Pharmacological Strategies to Counteract Antipsychotic-Induced Weight Gain and Metabolic Adverse Effects in Schizophrenia: A Systematic Review and Meta-analysis

Background: Antipsychotic-induced metabolic adversities are often difficult to manage. Using concomitant medications to counteract these adversities may be a rational option. Objective: To systematically determine the effectiveness of medications to counteract antipsychotic-induced metabolic adversities in patients with schizophrenia. Data Sources: Published articles until November 2013 were searched using 5 electronic databases. Clinical trial registries were searched for unpublished trials. Study Selection: Double-blind randomized placebo-controlled trials focusing on patients with schizophrenia were included if they evaluated the effects of concomitant medications on antipsychotic-induced metabolic adversities as a primary outcome. Data Extraction: Variables relating to participants, interventions, comparisons, outcomes, and study design were extracted. The primary outcome was change in body weight. Secondary outcomes included clinically relevant weight change, fasting glucose, hemoglobin A1c, fasting insulin, insulin resistance, cholesterol, and triglycerides. Data Synthesis: Forty trials representing 19 unique interventions were included in this meta-analysis. Metformin was the most extensively studied drug in regard to body weight, the mean difference amounting to −3.17 kg (95% CI: −4.44 to −1.90 kg) compared to placebo. Pooled effects for topiramate, sibutramine, aripiprazole, and reboxetine were also different from placebo. Furthermore, metformin and rosiglitazone improved insulin resistance, while aripiprazole, metformin, and sibutramine decreased blood lipids. Conclusion: When nonpharmacological strategies alone are insufficient, and switching antipsychotics to relatively weight-neutral agents is not feasible, the literature supports the use of concomitant metformin as first choice among pharmacological interventions to counteract antipsychotic-induced weight gain and other metabolic adversities in schizophrenia.Key words: antipsychotic, meta-analysis, metabolic, concomitant, PRISMA, schizophrenia     

Effectiveness of Pharmacotherapy for Pathological Gambling: A Chart Review

Although pathological gambling is a relatively common disorder, there exists only limited information regarding the effectiveness of pharmacotherapy for this illness. This study examines which medications may be effective, dose and duration of medication trials needed to achieve response, and possible predictors of response. Using a chart review, 50 adult outpatients with DSM-IV pathological gambling treated in clinical practice were assessed regarding response to a variety of medications, including augmentation strategies, and response to concomitant psychotherapy. All subjects received pharmacotherapy for gambling symptoms. Thirty-nine (78%) achieved response to medication treatment. Mean duration of treatment needed for response was 104.9 ± 85.0 days. Of those treated with an adequate trial of naltrexone as monotherapy, 90.9% were responders, whereas only 45.5% of those treated with an adequate trial of an SSRI achieved response. Patients with poorer social and occupational functioning due to urges and thoughts about gambling were less likely to respond to medication. These findings from a clinical setting suggest that a majority of pathological gamblers improve with medication treatment. Naltrexone, or augmentation of naltrexone with an SSRI, appears to be most effective in relieving gambling symptoms.     

Topiramate Treatment of Bipolar Spectrum Disorders: A Retrospective Chart Review

The objective of this paper was to determine if topiramate is effective as treatment for bipolar spectrum disorders in a naturalistic setting. All charts of outpatients treated with topiramate (n = 76) were reviewed, and clinical response was assessed retrospectively using the Clinical Global Impressions Scale for Improvement. Mild improvement was seen in 47% (n = 36) and moderate-to-marked improvement in 13% (n = 10) Responders received a higher mean dose (180 mg/day) than did nonresponders (83.2 mg/day, p = 0.002). Topiramate dose was also higher in those who lost weight (138.3 mg/day) than in those who did not (70 mg/day, p = 0.007). Weight loss was experienced by 50% of the sample, with a mean loss of 14.2 lbs. Side effects were reported by 82% n = 62) of the population, including cognitive effects, sedation, parasthesias, nausea, insomnia, headache, and dizziness. Adverse effects led 36% (n = 27) of the total sample to discontinue treatment with topiramate. Topiramate led to significant weight loss in about half of this bipolar population, while also improving mood symptoms at least mildly in most patients. Topiramate response and weight loss were both dose-related, with efficacy, in particular, associated with higher doses (mean = 18 0 mg/day) than frequently used in current clinical practice.     

Structure of Self-other Reversal in Schizophrenic Disturbances in Sense of Self

Abstract: Disturbances in the sense of self are a fundamental state found in schizophrenia. In these phenomena, it is thought that the self and others become interchanged within the mind of patient. The structure of such reversal of self and others (self-other reversal) has its origin in a duplex state in which the body can perceive with the senses, and at the same time can be perceived. These disturbances can therefore be understood as disturbances of corporeity (Merleau-Ponty, M.) or disturbances in the duplex state of the body, and in this sense, they are contrasted with delusions expressed in words.     

Bipolar Disorder and Metabolic Syndrome: A Systematic Review

ObjectiveSummarize data on metabolic syndrome (MS) in bipolar disorder (BD).MethodsA systematic review of the literature was conducted using the Medline, Embase and PsycInfo databases, using the keywords “metabolic syndrome”, “insulin resistance” and “metabolic X syndrome” and cross-referencing them with “bipolar disorder” or “mania”. The following types of publications were candidates for review: (i) clinical trials, (ii) studies involving patients diagnosed with bipolar disorder or (iii) data about metabolic syndrome. A 5-point quality scale was used to assess the methodological weight of the studies.ResultsThirty-nine articles were selected. None of studies reached the maximum quality score of 5 points. The prevalence of MS was significantly higher in BD individuals when compared to a control group. The analysis of MS subcomponents showed that abdominal obesity was heterogeneous. Individuals with BD had significantly higher rates of hypertriglyceridemia than healthy controls. When compared to the general population, there were no significant differences in the prevalence of low HDL-c in individuals with BD. Data on hypertension were also inconclusive. Rates of hyperglycemia were significantly greater in patients with BD compared to the general population.ConclusionsThe overall results point to the presence of an association between BD and MS, as well as between their subcomponents.     

Long-Term Use of Pramipexole in Bipolar Depression: A Naturalistic Retrospective Chart Review

A naturalistic retrospective chart review of all patients given pramipexole for bipolar depression in addition to their mood stabilizers was undertaken. Sixteen patients were followed for an average of 6.7 ± SD 9.0 months. Half of the patients stopped the pramipexole an average of 2 months after starting it. For all patients, depressed mood, and the total profile of depressive symptoms improved significantly within 4 weeks and remained significantly improved for as long as 36 weeks. Both global function (GAF), and global impression (CGI) improved with pramipexole. Irritability and insomnia both increased slightly initially, and then subsided. There were no changes in mania ratings for up to 36 months. Long-term outcome of adjunctive pramipexole appears to be adequate, with apparent maintenance of effect for over 9 months.     

Patient Requests for Discharge from Voluntary Psychiatric Hospitalization: a Chart Review

Psychiatric Quarterly - The purpose of this study was to examine the rate of 72-hour letters (written requests for discharge, with 72 hours indicating the time the hospital has to...     

Pramipexole Augmentation in the Treatment of Unipolar and Bipolar Depression: A Retrospective Chart Review

Objective: To assess the effectiveness and safety of pramipexole as an adjunctive medication in refractory bipolar and unipolar depression in a naturalistic setting. Methods: Retrospective chart review by psychiatrists on staff at a university hospital identified all patients who had received pramipexole. Response was based on moderate to marked improvement in the Clinical Global Impression-Improvement (CGI-I) scale. Results: Pramipexole (mean dose 0.70 mg/d, mean duration 24.4 weeks) was effective in 6/12 (50.0%) of patients with bipolar depression, and 8/20 (40%) of patients with unipolar depression, mean duration of follow-up of 24.4 weeks. One case of transient hypomania was noted. Eight patients discontinued pramipexole due to lack of response and four due to side effects. Conclusions: Pramipexole, used as an adjunct to antidepressants or mood stabilizers, appeared to be effective and safe in the treatment of unipolar and bipolar depression. These uncontrolled, retrospective, naturalistic pilot data require confirmation by controlled research before conclusions can be made.     

Efficacy and Safety of ECT for Behavioral and Psychological Symptoms of Dementia (BPSD): A Retrospective Chart Review

ObjectiveMuch of the functional disturbance in patients with dementia reflects the presence of noncognitive behavioral and psychological symptoms of dementia (BPSD). Agitation is among the most distressing symptoms for patients, clinicians, and caregivers. Currently no pharmacotherapy has clearly been shown to be of value for this condition. This study used a chart review method to examine the safety and efficacy of electroconvulsive therapy (ECT) for patients with dementia receiving ECT for agitation.MethodsA retrospective chart review was conducted of patients with dementia presenting with symptoms of aggression or agitation and who received ECT treatments. Aggression and agitation were measured by pre- and post-ECT Pittsburg Agitation Scale (PAS) scores. Detailed history of the use of psychotropic medications as well as other clinically relevant variables was analyzed.FindingsSixty elderly patients (45 women and 15 men, 75% female, mean age 77.5 ± 8.0 years) were included in the analysis. Most patients were treatment resistant to multiple psychotropic medications prior to ECT (mean number 6.1±1.5). The baseline PAS total was 9.3 ± 3.7 and it decreased significantly after three (2.5±2.8) and six (1.5±2.3) ECT treatments. No significant ECT-related medical complications were observed except transient confusion. A decrease in the number of psychotropics prescribed along with an increase in the GAF score was observed after the ECT treatment course.ConclusionECT was safe in this sample of patients who had co-morbid medical conditions. ECT was associated with the following observations: 1) a reduction in agitation; 2) a reduction in psychotropic polypharmacy; and 3) an improvement in global functioning level. Further research evaluating the effects of ECT in the setting of dementia is warranted.     

Psychiatric Co-morbidity in Ketamine and Methamphetamine Dependence: a Retrospective Chart Review

Both ketamine and methamphetamine (MA) have become very popular and have been abused worldwide over the past two decades. However, the relationship between dependence on ketamine or MA and psychiatric comorbidities is still unclear. This study aimed to examine the frequency of co-morbid psychiatric disorders in patients dependent on ketamine or methamphetamine who were receiving treatment at three substance abuse treatment clinics (SACs) in Hong Kong. This was a retrospective chart review. The medical records of 183 patients (103 with ketamine and 80 with MA dependence) treated between January 2008 and August 2012 were retrieved. Patients’ demographic data, patterns of substance abuse and comorbid psychiatric diagnoses were recorded. The mean age of onset and duration of substance abuse were 18.1?±?4.7 and 9.2?±?6.2 years for ketamine and 19.9?±?8.8 and 10.5?±?9.8 years for MA users, respectively. Psychotic disorders were more common in MA dependent users (76.2 % vs. 28.2 %, p?<?0.001), whereas mood disorders were more common in ketamine dependent users (27.2 % vs. 11.2 %, p?=?0.008). Ketamine and MA dependence have a notably different profile of psychiatric co-morbidity. Compared with MA dependence, ketamine dependence is more likely to be associated with mood disorders and less likely with psychotic disorders.     

Metabolic Disturbances Independent of Body Mass in Patients with Schizophrenia Taking Atypical Antipsychotics

ObjectiveAtypical antipsychotic (AAP) treatment is associated with weight gain and metabolic disturbances such as dyslipidemia and dysglycemia. The metabolic disturbances are usually considered to develop secondary to weight gain. We performed the comparison of metabolic disturbances of three AAP group with different risk of metabolic side effect after adjusting for body mass to investigate whether any metabolic disturbances develop independently from body mass index (BMI).MethodsThis cross-sectional study included 174 subjects with schizophrenia who were on 1) monotherapy with clozapine (CL), olanzapine (OL), or quetiapine (QT) (n=61), 2) monotherapy with risperidone (RSP) (n=89), or 3) monotherapy with aripiprizole (ARP), or ziprasidone (ZPS) (n=24) more than 1 year. Association between the prevalence of metabolic disturbances and groups were analysed using logistic regression after adjusting confounding variables including BMI. Analysese of covariance were used to compare the AAP groups in terms of the levels of metabolic parameters.ResultsThere were significant differences among groups in terms of the prevalence of hypertriglyceridemia (p=0.015), low HDL-cholesterol (p=0.017), and hyperglycemia (p=0.022) after adjusting for BMI. Triglyceride level (p=0.014) and the ratio of triglyceride to HDL-cholesterol (p=0.004) were significantly different among groups after adjusting for BMI.ConclusionIn conclusion, metabolic disturbances are significantly different in AAP groups even after adjusting BMI. AAPs may have direct effect on metabolic parameters. Blood lipid and glucose levels should be monitored regularly regardless of whether patients tend to gain weight.     

Determinants of Length of Stay in a Psychiatric Ward: a Retrospective Chart Review

Psychiatric Quarterly - Considering the limited resources for providing inpatient services, identification of the factors influencing length of stay (LOS) is of great importance. The current study...     

Posttraumatic Stress Disorder,Cardiovascular, and Metabolic Disease: A Review of the Evidence

Background  

Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease.     

多发性硬化中的脂代谢障碍和多不饱和脂肪酸的治疗

复习与多发性硬化相关的细胞膜脂蛋白的研究,及其生化和临床研究的资料,发现多不饱和脂肪酸,主要是n-6脂肪酸在多发性硬化的发病和治疗中具有重要意义。有研究发现高剂量γ-亚油酸[GIA(18:3n-6)oil]能减少复发性多发性硬化的复发率和疾病的进展。     

A Diagnostic Algorithm for Metabolic Myopathies

Metabolic myopathies comprise a clinically and etiologically diverse group of disorders caused by defects in cellular energy metabolism, including the breakdown of carbohydrates and fatty acids to generate adenosine triphosphate, predominantly through mitochondrial oxidative phosphorylation. Accordingly, the three main categories of metabolic myopathies are glycogen storage diseases, fatty acid oxidation defects, and mitochondrial disorders due to respiratory chain impairment. The wide clinical spectrum of metabolic myopathies ranges from severe infantile-onset multisystemic diseases to adult-onset isolated myopathies with exertional cramps. Diagnosing these diverse disorders often is challenging because clinical features such as recurrent myoglobinuria and exercise intolerance are common to all three types of metabolic myopathy. Nevertheless, distinct clinical manifestations are important to recognize as they can guide diagnostic testing and lead to the correct diagnosis. This article briefly reviews general clinical aspects of metabolic myopathies and highlights approaches to diagnosing the relatively more frequent subtypes (Fig. 1).