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See detailDifferential effects of olanzapine and risperidone on plasma adiponectin levels over time: Results from a 3-month prospective open-label study.
Wampers, M.; Hanssens, L.; van Winkel, R. et al

in European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology (2012), 22

Second-generation antipsychotics (SGA), especially clozapine and olanzapine, are associated with an increased metabolic risk. Recent research showed that plasma adiponectin levels, an adipocyte-derived ... [more ▼]

Second-generation antipsychotics (SGA), especially clozapine and olanzapine, are associated with an increased metabolic risk. Recent research showed that plasma adiponectin levels, an adipocyte-derived hormone that increases insulin sensitivity, vary in the same way in schizophrenic patients as in the general population according to gender, adiposity and metabolic syndrome (MetS). The aim of the present study was to investigate whether different SGAs differentially affect plasma adiponectin levels independent of body mass index (BMI) and MetS status. 113 patients with schizophrenia (65.5% males, 32.3years old) who were free of antipsychotic medication were enrolled in this open-label prospective single-center study and received either risperidone (n=54) or olanzapine (n=59). They were followed prospectively for 12weeks. Average daily dose was 4.4mg/day for risperidone and 17.4mg/day for olanzapine. Plasma adiponectin levels as well as fasting metabolic parameters were measured at baseline, 6weeks and 12weeks. The two groups had similar baseline demographic and metabolic characteristics. A significant increase in body weight was observed over time. This increase was significantly larger in the olanzapine group than in the risperidone group (+7.0kg versus +3.1kg, p<0.0002). Changes in fasting glucose and insulin levels and in HOMA-IR, an index of insulin resistance, were not significantly different in both treatment groups. MetS prevalence increased significantly more in the olanzapine group as compared to the risperidone groups where the prevalence did not change over time. We observed a significant (p=0.0015) treatment by time interaction showing an adiponectin increase in the risperidone-treated patients (from 10,154 to 11,124ng/ml) whereas adiponectin levels decreased in olanzapine treated patients (from 11,280 to 8988ng/ml). This effect was independent of BMI and the presence/absence of MetS. The differential effect of antipsychotic treatment (risperidone versus olanzapine) on plasma adiponectin levels over time, independent of changes in waist circumference and antipsychotic dosing, suggests a specific effect on adipose tissues, similar to what has been observed in animal models. The observed olanzapine-associated reduction in plasma adiponectin levels may at least partially contribute to the increased metabolic risk of olanzapine compared to risperidone. [less ▲]

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See detailTraitements neuroleptiques et troubles métaboliques
Scheen, André ULg; van Winkel, R.; De Hert, Marc

in Médecine des Maladies Métaboliques (2008), 2(6), 593-599

Les neuroleptiques, en particulier les antipsychotiques atypiques ou de seconde génération, sont associés à des troubles métaboliques dont un gain pondéral, parfois majeur, un syndrome métabolique et la ... [more ▼]

Les neuroleptiques, en particulier les antipsychotiques atypiques ou de seconde génération, sont associés à des troubles métaboliques dont un gain pondéral, parfois majeur, un syndrome métabolique et la survenue (ou l’aggravation) d’un diabète sucré. Outre la survenue, assez fréquente, d’une diminution de tolérance au glucose ou d’un diabète (généralement dans un contexte de syndrome métabolique) chez des sujets présentant, par ailleurs, les facteurs de risque habituel de diabète de type 2, de rares cas de décompensations métaboliques aiguës avec acidocétose sévère et/ou pancréatite aiguë, allant jusqu’au décès, ont été rapportés. Le risque métabolique paraît différent selon les molécules considérées et non nécessairement lié à la prise pondérale. Une surveillance métabolique attentive et des conseils hygiéno-diététiques, sont recommandés chez tout patient sous antipsychotiques atypiques. Éventuellement, une intervention pharmacologique pourra être envisagée. Enfin, le choix du neuroleptique le plus approprié devrait être influencé, non seulement par son efficacité sur le plan psychiatrique, mais aussi par le profil de risque métabolique du patient et de l’antipsychotique. [less ▲]

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See detailLe cerveau au centre des regulations metaboliques: anomalies chez les patients schizophrenes traites par antipsychotiques atypiques.
Hanssens, L.; Scheen, André ULg; van Winkel, R. et al

in Revue Médicale de Liège (2008), 63(5-6), 417-23

Schizophrenia is associated with an increased risk of metabolic disorders such as diabetes, dyslipidaemia and the metabolic syndrome. The prevalence of type 2 diabetes in schizophrenic patients is at ... [more ▼]

Schizophrenia is associated with an increased risk of metabolic disorders such as diabetes, dyslipidaemia and the metabolic syndrome. The prevalence of type 2 diabetes in schizophrenic patients is at least twice that of the general population. Around 40 percent of patients meet criteria for the metabolic syndrome. Recently there is a growing concern on the metabolic side effects of treatment with second generation antipsychotics. According to various studies, including a prospective study performed in Flanders, treatment with clozapine and olanzapine has the highest metabolic risk, followed by quetiapine and risperidone. Amisulpride, ziprasidone and aripiprazole appear to have a low metabolic risk. Appropriate care, taking into account the possible improvement of the metabolic risks factors, is important to reduce morbidity and mortality in schizophrenic patients treated with antipsychotic medications. [less ▲]

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See detailA case series: Evaluation of the metabolic safety of aripiprazole
De Hert, M.; Hanssens, L.; van Winkel, R. et al

in Schizophrenia Bulletin (2007), 33(3), 823-830

Metabolic abnormalities occur frequently in patients treated with antipsychotics and are of growing concern to clinicians. This study sought to determine whether antipsychotic-associated metabolic ... [more ▼]

Metabolic abnormalities occur frequently in patients treated with antipsychotics and are of growing concern to clinicians. This study sought to determine whether antipsychotic-associated metabolic abnormalities identified through intensive monitoring can be reversed by switching to aripiprazole. Recent evidence suggests that aripiprazole may exhibit a favorable metabolic safety profile. The study population is a subset of a large (n > 500) ongoing prospective cohort. Thirty-one consecutive patients with schizophrenia who were started on aripiprazole were included in the study. All patients underwent an extensive metabolic evaluation, including an oral glucose tolerance test, at baseline, at 6 weeks, and at 3 months post switch. Metabolic abnormalities were defined as any of the following: new onset diabetes, impaired fasting glucose, impaired glucose tolerance, metabolic syndrome (MetS) according to various definitions, and dyslipidemia. After 3 months of treatment with aripiprazole (mean daily dose 16.3 mg), there was a significant decrease in body weight, body mass index, and waist circumference. There was a significant reduction in fasting glucose, fasting insulin, insulin resistance index, and serum lipids levels (cholesterol, triglycerides, low-density lipoprotein (LDL), LDL/HDL, Chol/HDL, and non-HDL cholesterol). There was also a significant reduction in prolactin levels. All 7 cases of recent onset diabetes were reversed at 3 months follow-up. The MetS was reversed in 50% of patients at 3 months follow-up. Our results support the reversibility of recent onset diabetes on antipsychotic medication when detected early and followed by a switch to aripiprazole. [less ▲]

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See detailAnomalies of tolerance in glucose in schizophrenic patients treated with antipsychotics of second generation: 3 months prospective comparative study
Scheen, André ULg; De Hert, M.; Hanssens, L. et al

in Diabetes & Metabolism (2007, March), 33(Sp. Iss. 1), 129

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See detailReversibility of antipsychotic treatment-related diabetes in patients with schizophrenia - A case series of switching to aripiprazole
De Hert, M.; Hanssens, L.; van Winkel, R. et al

in Diabetes Care (2006), 29(10), 2329-2330

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See detailScreening for metabolic abnormalities in patients with schizophrenia treated with antipsychotics: are we doing enough?
Van Winkel, R.; De Hert, M.; Van Eyck, D. et al

in European Neuropsychopharmacology (2006, September), 16(Suppl. 4), 398

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See detailPrevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study.
De Hert, M.; van Winkel, R.; Van Eyck, D. et al

in Clinical Practice and Epidemiology in Mental Health (2006), 2

BACKGROUND: Patients with schizophrenia are at high risk of developing metabolic abnormalities. METHOD: A prospective study focusing on metabolic disturbances in patients with schizophrenia, including an ... [more ▼]

BACKGROUND: Patients with schizophrenia are at high risk of developing metabolic abnormalities. METHOD: A prospective study focusing on metabolic disturbances in patients with schizophrenia, including an oral glucose tolerance test, is currently ongoing at our University Hospital and affiliate services. The prevalence of metabolic abnormalities at baseline was assessed in a cohort of 415 patients with schizophrenia. The sample was divided into 4 groups according to duration of illness: first-episode patients (<1.5 years), recent-onset patients (between 1.5 and 10 years), subchronic patients (between 10 and 20 years) and chronic patients (>20 years). RESULTS: Metabolic abnormalities were already present in first-episode patients, and considerably increased with increasing duration of illness. When compared to the general population matched for age and gender, much higher rates of the metabolic syndrome (MetS) and diabetes were observed for patients with schizophrenia. For MetS, the increase over time was similar to that of the general population. In contrast, the difference in the prevalence of diabetes in patients with schizophrenia and the general population dramatically and linearly increased from 1.6% in the 15-25 age-band to 19.2% in the 55-65 age-band. CONCLUSION: Thus, the current data suggest that on the one hand metabolic abnormalities are an inherent part of schizophrenic illness, as they are already present in first-episode patients. On the other hand, however, our results suggest a direct effect of the illness and/or antipsychotic medication on their occurrence. The data underscore the need for screening for metabolic abnormalities in patients diagnosed with schizophrenia, already starting from the onset of the illness. [less ▲]

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