Artículos de revistas: "Antipsychotic drugs. Diabetes"

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Taylor, David, Corina Young, Raadiyya Esop, Carol Paton y Rebecca Walwyn. "Testing for diabetes in hospitalised patients prescribed antipsychotic drugs". British Journal of Psychiatry 185, n.º 2 (agosto de 2004): 152–56. http://dx.doi.org/10.1192/bjp.185.2.152.

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BackgroundStudies using computer databases suggest that atypical antipsychotic agents are more likely to be associated with diabetes than are conventional drugs.AimsTo discover the extent of testing for diabetes mellitus in hospital in-patients prescribed antipsychotics.MethodPrescription charts were screened to identify patients prescribed antipsychotics. Case notes were then searched for evidence of testing for diabetes.ResultsIn all, 606 patients were prescribed antipsychotics, of whom 250 (41.3%) had evidence of prior testing for diabetes. Patients prescribed atypicals were 40% more likely to have been tested than those prescribed conventional drugs (RR = 1.4, 95% C11.1–1.9). Adjusted odds ratios v. conventional antipsychotics for testing were significantly higher for clozapine (OR = 4.64, 95% C12.42–8.90), olanzapine (OR= 1.85, 95% C11.04–3.30) and antipsychotic polypharmacy (OR= 2.96, 95% C11.59–5.52).ConclusionsTesting for diabetes was undertaken in less than half of the patients studied. Testing was more common in those receiving atypical antipsychotics. Apparent differences in claimed causal association of the use of some antipsychotics with diabetes may in part reflect different rates of testing.

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Kessing, Lars Vedel, Anders Frøkjær Thomsen, Ulla Brasch Mogensen y Per Kragh Andersen. "Treatment with antipsychotics and the risk of diabetes in clinical practice". British Journal of Psychiatry 197, n.º 4 (octubre de 2010): 266–71. http://dx.doi.org/10.1192/bjp.bp.109.076935.

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BackgroundTreatment with antipsychotics seems to increase the risk of developing diabetes but the association is poorly characterised in clinical practice.AimsTo investigate and characterise the incidence of diabetes for people treated with antipsychotic medication in clinical practice.MethodThe study used the linkage of registers of all prescribed antipsychotics, antidiabetics and diagnoses of diabetes in Denmark during a period from 1996 to 2005 and identified all people treated with antipsychotics in Denmark and a random sample of about 30% of the total Danish population.ResultsIn total, 345 937 patients who purchased antipsychotics and 1 426 488 unexposed individuals were included in the study. Among the total population, 50 379 individuals subsequently developed incident diabetes. Compared with unexposed individuals, treatment with first- (rate ratio, RR = 1.53, 95% CI 1.49–1.56) as well as second-generation (RR = 1.32, 95% CI 1.22–1.42) antipsychotics was associated with increased risk of subsequent incident diabetes. The rate of incident diabetes varied substantially between individual second-generation antipsychotic drugs (olanzapine, risperidone clozapine compared with unexposed individuals: low to moderate rate ratio between 1.17 and 1.57; ziprasidone and sertindol: two or more times increased rate ratio; amisulpride, quetiapine and aripiprazole: no significantly increased rate ratio). For both first- and second-generation antipsychotics, the incidence of diabetes increased with the number of prescriptions. Additionally, the incidence of diabetes increased with the number of combined antipsychotic drugs.ConclusionsIn clinical practice, treatment with first- and second-generation antipsychotics is associated with an increased risk of developing incident diabetes with large differences between individual drugs. The risk increases with the duration of treatment and with polypharmacy of antipsychotic drugs.

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Proietto, Joseph. "Diabetes and antipsychotic drugs". Australian Prescriber 27, n.º 5 (1 de octubre de 2004): 118–19. http://dx.doi.org/10.18773/austprescr.2004.098.

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M, Jagadeesan, Kiran Kumar R y Justin Jacob Abraham. "A CASE STUDY ON SCHIZOPHRENIA INDUCED MULTIPLE COMORBIDITIES". Asian Journal of Pharmaceutical and Clinical Research 11, n.º 6 (7 de junio de 2018): 1. http://dx.doi.org/10.22159/ajpcr.2018.v11i6.23979.

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Schizophrenia is a mental disorder characterized by abnormal social behavior which includes false beliefs, confusion, and auditory hallucination. Antipsychotic drugs therapy increases the risk of developing diabetes mellitus and coronary artery disease (CAD) in schizophrenic patients. Hence, we have planned for a systematic approach toward the management of comorbidities induced in schizophrenic patients. A case study was conducted in 42-year-old female patient diagnosed with schizophrenia along with Type-2 diabetes mellitus, hypothyroidism, diabetic retinopathy, diabetic nephropathy, systemic hypertension, CAD-acute coronary syndrome recent inferior wall myocardial infarction. The patient was treated with atypical antipsychotics, antiplatelets, antianginals, statins, hypoglycemic agents, and other supportive measures. The patient improved symptomatically. The antipsychotic treatment for schizophrenia induces abnormal metabolic syndrome which results in decreased glucose and lipid metabolism that leads to obesity, hyperglycemia, and dyslipidemia associated with cardiovascular risks. Often antipsychotics are combined with benzodiazepines and antiparkinson agents to reduce the risks caused from large doses of antipsychotic medication. However, people receiving first-generation antipsychotics have higher prevalence of developing diabetes mellitus and cardiac risks compared to second-generation antipsychotics. Hence, we conclude that atypical antipsychotic drugs such as amisulpride, aripiprazole, and ziprasidone should be given to schizophrenic patients because these drugs have little effects on abnormal metabolic syndrome when compared to other antipsychotics. There is a need for proper screening of blood glucose level and cardiovascular risks assessment before the administration of antipsychotic medications to schizophrenic patients and also during the course of treatment regularly.

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Livingstone, C. y H. Rampes. "Atypical antipsychotic drugs and diabetes". Practical Diabetes International 20, n.º 9 (2003): 327–31. http://dx.doi.org/10.1002/pdi.552.

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Henderson, Valerie. "Atypical antipsychotic drugs and diabetes". Practical Diabetes International 20, n.º 9 (2003): 331. http://dx.doi.org/10.1002/pdi.553.

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Abdelmawla, Nasser y Alex J. Mitchell. "Sudden cardiac death and antipsychotics Part 2: Monitoring and prevention". Advances in Psychiatric Treatment 12, n.º 2 (marzo de 2006): 100–109. http://dx.doi.org/10.1192/apt.12.2.100.

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Cardiac safety of antipsychotic drugs continues to be a concern for both typical and atypical antipsychotics. Risk appears greatest in those with pre-existing cardiac disease but many patients may have occult cardiovascular disease. In addition, several drugs appear to increase the likelihood of diabetes and weight gain, which may have an additive adverse effect. On the basis of risk of sudden cardiac death and risk of QTc prolongation we suggest considering antipsychotics in two categories – higher and lower risk. Of most concern is the use of large cumulative doses of antipsychotics that are sometimes given inadvertently by different prescribers. Clinicians need to be aware how to read an ECG, and how to monitor physical parameters and interpret the significance of QTc prolongation in relation to antipsychotic prescribing. We suggest provisional guidance on antipsychotic monitoring in relation to cardiac safety but acknowledge that future studies will help clarify which antipsychotic drugs and which concomitant risk factors are most important for those with and without established cardiac disease.

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Bottai, T., P. Quintin y E. Perrin. "Antipsychotics and the risk of diabetes: A general data review". European Psychiatry 20, S4 (diciembre de 2005): S349—S357. http://dx.doi.org/10.1016/s0924-9338(05)80190-7.

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AbstractRecently, attention has focused on a potential link between schizophrenia and diabetes, with speculation that this potential associationis stronger in patients who are prescribed atypical antipsychotics. Pharmacoepidemiological studies can help to evaluate this potential association. Source data on the incidence of diabetes in patients treated with antipsychotics is available in the FDA MedWatch database, prescription claims databases and other patient registries. These data indicate that antipsychotic drugs may increase the risk of developing diabetes and that there may be an interaction with age. However, current data are insufficient to accurately assess potential differences in the risk of diabetes between users of individual antipsychotic medications. In addition, antipsychotic treatment-emergent diabetes has several distinct features, notably relating to age of onset, gender ratio, rate of deterioration of glycaemic control, and independence from initial treatment emergent weight gain. Nonetheless, guidelines for the control of risk factors for diabetes developed for the general population appear to be applicable to patients with schizophrenia.

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Tournier, M., A. Cougnard, B. Bégaud, A. Thiébaut y H. Verdoux. "The Metabolic Impact of the Antipsychotic Drugs in Patients with Bipolar Disorder". European Psychiatry 24, S1 (enero de 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70490-0.

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Objective:To assess the metabolic impact of adding an antipsychotic to a mood stabilizer or switching a mood stabilizer to an antipsychotic in patients with bipolar disorder.Methods:A retrospective fixed cohort study was conducted through the claims database of the French health care program for the self-employed workers. The study population consisted of 3.172 patients age 18 and over who were exposed to mood stabilizers (i.e. lithium, valproate) a 3 month-period in 2004 without dispensing of non-sedative antipsychotic, antidiabetic or lipid-lowering drugs. The outcome was the occurrence of a metabolic incident over the follow-up period, using the dispensing of an antidiabetic drug as a marker of diabetes and the dispensing of a lipid-lowering drug as a marker of hypercholesterolemia or hypertriglyceridemia. A Cox proportional hazard model was used to assess the metabolic impact of the antipsychotics; using mood stabilizers as a reference. Antipsychotic exposition was stratified in «current» and «recent» (discontinued for less than 6 months) at the time of the metabolic incident.Results:196 patients (6.2%) received a first-generation antipsychotic, 352 (11.1%) a second-generation antipsychotic, 565 (17.8%) a sedative antipsychotic and 367 patients (11.6%) presented with a metabolic incident over the study period. The recent dispensing of a second-generation antipsychotic was associated with the occurrence of a metabolic incident [HR 2.1 (95%CI 1.2-3.7) p=0.006], while current dispensing or dispensing of first-generation antipsychotics were not.Conclusion:Second-generation antipsychotics have a metabolic impact compared to classic mood stabilizers in patients with bipolar disorder.

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Ananth, Jambur, Smitha Kolli, Sarath Gunatilake y Steven Brown. "Atypical antipsychotic drugs, diabetes and ethnicity". Expert Opinion on Drug Safety 4, n.º 6 (28 de octubre de 2005): 1111–24. http://dx.doi.org/10.1517/14740338.4.6.1111.

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Holt, Richard I. G. y Robert C. Peveler. "Association between antipsychotic drugs and diabetes". Diabetes, Obesity and Metabolism 8, n.º 2 (marzo de 2006): 125–35. http://dx.doi.org/10.1111/j.1463-1326.2005.00495.x.

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Currie, Olivia, Jonathan Williman, Dee Mangin, Bianca McKinnon-Gee y Paul Bridgford. "Comparative risk of new-onset diabetes following commencement of antipsychotics in New Zealand: a population-based clustered multiple baseline time series design". BMJ Open 9, n.º 2 (febrero de 2019): e022984. http://dx.doi.org/10.1136/bmjopen-2018-022984.

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ObjectiveNewer antipsychotics are increasingly prescribed off-label for non-psychotic ailments both in primary and secondary care settings, despite the purported risk of weight gain and development of type 2 diabetes mellitus. This study aims to determine any relationship between the development of clinically significant new-onset type 2 diabetes mellitus and novel antipsychotic use in New Zealand using hypnotic drugs as control.DesignA population-based clustered multiple baseline time series design.SettingRoutinely collected data from a complete national pharmaceutical database in New Zealand between 2005 and 2011.ParticipantsPatients aged 40–60 years in the year 2006 who were ever dispensed antipsychotics (exposure groups—first-generation antipsychotics, second-generation antipsychotics and antipsychotics with low, medium and high risk for weight gain) or hypnotics (control group) between 2006 and 2011.Main outcome measureFirst ever metformin dispensed to patients in each study group between 2006 and 2011 as proxy for development of clinically significant type 2 diabetes mellitus, no longer amendable by lifestyle modifications.ResultsPatients dispensed a second-generation antipsychotic had 1.49 times increased risk (95% CI 1.10 to 2.03, p=0.011) of subsequently commencing metformin. Patients dispensed an antipsychotic with high risk of weight gain also had a 2.41 times increased risk of commencing on metformin (95% CI 1.42 to 4.09, p=0.001).ConclusionsPatients dispensed a second-generation antipsychotic and antipsychotics with high risk of weight gain appear to be at increased risk of being secondarily dispensed metformin. Caution should be taken with novel antipsychotic use for patients with increased baseline risk of type 2 diabetes mellitus.

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Manu, P., C. U. Correll, R. van Winkel, M. Wampers y M. De Hert. "Prediabetes in patients treated with antipsychotic drugs". European Psychiatry 26, S2 (marzo de 2011): 1164. http://dx.doi.org/10.1016/s0924-9338(11)72869-3.

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BackgroundIn 2010, the American Diabetes Association (ADA) proposed that individuals with fasting glucose 100–125 mg/dl (5.6-6.9 mmol/l) or glucose 140–199 mg/dl (7.8–11.0 mmol/l) 2 hours after a 75 gm oral glucose tolerance test (OGGT) or hemoglobin A1c (A1c) 5.7–6.4% be classified as prediabetic to indicate a high risk for the development of diabetes.ObjectiveTo determine the prevalence of prediabetes in psychiatric patients receiving antipsychotics and to compare the clinical and metabolic features of patients with normal glucose tolerance, prediabetes and diabetes.MethodThe 2010 ADA criteria were applied to a large consecutive cohort of psychiatric patients treated at one institution in Belgium. All patients were evaluated with OGTT, A1c, insulin levels and lipid profiles.ResultsThe study sample was restricted to the 783 adult patients (mean age 37.6) without known history of diabetes. 413 (52.8%) patients had normal glucose tolerance, 290 (37%) were prediabetic and 80 (10.2%) were diabetic. The 3 groups were similar with regard to psychiatric diagnoses, severity of mental illness and antipsychotic treatment. A statistically significant crescendo gradient from normal to prediabetes and from prediabetes to diabetes was observed for age, body mass index, waist circumference, fasting insulin, homeostatic model of insulin resistance (HOMA-IR) and triglyceride levels. The intergroups differences for fasting insulin and HOMA-IR were confirmed for treatment with clozapine, olanzapine, quetiapine, risperidone and amilsulpride, but not for aripiprazole or first-generation antipsychotics.ConclusionPrediabetes is highly prevalent in adults treated with antipsychotic drugs and correlates with markers of intraabdominal adiposity and insulin resistance.

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Wilson, Carol. "Antipsychotic drugs and hyperglycemia risk in diabetes". Nature Reviews Endocrinology 5, n.º 11 (noviembre de 2009): 584. http://dx.doi.org/10.1038/nrendo.2009.185.

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Vigod, Simone N., Yona Lunsky, Virginie Cobigo, Andrew S. Wilton, Sarah Somerton y Dallas P. Seitz. "Morbidity and mortality of women and men with intellectual and developmental disabilities newly initiating antipsychotic drugs". BJPsych Open 2, n.º 2 (marzo de 2016): 188–94. http://dx.doi.org/10.1192/bjpo.bp.116.002691.

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BackgroundWhile up to 45% of individuals with intellectual and developmental disabilities (IDD) have a comorbid psychiatric disorder, and antipsychotics are commonly prescribed, gender differences in the safety of antipsychotics have rarely been studied in this population.AimsTo compare men and women with IDD on medical outcomes after antipsychotic initiation.MethodOur population-based study in Ontario, Canada, compared 1457 women and 1951 men with IDD newly initiating antipsychotic medication on risk for diabetes mellitus, hypertension, venous thromboembolism, myocardial infarction, stroke and death, with up to 4 years of follow-up.ResultsWomen were older and more medically complex at baseline. Women had higher risks for venous thromboembolism (HR 1.72, 95% CI 1.15–2.59) and death (HR 1.46, 95% CI 1.02–2.10) in crude analyses; but only thromboembolism risk was greater for women after covariate adjustment (aHR 1.58, 95% CI 1.05–2.38).ConclusionsGender should be considered in decision-making around antipsychotic medications for individuals with IDD.

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Sivolap, Yuriy y Anna Portnova. "Excessive use of antipsychotics as a global problem of clinical medicine". Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), n.º 5 (1 de mayo de 2020): 9–16. http://dx.doi.org/10.33920/med-01-2005-01.

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In recent decades in many regions of the world there has been an increase in prescribing antipsychotics, including for children and adolescents, and in many cases the drugs are used off label, in patients without diagnosis of schizophrenia and other psychoses and bipolar disorder or — in child and adolescent practice — without severe behavioral disorders. In addition, antipsychotics are often prescribed at excessive doses, and antipsychotic therapy is not accompanied by proper monitoring of physiological functions and laboratory parameters. The metabolic effects of antipsychotics contribute to weight gain, obesity and metabolic syndrome, increase the risk of type 2 diabetes, as well as cardiovascular diseases development. Children and adolescents, as well as young adults, are particularly vulnerable to the undesirable metabolic effects of antipsychotic drugs. The deterioration of physical health due to side effects of antipsychotics is one of the reasons for reducing life expectancy in patients with mental disorders.

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AlDakheel, S. "Antipsychotic drugs in pregnancy". European Psychiatry 41, S1 (abril de 2017): S562. http://dx.doi.org/10.1016/j.eurpsy.2017.01.816.

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BackgroundThere has been significant increase in prescription of antipsychotic medication in the community for females in childbearing age the problem is we do not have clear guidelines because we do not have a control group.ObjectivesTo evaluate maternal psychiatric, medical and perinatal outcomes associated with antipsychotic drugs in pregnancy.AimTo use wisdom when the risk is minimal for both mother and child.MethodWe study 3 pregnant women, one with a 6 years old, one with a 2 years old child and one still pregnant. We measure their blood sugar, blood pressure, fetal heart, movement, ultrasound using first generation antipsychotic (FGA).ResultsPatient became less psychotic then back to normal and fetal development is normal till now, no diabetes mellitus or hypertension, no malformation or abortion.ConclusionIt is still too early to reach a clear and absolute use of safe antipsychotic drugs in pregnancy. A large sample is needed for a study and a control should be needed.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Manu, P., C. U. Correll, M. Wampers, R. van Winkel, W. Yu, D. Shiffeldrim y M. De Hert. "Dysmetabolic features of the overweight patients receiving antipsychotic drugs: A comparison with normal weight and obese subjects". European Psychiatry 29, n.º 3 (marzo de 2014): 179–82. http://dx.doi.org/10.1016/j.eurpsy.2012.12.001.

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AbstractBackground:Extensive research indicates that obesity, defined by a body mass index (BMI) greater or equal to 30, is common in patients treated with antipsychotic drugs and is frequently associated with carbohydrate and lipid abnormalities leading to metabolic syndrome and diabetes. In contrast, the metabolic health of overweight patients (BMI = 25–29.9) without metabolic syndrome or diabetes has not been thoroughly investigated.Objective:To assess the metabolic health of overweight patients receiving antipsychotic drugs.Methods:We compared standard metabolic parameters (BMI; waist circumference; hemoglobin A1c; fasting lipids; and fasting and post-challenge glucose and insulin) of normal weight, overweight and obese individuals from a consecutive cohort of antipsychotic-treated patients without metabolic syndrome and/or diabetes.Results:Compared with the normal weight subjects (n = 286), overweight patients (n = 212) had higher fasting insulin resistance as assessed with the homeostatic model (P = 0.023), insulin secretion during the oral glucose tolerance test (P = 0.0037), triglycerides (P = 0.0004) and low-density lipoprotein cholesterol (P = 0.0089), and lower levels of high-density lipoprotein cholesterol (P = 0.0014). The obese (n = 50) were different from the overweight subjects only with respect to higher post-challenge insulin levels (P = 0.0002). The average fasting glucose, post-challenge glucose, and hemoglobin A1c, severity of psychiatric disorders and antipsychotics used were similar in the three groups.Conclusions:Overweight (BMI = 25–29.9) patients receiving antipsychotics are metabolically closer to the obese than to normal weight counterparts. The findings suggest that interventions promoting weight loss and metabolic health are required for overweight patients even in the absence of metabolic syndrome or diabetes.

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Smith, Greg. "How do antipsychotic drugs cause diabetes and obesity?" Obesity Research & Clinical Practice 7 (diciembre de 2013): e41. http://dx.doi.org/10.1016/j.orcp.2013.12.579.

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Panariello, Fabio, Vincenzo De Luca y Andrea de Bartolomeis. "Weight Gain, Schizophrenia and Antipsychotics: New Findings from Animal Model and Pharmacogenomic Studies". Schizophrenia Research and Treatment 2011 (2011): 1–16. http://dx.doi.org/10.1155/2011/459284.

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Excess body weight is one of the most common physical health problems among patients with schizophrenia that increases the risk for many medical problems, including type 2 diabetes mellitus, coronary heart disease, osteoarthritis, and hypertension, and accounts in part for 20% shorter life expectancy than in general population. Among patients with severe mental illness, obesity can be attributed to an unhealthy lifestyle, personal genetic profile, as well as the effects of psychotropic medications, above all antipsychotic drugs. Novel “atypical” antipsychotic drugs represent a substantial improvement on older “typical” drugs. However, clinical experience has shown that some, but not all, of these drugs can induce substantial weight gain. Animal models of antipsychotic-related weight gain and animal transgenic models of knockout or overexpressed genes of antipsychotic receptors have been largely evaluated by scientific community for changes in obesity-related gene expression or phenotypes. Moreover, pharmacogenomic approaches have allowed to detect more than 300 possible candidate genes for antipsychotics-induced body weight gain. In this paper, we summarize current thinking on: (1) the role of polymorphisms in several candidate genes, (2) the possible roles of various neurotransmitters and neuropeptides in this adverse drug reaction, and (3) the state of development of animal models in this matter. We also outline major areas for future research.

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Linck, Viviane M., Ana P. Herrmann, Ângelo L. Piato, Bernardo C. Detanico, Micheli Figueiró, Jorge Flório, Maurice M. Iwu, Christopher O. Okunji, Mirna B. Leal y Elaine Elisabetsky. "Alstonine as an Antipsychotic: Effects on Brain Amines and Metabolic Changes". Evidence-Based Complementary and Alternative Medicine 2011 (2011): 1–7. http://dx.doi.org/10.1093/ecam/nep002.

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Managing schizophrenia has never been a trivial matter. Furthermore, while classical antipsychotics induce extrapyramidal side effects and hyperprolactinaemia, atypical antipsychotics lead to diabetes, hyperlipidaemia, and weight gain. Moreover, even with newer drugs, a sizable proportion of patients do not show significant improvement. Alstonine is an indole alkaloid identified as the major component of a plant-based remedy used in Nigeria to treat the mentally ill. Alstonine presents a clear antipsychotic profile in rodents, apparently with differential effects in distinct dopaminergic pathways. The aim of this study was to complement the antipsychotic profile of alstonine, verifying its effects on brain amines in mouse frontal cortex and striatum. Additionally, we examined if alstonine induces some hormonal and metabolic changes common to antipsychotics. HPLC data reveal that alstonine increases serotonergic transmission and increases intraneuronal dopamine catabolism. In relation to possible side effects, preliminary data suggest that alstonine does not affect prolactin levels, does not induce gains in body weight, but prevents the expected fasting-induced decrease in glucose levels. Overall, this study reinforces the proposal that alstonine is a potential innovative antipsychotic, and that a comprehensive understanding of its neurochemical basis may open new avenues to developing newer antipsychotic medications.

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Firestone, Andrew. "Weight gain and diabetes with “second‐generation” antipsychotic drugs". Medical Journal of Australia 182, n.º 12 (junio de 2005): 652–53. http://dx.doi.org/10.5694/j.1326-5377.2005.tb06860.x.

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Lipscombe, Lorraine L., Linda Lévesque, Andrea Gruneir, Hadas D. Fischer, David N. Juurlink, Sudeep S. Gill, Nathan Herrmann, Janet E. Hux, Geoff M. Anderson y Paula A. Rochon. "Antipsychotic Drugs and Hyperglycemia in Older Patients With Diabetes". Archives of Internal Medicine 169, n.º 14 (27 de julio de 2009): 1282. http://dx.doi.org/10.1001/archinternmed.2009.207.

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Davis, Vanessa y Arlan L. Rosenbloom. "Metabolic effects of antipsychotic drugs". Pediatric Diabetes 7, n.º 3 (junio de 2006): 176–86. http://dx.doi.org/10.1111/j.1399-543x.2006.00178.x.

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Rouillon, F. y F. Sorbara. "Schizophrenia and diabetes: Epidemiological data". European Psychiatry 20, S4 (diciembre de 2005): S345—S348. http://dx.doi.org/10.1016/s0924-9338(05)80189-0.

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AbstractThe association of diabetes mellitus and mental illness, in particular, schizophrenia, has been remarked upon for over a century. Recentepidemiological studies have shown the age- and sex-matched prevalence of diabetes in patients with schizophrenia to be 1.5–2 times those in the general population. This difference is particularly noticeable in younger patients. The explanation for this finding probably resides in both environmental and biological factors. Patients with schizophrenia tend to be sedentary and have a poor diet, which are both known risk factors for diabetes. However, familial studies have indicated a heritable component to the risk of diabetes in patients with schizophrenia. A number of biological mechanisms have been proposed to explain this, including neuroendocrine changes and neurodevelopmental anomalies, but none are entirely satisfactory. In addition, it has been suggested that treatment with antipsychotic medication may potentially increase the risk of diabetes and account for some of the increased prevalence seen in patients with schizophrenia. It has been suggested that different antipsychotic drugs may differ in their ability to facilitate the emergence of poor glycaemic control in patients with schizophrenia. However, the situation is far from clear and more work is required to accurately assess the potential risk associated with different antipsychotic drugs.

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Atti, A. R., B. Ferrari Gozzi, G. Zuliani, V. Bernabei, P. Scudellari, D. Berardi, D. De Ronchi, I. Tarricone y M. Menchetti. "A systematic review of metabolic side effects related to the use of antipsychotic drugs in dementia". International Psychogeriatrics 26, n.º 1 (9 de octubre de 2013): 19–37. http://dx.doi.org/10.1017/s1041610213001658.

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ABSTRACTBackground:In clinical practice, Second Generation Antipsychotics (SGAs) are often used as first-line treatment for the Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults due to their fewer neurological adverse events and similar effectiveness compared with First Generation Antipsychotics (FGAs). SGAs, however, are associated with more severe metabolic side effects (weight gain, hyperglycemia, diabetes risk, and hyperlipidemia) than FGAs are. In general, older patients, especially those affected by dementia, are at increased risk for malnutrition, and tend to have lower basal metabolism and reduced liver and kidney function. However, little is known about the metabolic side effects of antipsychotic drugs in this population.Methods:A comprehensive review of the literature published between January 1996 and December 2012 investigating the metabolic side effects related to FGAs and SGAs use in old patients affected by dementia.Results:Antipsychotic drugs currently used to treat BPSD in subjects with mild to moderate dementia are associated with weight gain. Currently, there are insufficient data to support a causal relationship between the use of FGAs and SGAs and changes in glucose homeostasis or lipid metabolism in older persons affected by severe dementia (MMSE <14).Conclusion:A possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals.

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Bughio, Abdul Hafeez, Shafak Ansari, Rajesh Kumar, Muhammad Hassan Sheikh y Tarachand Devrajani. "Effect of atypical antipsychotics on blood glucose levels and HbA1c in patients of schizophrenia and bipolar disorder." Professional Medical Journal 28, n.º 02 (10 de febrero de 2021): 158–64. http://dx.doi.org/10.29309/tpmj/2021.28.02.5189.

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Objectives: To evaluate the effect of atypical antipsychotics on serum glucose levels and HbA1C in patients of schizophrenia and bipolar disorder. Study Design: Quasi-experimental study. Setting: Department of Neurology and Sir C. J Institute of Psychiatry LUMHS Jamshoro/Hyderabad. Period: Dec 2018-Dec 2019. Material & Methods: Total 360 participants of age more than 15 years of either gender presenting with psychiatric illness i.e. schizophrenia and bipolar disorder and prescribed same brand of antipsychotic drugs were included in the study. Fasting blood glucose (FBS), random blood glucose (RBS) and glycosylated hemoglobin (HbA1c) were measured at baseline and 6th months after treatment with atypical antipsychotic agents. SPSS version 23 was used to analyze data. Results: A total of 360 patients were enrolled in the study duration, among them 338 patients were followed up till 6 months, while 22 patients were lost to follow up. The mean age of the study sample was reported as 39.33±8.83 years. At baseline mean FBS, RBS and HbA1c were reported as 92.52±9 mg/dl, 143.21±14.91, 5.83±0.37 which significantly increase after treatment with antipsychotics at 6 months (p<0.05). About 23.6% developed diabetes mellitus and 21.3% developed hyperglycemia at the end of 6 months. Conclusion: Non-diabetic treatment naïve schizophrenia and bipolar disorders patients have higher chances developing side-effects on the glucose regulations after initiation of antipsychotic therapy. Overall, the early identification and diagnosis of antipsychotic-induced diabetes mellitus and hyperglycemia requires proper evaluation, reporting, and physician and patient awareness.

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Citrome, Leslie y Jan Volavka. "Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes". Journal of Clinical Psychiatry 66, n.º 08 (15 de agosto de 2005): 1073–74. http://dx.doi.org/10.4088/jcp.v66n0818c.

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Lamberti, J., J. Crilly, K. Maharaj, D. Olson y O. Costea. "Prevalence of adult-onset diabetes among outpatients receiving antipsychotic drugs". Schizophrenia Research 60, n.º 1 (marzo de 2003): 360. http://dx.doi.org/10.1016/s0920-9964(03)80179-2.

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30

Medak, Kyle D., Hesham Shamshoum, Willem T. Peppler y David C. Wright. "GLP1 receptor agonism protects against acute olanzapine-induced hyperglycemia". American Journal of Physiology-Endocrinology and Metabolism 319, n.º 6 (1 de diciembre de 2020): E1101—E1111. http://dx.doi.org/10.1152/ajpendo.00309.2020.

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Antipsychotic drugs cause rapid perturbations in glucose and lipid metabolism. In the present study we have demonstrated that cotreatment with glucagon-like peptide 1 (GLP1) receptor agonists, such as liraglutide, protects against metabolic dysregulation caused by the antipsychotic drug olanzapine. These findings suggest that pharmacological targeting of the GLP1 receptor could be an effective adjunct approach to mitigate the harmful acute metabolic side effects of antipsychotic drugs.

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31

Bushe, Chris y Brian Leonard. "Association between atypical antipsychotic agents and type 2 diabetes: Review of prospective clinical data". British Journal of Psychiatry 184, S47 (abril de 2004): s87—s93. http://dx.doi.org/10.1192/bjp.184.47.s87.

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BackgroundMost evidence suggesting an association between schizophrenia, antipsychotic medications and diabetes has been based on retrospective studies not controlled for important confounders.AimsTo compare diabetogenic risk between antipsychotic medications; and to describe the limitations of current prospective data-sets.MethodSystematic review of prospective clinical data.ResultsNo difference in the incidence of glycaemic abnormalities between placebo cohorts and antipsychotic medication cohorts was identified. No significant difference between any of the antipsychotic medications studied in terms of their association with glycaemic abnormalities was identified. Treatment-related weight gain did not appear to increase the risk of developing diabetes.ConclusionsDiabetogenic potential ascribed to atypical antipsychotic drugs, resulting from retrospective studies, may be incorrect. Cohort sizes and incomplete sampling must preclude any definitive conclusions. Long-term, large, comparative prospective trials are needed, along with agreement upon glucose measurement of choice.

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32

Molitch, Mark E. "Dopamine agonists and antipsychotics". European Journal of Endocrinology 183, n.º 3 (septiembre de 2020): C11—C13. http://dx.doi.org/10.1530/eje-20-0607.

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There can potentially be a number of clinical interactions that could adversely affect patient outcomes in a patient with a prolactinoma and psychiatric disease that might require antipsychotic and dopamine agonist treatment. Dopamine agonists stimulate the dopamine D2 receptor, resulting in a decrease in prolactin (PRL) levels and in prolactinoma size but action on dopamine receptors in the meso-limbic system may rarely cause psychosis and more commonly cause impulse control disorders. The psychiatric benefits of antipsychotic agents involve blocking the D2 and other dopamine receptors but this blockade often also causes hyperprolactinemia. In patients with macroprolactinomas and psychosis, observation, estrogen/progestin replacement, and surgery can be considered in addition to dopamine agonists. In those who require dopamine agonists for PRL and tumor size control, the introduction of antipsychotics may blunt this effect, so that higher doses of the dopamine agonists may be needed. Alternatively, antipsychotics that have less of a blocking effect at the D2 receptor, such as aripiprazole, can be tried, if appropriate. For patients already on antipsychotic drugs who are found to have a macroprolactinoma for which dopamine agonists are required, dopamine agonists can be initiated at low dose and the dose escalated slowly. However, such patients require careful monitoring of psychiatric status to avoid the rare complication of exacerbation of the underlying psychosis. Again, if appropriate, use of antipsychotics that have less of a blocking effect at the D2 receptor may allow lower doses of dopamine agonists to be used in this situation.

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33

Morrato, E. H., J. W. Newcomer, S. Kamat, O. Baser, J. Harnett y B. Cuffel. "Metabolic Screening After the American Diabetes Association's Consensus Statement on Antipsychotic Drugs and Diabetes". Diabetes Care 32, n.º 6 (24 de febrero de 2009): 1037–42. http://dx.doi.org/10.2337/dc08-1720.

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Spoelstra, José A., Ronald P. Stolk, Dan Cohen, Olav H. Klungel, Joëlle A. Erkens, Hubertus G. M. Leufkens y Diederick E. Grobbee. "Antipsychotic Drugs May Worsen Metabolic Control in Type 2 Diabetes Mellitus". Journal of Clinical Psychiatry 65, n.º 5 (15 de mayo de 2004): 674–78. http://dx.doi.org/10.4088/jcp.v65n0512.

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Erkens, JA, K. Pugner, P. Lapuerta y RMC Herings. "DB1 ASSOCIATION BETWEEN ANTIPSYCHOTIC DRUGS AND DIABETES MELLITUS: A PHARMO STUDY". Value in Health 7, n.º 6 (noviembre de 2004): 648. http://dx.doi.org/10.1016/s1098-3015(10)65670-7.

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Matchett, J. L., N. B. Fishman, S. B. Radmaker y D. E. Casey. "The effect of atypical antipsychotic drugs in patients with preexisting diabetes". Schizophrenia Research 60, n.º 1 (marzo de 2003): 362. http://dx.doi.org/10.1016/s0920-9964(03)80185-8.

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Sumiyoshi, Tomiki, Ajanta Roy, A. Elif Anil, Karu Jayathilake, Aygun Ertugrul y Herbert Y. Meltzer. "A Comparison of Incidence of Diabetes Mellitus Between Atypical Antipsychotic Drugs". Journal of Clinical Psychopharmacology 24, n.º 3 (junio de 2004): 345–48. http://dx.doi.org/10.1097/01.jcp.0000126668.67820.00.

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38

de Hert, M., B. Falissard, M. Mauri, K. Shaw y T. Wetterling. "Epidemiological Study for the Evaluation of Metabolic Disorders in Patients with Schizophrenia: The Meteor Study". European Psychiatry 24, S1 (enero de 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71367-7.

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A large, observational, multinational cross-sectional pharmacoepidemiological study was performed to determine the prevalence of diabetes and other metabolic disorders in patients with schizophrenia receiving atypical antipsychotic drugs in Europe.The study included adult outpatients with schizophrenia (DSM-IV-TR) treated for at least three months by an antipsychotic drug. Patients treated with classical or atypical antipsychotic drugs were recruited into two parallel strata (ratio of 1:3). A fasting blood sample was taken and height, weight, waist and hip circumference and blood pressure measured during a single visit. Biochemical parameters assessed included glucose, insulin, HbA1c, triglycerides, total cholesterol, HDL-cholesterol and apolipoprotein B.2463 patients (median age: 41.0 years; 54.6% male) were included in twelve countries. among these, 10.9% of patients were treated for hypertension, 7.1% for a lipid disorder, 0.3% for type I diabetes and 3.5% for type II diabetes. in addition, 26% of untreated patients had dysglycaemia, 67.7% dyslipidemia and 38% had hypertension. 34% of the patients presented a metabolic syndrome. No overall difference was observed in the proportion of patients with glycaemic and lipid disorders between the two treatment strata. Values for weight-related variables were slightly higher in the atypical stratum, whereas hypertension was more frequent in the classical stratum (47.3%) than in the atypical stratum (42.2%).The results of this study emphasise the need for careful follow-up of patients with schizophrenia treated with antipsychotic drugs to detect the occurrence of metabolic disorders. the proportion of patients with glycaemic or lipid disorders was very high and largely underdiagnosed.This study was funded by sanofi-aventis.

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Carpéné, Christian, Francisco Les, Josep Mercader, Saioa Gomez-Zorita, Jean-Louis Grolleau, Nathalie Boulet, Jessica Fontaine, Mari Carmen Iglesias-Osma y Maria José Garcia-Barrado. "Opipramol Inhibits Lipolysis in Human Adipocytes without Altering Glucose Uptake and Differently from Antipsychotic and Antidepressant Drugs with Adverse Effects on Body Weight Control". Pharmaceuticals 13, n.º 3 (5 de marzo de 2020): 41. http://dx.doi.org/10.3390/ph13030041.

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Treatment with several antipsychotic drugs exhibits a tendency to induce weight gain and diabetic complications. The proposed mechanisms by which the atypical antipsychotic drug olanzapine increases body weight include central dysregulations leading to hyperphagia and direct peripheral impairment of fat cell lipolysis. Several investigations have reproduced in vitro direct actions of antipsychotics on rodent adipocytes, cultured preadipocytes, or human adipose tissue-derived stem cells. However, to our knowledge, no such direct action has been described in human mature adipocytes. The aim of the present study was to compare in human adipocytes the putative direct alterations of lipolysis by antipsychotics (haloperidol, olanzapine, ziprazidone, risperidone), antidepressants (pargyline, phenelzine), or anxiolytics (opipramol). Lipolytic responses to the tested drugs, and to recognized lipolytic (e.g., isoprenaline) or antilipolytic agents (e.g., insulin) were determined, together with glucose transport and amine oxidase activities in abdominal subcutaneous adipocytes from individuals undergoing plastic surgery. None of the tested drugs were lipolytic. Surprisingly, only opipramol exhibited substantial antilipolytic properties in the micromolar to millimolar range. An opipramol antilipolytic effect was evident against isoprenaline-, forskolin-, or atrial natriuretic peptide-stimulated lipolysis. Opipramol did not impair insulin activation of glucose transport but inhibited monoamine oxidase (MAO) activity to the same extent as antidepressants recognized as MAO inhibitors (pargyline, harmine, or phenelzine), whereas antipsychotics were inefficient. Considering its unique properties, opipramol, which is not associated with weight gain in treated patients, is a good candidate for drug repurposing because it limits exaggerated lipolysis, prevents hydrogen peroxide release by amine oxidases in adipocytes, and is thereby of potential use to limit lipotoxicity and oxidative stress, two deleterious complications of diabetes and obesity.

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Milano, Walter, Michele De Rosa, Luca Milano y Anna Capasso. "Antipsychotic Drugs Opposite to Metabolic Risk: Neurotransmitters, Neurohormonal and Pharmacogenetic Mechanisms Underlying with Weight Gain and Metabolic Syndrome". Open Neurology Journal 7, n.º 1 (31 de mayo de 2013): 23–31. http://dx.doi.org/10.2174/1874205x01307010023.

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Important sources of metabolic diseases such as obesity and metabolic syndrome are significantly more prevalent in patients treated with antipsychotic drugs than the general population and they not only reduce the quality of life but also significantly reduce the life expectancy, being important risk factors for cardiovascular disease. The pathogenic mechanisms underlying these events are not entirely clear they are complex and multi-determined or not tied to a single defining event. In this review we examine the literature on the interactions of antipsychotic drugs with neurotransmitters in the brain, with pharmacogenetics hormones and peripheral mechanisms that may induce, albeit in different ways between different molecules, not only weight gain but also 'onset of major diseases such as diabetes, dyslipidemia and hypertension that are the basis of the metabolic syndrome. Today, the possible metabolic changes induced by various antipsychotic drugs and their major physical health consequences, are among the major concerns of clinicians and it is therefore necessary to monitor the main metabolic parameters to prevent or minimize any of these patients as well as the metabolism events associated with the use of antipsychotic drugs.

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Fleischhacker, W. Wolfgang, Cynthia O. Siu, Robert Bodén, Elizabeth Pappadopulos, Onur N. Karayal y René S. Kahn. "Metabolic risk factors in first-episode schizophrenia: baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial". International Journal of Neuropsychopharmacology 16, n.º 5 (1 de junio de 2013): 987–95. http://dx.doi.org/10.1017/s1461145712001241.

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Abstract Available data on antipsychotic-induced metabolic risks are often constrained by potential confounding effects due to prior antipsychotic treatment. In this study, we assessed the baseline prevalence of metabolic abnormalities and changes following treatment with five commonly-used antipsychotic drugs (haloperidol, amisulpride, olanzapine, quetiapine or ziprasidone) in first-episode, partially antipsychotic-naive patients with schizophrenia in the European first-episode schizophrenia trial (EUFEST). Overall baseline prevalence of metabolic syndrome (MetS) was 6.0%, with similar rates observed in the antipsychotic-naive patients (5.7%, 9/157) and in the other patients with only a brief prior exposure to antipsychotics (6.1%, 20/326). These results are consistent with the MetS prevalence rate estimated in a general population of similar age. Examination of individual risk factors showed 58.5% of subjects had one or more elevated metabolic risks at baseline: 28.5% demonstrated suboptimal HDL; 24.2% hypertension; 17.7% hypertriglyceridemia; 8.2% abdominal obesity; 7.3% hyperglycaemia. Increase in body weight (kg/month) occurred in patients treated with haloperidol (0.62 s.e. 0.11), amisulpride (0.76 s.e. 0.08), olanzapine (0.98 s.e. 0.07) and quetiapine (0.58 s.e. 0.09), which was significantly greater than that in the ziprasidone group (0.18 s.e. 0.10). The incidence rate of new diabetes cases over a 52-wk follow-up period was 0.82% (4/488). More patients experienced worsening rather than improvement of hypertriglyceridemia or hyperglycaemia in all treatment groups. Our findings suggest that in first-episode, partially antipsychotic-naive patients, the baseline prevalence rate of MetS appears to be no higher than that in the general population, but serious underlying individual risk factors nevertheless existed.

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42

Taylor, David, Corina Young, Radia Mohamed, Carol Paton y Rebecca Walwyn. "Undiagnosed impaired fasting glucose and diabetes mellitus amongst inpatients receiving antipsychotic drugs". Journal of Psychopharmacology 19, n.º 2 (marzo de 2005): 182–86. http://dx.doi.org/10.1177/0269881105049039.

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Bellantuono, Cesario, Luigi Tentoni y Pietro Donda. "Antipsychotic drugs and risk of type 2 diabetes: An evidence-based approach". Human Psychopharmacology: Clinical and Experimental 19, n.º 8 (2004): 549–58. http://dx.doi.org/10.1002/hup.628.

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Holt, R. I. G. y R. C. Peveler. "Antipsychotic drugs and diabetes—an application of the Austin Bradford Hill criteria". Diabetologia 49, n.º 7 (13 de mayo de 2006): 1467–76. http://dx.doi.org/10.1007/s00125-006-0279-3.

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Nasrallah, Henry A. "Metabolic Findings From the CATIE Trial and Their Relation to Tolerability". CNS Spectrums 11, S7 (2006): 32–39. http://dx.doi.org/10.1017/s1092852900026663.

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AbstractThe overall effectiveness of antipsychotics for the management of schizophrenia is restricted by their side-effect profiles, particularly over an extended treatment period. Intolerable side effects can reduce patient adherence to medication and often lead to treatment discontinuation. Some side effects that result from antipsychotic use are precursors to the metabolic syndrome, which is prevalent among individuals with schizophrenia and represents a significant source of cardiovascular risk. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study assessed the efficacy of the atypical antipsychotics olanzapine, quetiapine, risperidone, and ziprasidone relative to the conventional drug perphenazine. Additional assessments included the metabolic effects of these agents in patients with schizophrenia and the incidence of negative side effects. No significant differences were found between treatment groups for time to discontinuation due to intolerability, but the rates of side effects significantly differed (P=.04). For metabolic parameters, olanzapine was associated with greater and significant adverse effects on weight, lipids, and glucose metabolism versus the other antipsychotics tested. The CATIE results show that important distinctions exist among currently available atypical antipsychotics. Physicians should be aware of the propensity of these drugs to increase the risks of cardiovascular disease and diabetes in treated patients and tailor individual treatment decisions accordingly. This article highlights the metabolic findings from the CATIE schizophrenia study, and explores the differences shown by atypical antipsychotics, with regard to metabolic side effects that increase cardiovascular risk.

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Prifti, A., V. Qemalli y L. Zikaj. "Monitoring of biochemicals changes in antipsychotics and anti-depressive therapy". European Psychiatry 33, S1 (marzo de 2016): S339. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1187.

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ObjectiveBiochemical changes in treatment of schizophrenic and bipolar disorders, in Albanian patients, with atypical antipsychotic and anti-depressive drugs. Some of the adverse effects related to their use are hyperlipidemia, hepatic enzymes, type 2 diabetes and CK level, which may result in development of metabolic syndrome. This study aimed to investigate a possible increase of biochemical parameters, in patients with schizophrenia and bipolar disorders treated with atypical antipsychotic and antidepressive drugs (Olanzapin, Risperidon, Clozapin, Antidepresiv triciclik, SSRI, SNRI).MethodsForty subjects with schizophrenia and bipolar disorders were evaluated, 12 women and 28 men, aged between 17 and 72 years. Blood collection of the patients was taken in our laboratory and this values were measure in long treatment patients, after years of treatment. Analyses were perform in our laboratory with autoanalysator SAT 450.ResultsEvaluation after measurements showed significant differences when comparing the mean values obtained in each patients. The biochemical indicators of development of metabolic syndrome measured in our study, show that is an increasement of lipids panel, specially triglycerides and total cholesterol, also in glucose, CK level and hepatic enzymes, presenting statistically significant changes (P < 0.05) for prolong treatment.ConclusionWe conclude that the treatment with atypical antipsychotic and antidepressive drugs, promoted a substantial increasing of biochemical blood parameters. Lipids panel, hepatic enzymes, type 2 diabetes, CK levels are observed in among subjects evaluated.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Kwok, Jeffrey SS y Thomas YK Chan. "Recurrent Heat-Related Illnesses During Antipsychotic Treatment". Annals of Pharmacotherapy 39, n.º 11 (noviembre de 2005): 1940–42. http://dx.doi.org/10.1345/aph.1g130.

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OBJECTIVE To report a case of recurrent heat-related illnesses associated with the use of benzhexol, chlorpromazine, and zuclopenthixol decanoate. CASE SUMMARY During the summer of 2004, a 48-year-old man with a history of diabetes mellitus and schizophrenia was twice admitted to the hospital because of heat-related illnesses. On both occasions, he had been working under the sun in an open car park. His medications included benzhexol 2 mg twice daily, chlorpromazine 650 mg at bedtime, and zuclopenthixol decanoate intramuscular injection 600 mg every 4 weeks. In the first admission, the clinical diagnosis was heat stroke. He was discharged home on day 14, with precautionary advice against heat stroke. In the second admission, the clinical diagnosis was heat exhaustion. He was discharged home on day 4 and reminded of the precautions against heat stroke. An objective causality assessment revealed that the adverse event was possibly drug related in the first admission and probably drug related in the second admission. DISCUSSION Several drugs can impair thermoregulation during exercise or under conditions of environmental heat stress. Anticholinergic drugs or drugs with anticholinergic effects can inhibit sweating and reduce heat elimination. Neuroleptics (antipsychotics), such as phenothiazines, have combined anticholinergic and central thermoregulatory effects. The set point of the temperature regulation center can be elevated by the antidopaminergic effect of antipsychotics, such as phenothiazines and thioxanthenes. CONCLUSIONS Certain drugs may induce or worsen heat-related illnesses. During a heat wave, special attention should be given to those most at risk, and the importance of preventive measures should be emphasized.

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Allard, Lucie, Frédérique Albarel, Jérôme Bertherat, Philippe Jean Caron, Christine Cortet, Carine Courtillot, Brigitte Delemer et al. "Efficacy and safety of dopamine agonists in patients treated with antipsychotics and presenting a macroprolactinoma". European Journal of Endocrinology 183, n.º 2 (agosto de 2020): 221–31. http://dx.doi.org/10.1530/eje-20-0125.

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Context In patients treated with antipsychotics, the rare occurrence of a macroprolactinoma represents a therapeutic challenge. Objective Our aim was to evaluate the efficacy and psychiatric safety of dopamine agonists (DAs) prescribed for large macroprolactinomas in patients with psychosis treated with antipsychotics. Design This was a multicenter (France and Belgium) retrospective study. Patients Eighteen patients treated with antipsychotics were included. Results Under DA, median PRL levels decreased from 1247 (117–81 132) to 42 (4–573) ng/mL (P = 0.008), from 3850 (449–38 000) to 141 (60–6000) ng/mL (P = 0.037) and from 1664 (94–9400) to 1215 (48–5640) ng/mL (P = 0.56) when given alone (n = 8), before surgery (n = 7), or after surgery (n = 6), respectively. The prolactinoma median largest diameter decreased by 28% (0–57) in patients under DAs alone (P = 0.02) but did not change when given after surgery. Optic chiasm decompression was achieved in 82% of patients. Five patients (28%) were admitted for psychotic relapse while receiving DAs (but three of them had stopped antipsychotic treatment at that time). A more severe underlying psychosis, rather than the DA treatment itself, may explain such psychiatric admissions. Conclusion Even if the DA efficacy on PRL levels and tumor volume in patients with macroprolactinoma under antipsychotic drugs is less impressive than that typically observed, it may be considered satisfactory for half of our patients, particularly in cases of optic chiasm compression. Psychotic exacerbation was unusual in these patients, occurring mostly in those with the most severe psychotic forms. DAs may therefore be used as antitumor treatment for macroprolactinoma in patients with visual involvement, severe headaches or invasion into the skull base who receive antipsychotics.

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Lean, M. E. J. y F. G. Pajonk. "Patients on Atypical Antipsychotic Drugs: Another high-risk group for type 2 diabetes". Diabetes Care 26, n.º 5 (1 de mayo de 2003): 1597–605. http://dx.doi.org/10.2337/diacare.26.5.1597.

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van Keulen, Kris, Paul D. van der Linden, Patrick C. Souverein, Eibert R. Heerdink, Antoine C. G. Egberts y Wilma Knol. "Risk of Hospitalization for Hypoglycemia in Older Patients with Diabetes Using Antipsychotic Drugs". American Journal of Geriatric Psychiatry 23, n.º 11 (noviembre de 2015): 1144–53. http://dx.doi.org/10.1016/j.jagp.2015.04.006.

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