Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-23T09:24:46.089Z Has data issue: false hasContentIssue false
  • English
  • Français

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

Published online by Cambridge University Press:  24 March 2020

A. Lydon ,
J. Vallely ,
A. Tummon ,
S. Maher ,
S. Sabri ,
J. McLoughlin ,
A. Liew ,
C. McDonald Open the ORCID record for C. McDonald [Opens in a new window]  and
B. Hallahan
A. Lydon*
Affiliation:
College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland Child and Adolescent Mental Health Services, Galway, Ireland
J. Vallely
Affiliation:
College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
A. Tummon
Affiliation:
Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
S. Maher
Affiliation:
College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
S. Sabri
Affiliation:
College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
J. McLoughlin
Affiliation:
College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
A. Liew
Affiliation:
College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland Department of Medicine, Galway University Hospital, Galway, Ireland Department of Medicine, Portiuncula University Hospital, Galway, Ireland
C. McDonald
Affiliation:
College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
B. Hallahan
Affiliation:
College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
*
*Address for correspondence: A. Lydon, Galway University Hospital, West Galway CAMHS, Ballard House, Bothar le Cheile, Westside, GalwayH91 CKA4, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To examine the rate of monitoring of metabolic syndrome and actual rates of metabolic syndrome in two patient cohorts [clozapine treatment and long-acting injectable (LAI) antipsychotic] who are reviewed on an equally regular basis (1–4 weekly) for administration of treatment.

Methods

Clinical and laboratory data are examined on 119 patients treated with clozapine and 116 patients treated with LAI antipsychotic medications to determine the rates of metabolic syndrome and evidence of monitoring for metabolic syndrome in the previous 6 months. Individuals with insufficient data from these cohorts were invited to attend for metabolic screening to determine actual rates of metabolic syndrome in these two cohorts of patients.

Results

All metabolic parameters were monitored to a significantly greater extent in the clozapine cohort (>90%), compared to those treated with LAI antipsychotic medications (<50%) (blood pressure, weight, lipid and glucose levels; p < 0.001). Metabolic syndrome was present in 38.9% of those treated with clozapine compared to 31.1% of patients treated with LAI antipsychotic medications (X2 = 0.54, p = 0.46).

Conclusions

These findings suggest that a robust screening plan should be in place to monitor for metabolic syndrome in individuals treated with LAI antipsychotic medications. This screening should include measurement of body weight, waist circumference, fasting glucose, lipids and fasting insulin levels. Early recognition of abnormal metabolic parameters allows early intervention, therefore, improving long-term cardiovascular outcomes.

Keywords

ClozapineLAI antipsychoticsmetabolic syndromeroutine monitoring
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 38 , Issue 1: Themed Issue: Physical Health in Mental Illness , March 2021 , pp. 40 - 48
Copyright
© College of Psychiatrists of Ireland 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmed, M, Hussain, I, O’Brien, SM, Dineen, B, Griffen, D, McDonald, C (2008). Prevalence and associations of the metabolic syndrome among patients prescribed clozapine. Irish Journal of Medical Science 177, 205–210.CrossRefGoogle ScholarPubMed
Alberti, KGM, Zimmet, P, Shaw, J (2005). The metabolic syndrome – a new worldwide definition. The Lancet 366, 1059–1062.CrossRefGoogle ScholarPubMed
Alberti, KGM, Zimmet, P, Shaw, J (2006). Metabolic syndrome- a new worldwide definition. A consensus statement from the International Diabetes Federation. Diabetic Medicine 23, 469–480.CrossRefGoogle Scholar
American Diabetes Association (ADA) (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 27, 596–601.CrossRefGoogle Scholar
Barnes, TR, Paton, C, Cavanagh, MR, Hancock, E, Taylor, DM (2007). A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophrenia Bulletin 33, 1397–1403.CrossRefGoogle ScholarPubMed
Bly, MJ, Taylor, SF, Dalack, G, Pop-Busui, R, Burghardt, KJ, Evans, SJ, McInnis, MI, Grove, TB, Brook, RD, Zöllner, SK, Ellingrod, VL (2014). Metabolic syndrome in bipolar disorder and schizophrenia: dietary and lifestyle factors compared to the general population. Bipolar Disorders 16, 277–288.CrossRefGoogle ScholarPubMed
Brunero, S, Lamont, S (2009). Systematic screening for metabolic syndrome in consumers with severe mental illness. International Journal of Mental Health Nursing 18, 144–150.CrossRefGoogle ScholarPubMed
Buhagiar, K, Jabbar, F (2019). Association of first- vs. second-generation antipsychotics with lipid abnormalities in individuals with severe mental illness: a systematic review and meta-analysis. Clinical Drug Investigation 39, 253–273.CrossRefGoogle ScholarPubMed
Citrome, L, Yeomans, D (2005). Do guidelines for severe mental illness promote physical health and well-being?. Journal of Psychopharmacology 19, 102–109.CrossRefGoogle ScholarPubMed
Cohn, T (2013). Metabolic monitoring for patients on antipsychotic medications. Psychiatric Times 30, 33.Google Scholar
De Hert, M, Detraux, J, van Winkel, R, Yu, W, Correll, CU (2011). Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nature Reviews Endocrinology 8, 114–126.CrossRefGoogle ScholarPubMed
De Hert, M, Van Eyeck, D, De Nayer, A (2006). Metabolic abnormalities associated with second generation antipsychotics: fact or fiction? Development of guidelines for screening and monitoring. International Clinical Psychopharmacology 21, 1–5.Google ScholarPubMed
De Leon, J, Diaz, FJ (2005). A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviours. Schizophrenia Research 76, 135–157.CrossRefGoogle Scholar
Druss, BG, Bradford, WD, Rosenheck, RA, Radford, MJ, Krumholz, HM (2001). Quality of medical care and excess mortality in older patients with mental disorders. Archives of General Psychiatry 58, 565–572.CrossRefGoogle ScholarPubMed
Gianfrancesco, FD, Grogg, AL, Mahmoud, RA, Wang, RH, Nasrallah, HA (2002). Differential effects of risperidone, olanzapine, clozapine and conventional antipsychotics on type 2 diabetes: findings from a large health plan database. The Journal of Clinical Psychiatry 63, 920–930.CrossRefGoogle ScholarPubMed
Hakko, H, Wahlberg, KE, Tienari, P, Räsänen, S (2011). Genetic vulnerability and premature death in schizophrenia spectrum disorders a 28-year follow-up of adoptees in the Finnish Adoptive Family Study of Schizophrenia. Nordic Journal of Psychiatry 65, 259–265.CrossRefGoogle ScholarPubMed
Hasnain, M, Fredrickson, SK, Vieweg, WVR, Paudurangi, AK (2010). Metabolic syndrome associated with schizophrenia and atypical antipsychotics. Current Diabetes Reports 10, 209–216.CrossRefGoogle ScholarPubMed
Henderson, DC, Cagliero, E, Gray, C, Nasrallah, RA, Hayden, DL, Schoenfeld, DA, Goff, DC (2000). Clozapine, diabetes mellitus, weight gain and lipid abnormalities: a 5 year naturalistic study. American Journal of Psychiatry 157, 975–981.CrossRefGoogle Scholar
Hennekens, CH, Hennekens, AR, Hollar, D, Casey, DE (2005). Schizophrenia and increased risk of cardiovascular disease. American Heart Journal 150, 1115–1121.CrossRefGoogle Scholar
Hirsch, L, Yang, J, Bresee, L, Jette, N, Patten, S, Pringsheim, T (2017). Second generation antipsychotics and metabolic side effects: a systematic review of population-based studies. Drug Safety 40, 771–781.CrossRefGoogle ScholarPubMed
Hjorthoj, C, Sturup, AE, McGrath, JJ, Nordentoft, M (2017) Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry 4, 295–301.CrossRefGoogle ScholarPubMed
Ingimarsson, O, MacCabe, JH, Haraldsson, M, Jónsdóttir, H, Sigurdsson, E (2017). Risk of diabetes and dyslipidaemia during clozapine and other antipsychotic drug treatment of schizophrenia in Iceland. Nordic Journal of Psychiatry 71, 496–502.CrossRefGoogle ScholarPubMed
Isomaa, BO, Almgren, P, Tuomi, T, Forsén, B, Nissén, M, Taskinen, MR, Groop, L (2001). Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 24, 683–689.CrossRefGoogle ScholarPubMed
Lamberti, JS, Olson, D, Crilly, JF, Olivares, T, Williams, GC, Tu, X, Tang, W, Wiener, K, Dvorin, S, Dietz, MB (2006). Prevalence of the metabolic syndrome among patients receiving clozapine. American Journal of Psychiatry 163, 1273–1276.CrossRefGoogle ScholarPubMed
Lappin, JM, Wijaya, M, Watkins, A, Morrell, R, Teasdale, S, Lederman, I, Rosenbaum, S, Dick, S, Ward, P, Curtis, J (2018) Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients. Schizophrenia Research 199: 367–373.CrossRefGoogle Scholar
Laursen, TM, Nordentoft, M, Mortensen, PB (2014). Excess early mortality in Schizophrenia. Annual review of Clinical Psychology 10, 425–448.CrossRefGoogle Scholar
Leucht, S, Cipriani, A, Spineli, L, Mavridis, D, ÖD, D, Richter, F, Samara, M, Barbui, C, Engel, RR, Geddes, JR, Kissling, W (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple treatments meta-analysis. The Lancet 382, 951–962.CrossRefGoogle ScholarPubMed
Lorenzo, C, Williams, K, Hunt, KJ, Haffner, SM (2007). The National Cholesterol Education Program- Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care 30, 8–13.CrossRefGoogle ScholarPubMed
Mackin, P, Bishop, DR, Watkinson, HM (2007). A prospective study of monitoring practices for metabolic disease in antipsychotic treated community psychiatric patients. BMC Psychiatry 7, 28.CrossRefGoogle ScholarPubMed
Murtagh, A, Petrovici, R, Wong, W, Obadan, C, Solanke, O, Nnabuchi, E, Kilbride, K (2011). Improving monitoring for metabolic syndrome using audit. Irish Journal of Psychological Medicine 28, i–iv.CrossRefGoogle ScholarPubMed
O’Callaghan, C, Liew, A, Yusof, MSD, Duffy, R, Breen, EG, Kinsley, B, Kelly, BD (2011). Screening for metabolic syndrome in long-term psychiatric illness: audit of patients receiving depot antipsychotic medication at a psychiatry clinic. The European Journal of Psychiatry 25, 213–222.CrossRefGoogle Scholar
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in Schizophrenia: is the differential mortality gap worsening over time? Archive of General Psychiatry 64, 1123–1131.CrossRefGoogle ScholarPubMed
Stroup, TS, Gerhard, T, Huang, C, Olfson, M (2016). Comparative effectiveness of clozapine and standard antipsychotic treatment in adults with schizophrenia. The American Journal of Psychiatry 173, 166–173.CrossRefGoogle ScholarPubMed
Taylor, DM, Barnes, TRE, Young, AH (2018). The Maudsley Prescribing Guidelines in Psychiatry, 13th edn. Wiley-Blackwell: Chichester.Google Scholar
Thakore, JH (2005). Metabolic syndrome and schizophrenia. British Journal of Psychiatry 186, 455–456.CrossRefGoogle Scholar
Waterreus, AJ, Laugharne, JD (2009). Screening for the metabolic syndrome in patients receiving antipsychotic treatment: a proposed algorithm. The Medical Journal of Australia 190, 185–189.CrossRefGoogle ScholarPubMed