IntroductionRecent research has shown that adiponectin levels in patients with schizophrenia vary similar to the general population. Moreover, antipsychotic medication may influence adiponectin levels, independent of metabolic parameters. We hypothesise different antipsychotics might vary in their effect on adiponectin levels independent of BMI and metabolic syndrome (MetS) status.Methods113 patients, with similar baseline demographic and metabolic characteristics, received either risperidone (n=54) or olanzapine (n=59). They were followed prospectively for 12 weeks. Adiponectin levels as well as general metabolic parameters were measured at baseline, 6 weeks and 12 weeks.ResultsWe observed a significant treatment by time interaction, showing an adiponectin increase in the risperidone treated patients and an adiponectin decrease in olanzapine treated patients. This effect was independent of BMI and the presence/absence of the metabolic syndrome. There was a significant association between fall in adiponectin and increase in waist circumference in the Olanzapine treated group (Figure 1).There was no change in HOMA-IR as a measure of insulin resistance in either group. ConclusionWe observed a differential effect of antipsychotic treatment (risperidone vs olanzapine) on adiponectin levels over time, independent of BMI (and MetS) suggesting an effect of olanzapine on adipose tissues, similar to what has been observed in animals models. The effects on adiponectin levels may partly explain the increased rates of obesity with Olanzapine.

Severe mental disorders have a chronic course associated with a high risk for co-morbid somatic illnesses and premature mortality, but despite this increased risk, general health care needs in this population are often neglected. Over recent years, several groups have developed screening and monitoring guidelines for metabolic and cardiovascular risk assessment in patients treated with antipsychotics. The psychiatrist needs to be aware of the potential metabolic side-effects of antipsychotic medication and to include them in the risk/benefit assessment when choosing a specific antipsychotic. He should also be responsible for the implementation of the necessary screening assessments and referral for treatment of any physical illness. Multidisciplinary assessment of psychiatric and medical conditions is needed. The somatic treatments offered to people with severe and enduring mental illness should be at par with general health care in the non-psychiatrically ill population. In our University Centre, a structured and elaborate screening and monitoring protocol was introduced in late 2003. This paper describes the practical aspects of this monitoring protocol and the results obtained 4 years after its implementation.

Prior studies attempted to explore the association between schizophrenia and hepatitis C virus (HCV). However, their conclusions were inconsistent. This study aimed to examine the association of schizophrenia with HCV using a population-based dataset in Taiwan. There were 6097 patients with schizophrenia and 6097 sex- and age-matched comparison patients without schizophrenia included in this study. We defined the dependent variable of interest as whether or not a patient had received a diagnosis of HCV. We found that of the sampled patients, 2.1% of patients with schizophrenia and 1.4% of comparison patients had concurrent HCV. We further found that schizophrenia was not significantly associated with concurrent HCV after adjusting for sex, age, urbanization level, geographic region, monthly income, and drug abuse. However, of the sampled male patients, the adjusted odds of concurrent hepatitis C for patients with schizophrenia were 1.72-times higher than the odds of concurrent HCV among comparison patients. We failed to observe this association among female sampled patients. We concluded that schizophrenia was not significantly associated with concurrent HCV. However, of the sampled male patients, the risk of concurrent HCV among patients with schizophrenia was higher than comparison patients.

Les troubles métaboliques sont fréquents chez les patients psychiatriques, mais leur fréquence en fonction du diagnostic psychiatrique est mal connue. Tous les patients avec un diagnostic précis de troubles bipolaires (n = 112), schizophrénie (n = 503) et désordres schizoaffectifs (n = 92) ont été évalués prospectivement à la recherche d'un syndrome métabolique (SM, critères du NCEP-ATPIII 2004), d'un « pré-diabète » (« IFG/IGT » dans HGPO) ou d'un diabète. Une analyse de régression logistique a évalué si le diagnostic psychiatrique est un facteur indépendant de risque métabolique. SM est présent chez 23,2 %, 28,8 % et 50,0 % des patients avec troubles bipolaires, schizophrénie et désordres schizoaffectifs, respectivement (p < 0,001 entre SM et diagnostic psychiatrique). Le rapport de cote ajusté (odds ratiOou OR), avec les troubles bipolaires comme référence (OR 1,0), est de 1,98 en cas de schizophrénie, mais augmente à 4,22 en cas de désordres schizoaffectifs (p < 0,05 entre chacun des 3 groupes). Au total, 7,6 % des patients atteignent les critères de diabète et 22,2 % ceux de « prédiabète » (14,1 % IFG et/ou 10,3 % IGT). L'association entre le diagnostic psychiatrique et les anomalies du glucose est limite (p = 0,065). Les patients avec désordres schizoaffectifs ont un risque plus élevé de dysglycémie que ceux avec troubles bipolaires (OR 2,38 ; p = 0,029) ou avec schizophrénie (p = 0,051) alors que le risque apparaît comparable dans ces deux dernières catégories (OR 1,25 ; p = 0,516). Les anomalies glycémiques sont influencées par l'antipsychotique atypique utilisé (p < 0,001). Un traitement par stabilisateurs de l'humeur est étonnamment associé à un risque diminué de dysglycémie (OR 0,53 ; p = 0,02). Les différences de risque métabolique persistent après ajustement pour les nombreux facteurs confondants anthropométriques, relatifs au style de vie, à la durée/sévérité de la maladie ou aux divers médicaments, psychotropes ou non, ce qui suggère une composante génétique à confirmer. Le diagnostic psychiatrique est un facteur de risque indépendant d'anomalies glycémiques et métaboliques, avec le risque maximum pour les désordres schizoaffectifs, intermédiaire pour la schizophrénie et minimum pour les troubles bipolaires, même après ajustement pour les facteurs confondants.

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

BACKGROUNDMortality rates in patients with schizophrenia are double compared to those in the general population, with cardiovascular disease causing 50% of the excess. Lowering low-density lipoprotein (LDL) cholesterol is recognized as a primary target for the prevention of cardiovascular mortality according to the National Cholesterol Education Program-Adult Treatment Panel III. Use of lipid-lowering drugs such as statins is recommended when lifestyle changes are not sufficient to reach the LDL goal. The efficacy and safety of rosuvastatin treatment were evaluated in schizophrenic patients.METHOD100 schizophrenic patients with severe dyslipidemia were identified. All were treated with antipsychotics. Fifty-two patients were treated with rosuvastatin and compared with 48 who did not receive statin treatment. All patients were screened for cardiovascular risk factors and examined at baseline. The effects of lipid-lowering medication on lipid profile, glucose homeostasis, and components of metabolic syndrome were evaluated at 3-month follow-up. The study began in 2003, and all data available until December 2005 are reported.RESULTSAfter 3 months of statin therapy, a significant decrease in triglycerides, total cholesterol, LDL cholesterol, and non-high-density lipoprotein (non-HDL) cholesterol and in associated ratios (LDL/HDL, total cholesterol/HDL) was observed. The difference was highly significant compared to patients not receiving statin treatment. No significant changes occurred in HDL cholesterol, body mass index and waist circumference, or glucose homeostasis. The only component of metabolic syndrome affected by statin therapy was the serum triglyceride level.CONCLUSIONRosuvastatin proved effective in the management of dyslipidemia in patients with schizophrenia treated with antipsychotics. More complex treatment may be required for associated metabolic disturbances.

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

COMPARISON WITH PATIENTS STARTED ON STATIN L. Hanssens, M. De Hert, D. Van Eyck, M. Wampers, A. Scheen, J. Peuskens. 1-Dept of Epidemiology and Public Health, University Liege, Belgium 2-UC St Jozef Kortenberg, Catholic University Louvain, Belgium 3-Dept of Diabetology, CHU Sart Tilman, University Liege, Belgium Presenting Author details: lhanssens@student.ulg.ac.be Dept of Epidemiology and Public Health, CHU Sart Tilman, University Liege, 4000 liege, Belgium, Tel.: +32 4 366 71 11.

Although the use of antipsychotics has been associated with an increased risk of death, data on the safety of individual substances is scarce. We thus aimed to compare the risk of death in new users of individual antipsychotics aged =>65 years and conducted a cohort study in the German Pharmacoepidemiological Research Database between 2005 and 2011. Patients were followed from initiation of treatment until death, 90 days after cohort entry, end of insurance or the end of the study period. Multivariable cox regression was used to estimate confounder adjusted hazard ratios (aHR) of death for 14 individual antipsychotics compared to risperidone. In sensitivity analyses, we also applied high-dimensional propensity score (HDPS) methods to explore possible unmeasured confounding. In a cohort of 137,713 new users of antipsychotics, a higher risk of death was found for haloperidol (aHR: 1.45; 95% confidence interval: 1.35–1.55), levomepromazine (aHR: 1.34; 1.16–1.54), zuclopenthixol (aHR: 1.32; 1.02–1.72) and to a lesser extent for melperone (aHR: 1.13; 1.07–1.19) compared to risperidone. Lower risks were observed for quetiapine, prothipendyl, olanzapine, tiapride, clozapine, perazine and flupentixol. In subgroup analyses, levomepromazine and chlorprothixene were only associated with a higher risk of death in patients aged =>80 years and with dementia. The application of HDPS methods did not substantially change the results. In conclusion, our study suggests that initiation of haloperidol, levomepromazine, zuclopenthixol and chlorprothixene treatment is associated with an increased risk of death compared to risperidone and should be avoided in older patients except in palliative care when treatment alternatives are available.

Patients with schizophrenia are at high risk of developing metabolic abnormalities.