In a cohort of drug-naive subjects with schizophrenia untreated with medications, visceral fat content was threefold higher than in age- and BMI – matched control subjects. Drug-naive patients presenting with their first episode had an increased prevalence of impaired fasting glucose, were more insulin resistant, and had higher plasma levels of glucose, insulin and cortisol than did matched control subjects.
Case reports, case series, observational analytic epidemiologic studies, and randomized trials raise the possibility, that some antipsychotic drugs likely due to drugs - induced weight gain and hasten associated metabolic abnormalities including hyperglycemia, diabetes mellitus, and dyslipidemia. Most of phenotiazines and second generation antipsychotics (SGAs) can cause a rapid increase in body weight in the first few months of therapy that may not reach a plateau after l year of treatment. Use of many SGAs has been associated with the new onset, or exacerbation of diabetes. Several of these events occurred within a few weeks of initiating drugs treatment. In some, but not all eases, hyperglicemia promptly resolved after the medication was discontinued. Several repoits documented recurrent hyperglicemia after another challenge with the same drug. The data consistently show an increased risk for diabetes in patients treated with clozapine or olanzapine compared with patients not receiving treatment, with classical neuroleptics, or with other SGAs. The risk in patients taking risperidone and quetiapine is less clear. Aripiprazole and ziprazidone have relatively limited epidemiological data, but available clinical trial experience with these drugs has not shown an increased risk for diabetes. Patients treated with olanzapine and clozapine have higher fasting and postprandial insulin levels, than patients treated with FGAs, even after adjusting for body weight.
This both drugs produce the greatest weight gain, are associated with the greatest increases in total cholesterol, LDL cholesterol and triglycerides and with dereased HDL cholesterol. When prescribing an SGA, a commitment to baseline screening and follow-up monitoring is essential in order to mitigate the like hood of developing cardio-vascular disease, diabetes or other diabetes complications.
The assessment for initiation of any antipsychotic can determine, if the patients is overweight (BMI 25-29,9), has pre-diabetes (fasting plasma glucose 100-125 mg/dL) or diabetes (FPG ≥ 126 mg/dL), hypertension (blood pressure > 140/90 mmHg), or dyslipidemia. If any of these conditions are identified, appropriate treatment should be initiated.
The standards of pharmacotherapy in patients with metabolic syndrome are presented.