterol), and inflammatory markers. It is the leading natural cause of increased rate of death in people with schizophrenia.
An article by Dr. Jonathan M. Meyer, MD in the Psychiatric Times summarizes new findings exploring the link between metabolic syndrome and schizophrenia, and presents recent consensus recommendations for preventing and monitoring metabolic syndrome or "dysfunction". He states that minimization of cardiovascular risk remains a major clinical goal during antipsychotic therapy of schizophrenia.
Dr. Meyer points out that in spite of the high rate of metabolic syndrome (28%-54% depending on the study) in patients with schizophrenia, results from "Clinical Antipsychotic Trials of Intervention Effectiveness" (CATIE) studies showed an association between metabolic syndrome and poor perceived health, and of great concern, low rates of treatment for metabolic syndrome. Studies so far have not ruled out a natural predisposition to metabolic syndrome in people with schizophrenia, but most evidence to-date points to the treatments for schizophrenia as being an important causative factor in the high incidence of metabolic dysfunction.
Expert opinion from CATIE trials is that olanzapine and clozapine are the antipsychotic agents with the highest risk for metabolic dysfunction. Ziprasidone appears to be metabolically neutral. Long-term prospective studies (26 and 52 weeks) show that aripiprazole has a benign metabolic profile comparable to that for ziprasidone. Metabolic risk of the other antipsychotics were not discussed.
Guidelines suggest that metabolic risk factors be monitored. At baseline (initially) the following risk factors should be determined:
After that, these risk factors (other than family history) should be monitored regularly, with the fasting lipids and fasting glucose (which require blood testing) re-evaluated quaterly (every three months).
The parameters that define the metabolic syndrome provide useful markers for determining when to intervene. In the case of weight gain, Dr. Meyer says the American Diabetes Association (ADA) consensus panel recommends "intervention when the patient experiences a 5% weight gain, since most individuals have difficulty in losing more than 5% on their own".
Dr. Meyer then points out a problem that exists in implementing both the ADA consensus panel and National Cholesterol Education Program (NCEP) suggestion for intervention once metabolic abnormalities are identified - lack of programs being widely available to patients with schizophrenia. The interventions recommended is a trial of lifestyle modifications for up to 3 months. The interventions must be reassessed for effectiveness after 3 months.
Other strategies must be pursued if life-style interventions fail. These strategies can include medications for the metabolic symptoms or even switching antipsychotic medications, if possible.
Posted by Jeanie Wolfson at April 1, 2007 07:20 AM
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