A cross-sectional evaluation of adiponectin plasma levels in patients with schizophrenia and schizoaffective disorder.

in Schizophrenia Research (2008), 106(2-3), 308-14

BACKGROUND: In recent years, several studies showed increased rates of hyperglycaemia, diabetes, dyslipidemia, metabolic syndrome as well as cardiovascular disease in schizophrenic patients. The ... [more ▼]

BACKGROUND: In recent years, several studies showed increased rates of hyperglycaemia, diabetes, dyslipidemia, metabolic syndrome as well as cardiovascular disease in schizophrenic patients. The underlying mechanism, however, is poorly understood. Adiponectin is a recently identified adipocyte-derived protein, with low adiponectin levels being associated with metabolic abnormalities such as obesity, insulin resistance and type 2 diabetes. METHODS: Fasting adiponectin levels were assessed in a cross-sectional sample of 386 patients with schizophrenia or schizoaffective disorder. All patients were on monotherapy of second-generation antipsychotics (SGA) and underwent an extensive metabolic screening including an oral glucose tolerance test (OGTT). RESULTS: Adiponectin plasma levels were inversely correlated with BMI, and differed significantly between patients with normal weight, overweight or obesity (p<0.05). Patients who met criteria for the metabolic syndrome, according to adapted National Cholesterol Educational Program - Adult Treatment Panel criteria (NCEP-ATP III) (29.3%), had significantly lower adiponectin levels than patients not meeting metabolic syndrome criteria (p<0.0001). Patients without glucose abnormalities (78%) had significantly higher adiponectin levels than patients with diabetes (5.7%) (p<0.05). After controlling for components of metabolic syndrome and sex, antipsychotic medication independently influenced adiponectin levels (p<0.0001), with the lowest mean levels in patients on clozapine and olanzapine. CONCLUSIONS: Adiponectin levels in schizophrenic patients mirror what is observed in the general population, with the lowest levels in the most metabolically comprised subjects. However, antipsychotic medication may also influence adiponectin regulation independently, a finding that should be confirmed in longitudinal studies. [less ▲]

Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: a retrospective chart review.

in Schizophrenia Research (2008), 101(1-3), 295-303

The presence of the metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of MetS in patients with schizophrenia at the ... [more ▼]

The presence of the metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of MetS in patients with schizophrenia at the onset of the disorder and specifically no data on patients treated in the era when only first-generation antipsychotics were available. METHODS: Data from a historic cohort of consecutively admitted first-episode patients with schizophrenia treated with first-generation antipsychotics (FGAs) were compared with an age and sex matched series of consecutive first-episode patients treated only with second-generation antipsychotics (SGAs). Rates of MetS were compared at baseline and after on average 3 years of treatment exposure. RESULTS: At first episode there was no difference in the prevalence of MetS between the historic and the current cohort. Rates of MetS increased over time in both groups, but patients started on SGAs had a three times higher incidence rate of MetS (Odds Ratio 3.6, CI 1.7-7.5). The average increase in weight and body mass index was twice as high in patients started on SGA. The difference between the FGA and SGA group was no longer significant when patients started on clozapine and olanzapine were excluded. CONCLUSION: Rates of MetS at the first episode of schizophrenia today are not different from those of patients 15 to 20 years ago. This finding counters the notion that the high rates of metabolic abnormalities in patients with schizophrenia currently reported are mainly due to lifestyle changes over time in the general population. Some SGAs have a significantly more negative impact on the incidence of MetS compared to FGAs in first-episode patients. [less ▲]

Psychiatric diagnosis as an independent risk factor for metabolic disturbances: results from a comprehensive, naturalistic screening program.

in Journal of Clinical Psychiatry (2008), 69(8), 1319-27

OBJECTIVE: Unconfounded differences in inherent vulnerability to metabolic disturbance may be hypothesized for different diagnostic groups with severe mental illness. METHOD: A naturalistic cohort of ... [more ▼]

OBJECTIVE: Unconfounded differences in inherent vulnerability to metabolic disturbance may be hypothesized for different diagnostic groups with severe mental illness. METHOD: A naturalistic cohort of patients diagnosed with DSM-IV bipolar disorder (N = 112), schizophrenia (N = 503), and schizoaffective disorder (N = 92) were assessed for metabolic disturbances. The prospective inclusions started in November 2003 and were concluded in July 2007. RESULTS: Diagnosis was strongly associated with the metabolic syndrome (chi(2) = 14.90, df = 2, p < .001). Compared with bipolar patients, the unadjusted risk for metabolic syndrome was significantly higher for schizoaffective (odds ratio [OR] = 3.51, p < .0001) but not for schizophrenia patients (OR = 1.58, p = .094). Differences were not reducible to confounding factors including treatment. Rather, the difference between bipolar and schizophrenia patients also reached significance after adjustment (OR = 1.97, p = .046). Furthermore, the association between diagnosis and glucose dysregulation was significant (chi(2) = 6.97, df = 2, p = .031), with a significantly higher risk in schizoaffective (unadjusted OR = 2.12, p = .022) but not in schizophrenia patients (unadjusted OR = 1.13, p = .640) compared with bipolar patients. Diagnostic differences in glucose dysregulation were in part mediated by body mass index (BMI). CONCLUSIONS: Schizoaffective patients in particular may be at risk for metabolic disturbances compared with bipolar and schizophrenia patients. Differences were not reducible to known metabolic risk factors and could only be explained in part by higher BMI in schizoaffective patients, suggesting an increased inherent vulnerability in this group. [less ▲]

Usefulness of glycosylated haemoglobin (HbA1c) to screen for diabetes in patients with schizophrenia.

in Schizophrenia Research (2006), 85(1-3), 296-7

Treatment with rosuvastatin for severe dyslipidemia in patients with schizophrenia and schizoaffective disorder.

in Journal of Clinical Psychiatry (2006), 67(12), 1889-96

BACKGROUND: Mortality rates in patients with schizophrenia are double compared to those in the general population, with cardiovascular disease causing 50% of the excess. Lowering low-density lipoprotein ... [more ▼]

BACKGROUND: Mortality rates in patients with schizophrenia are double compared to those in the general population, with cardiovascular disease causing 50% of the excess. Lowering low-density lipoprotein (LDL) cholesterol is recognized as a primary target for the prevention of cardiovascular mortality according to the National Cholesterol Education Program-Adult Treatment Panel III. Use of lipid-lowering drugs such as statins is recommended when lifestyle changes are not sufficient to reach the LDL goal. The efficacy and safety of rosuvastatin treatment were evaluated in schizophrenic patients. METHOD: 100 schizophrenic patients with severe dyslipidemia were identified. All were treated with antipsychotics. Fifty-two patients were treated with rosuvastatin and compared with 48 who did not receive statin treatment. All patients were screened for cardiovascular risk factors and examined at baseline. The effects of lipid-lowering medication on lipid profile, glucose homeostasis, and components of metabolic syndrome were evaluated at 3-month follow-up. The study began in 2003, and all data available until December 2005 are reported. RESULTS: After 3 months of statin therapy, a significant decrease in triglycerides, total cholesterol, LDL cholesterol, and non-high-density lipoprotein (non-HDL) cholesterol and in associated ratios (LDL/HDL, total cholesterol/HDL) was observed. The difference was highly significant compared to patients not receiving statin treatment. No significant changes occurred in HDL cholesterol, body mass index and waist circumference, or glucose homeostasis. The only component of metabolic syndrome affected by statin therapy was the serum triglyceride level. CONCLUSION: Rosuvastatin proved effective in the management of dyslipidemia in patients with schizophrenia treated with antipsychotics. More complex treatment may be required for associated metabolic disturbances. [less ▲]