Metabolic and Cardiovascular Risks with Antipsychotics – How Can Clinicians Make a Difference?

Posted on September 20, 2018

Speaker Bio:

Christoph Correll, MD, is professor of Psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York, and Medical Director of the Recognition and Prevention (RAP) program at the Zucker Hillside Hospital in New York.

He completed his medical studies in Berlin and Scotland and his research and clinical work focuses on the identification, characterisation and treatment of adults and youths with severe psychiatric disorders, with a further focus on psychopharmacology and the risk–benefit evaluation of psychotropic medications.

Professor Correll has authored or co-authored over 450 journal articles, has received over 30 national and international research awards and fellowships for his work and is listed by Thomson Reuters as one of “the most influential scientific minds” and “top 1% cited scientists in the area of psychiatry”.

Author Quotes

In terms of first episode there is a debate, how much is the illness, how much is the medication? When there’s a longstanding debate the answer is always ‘both,’ that’s true, but what’s the major contribution? Most likely it’s the medication…

 

None of these medications are weight neutral, but some seem to have better long-term capacity.

Summary:

Prof Correll introduces the presentation with a look at metabolic and cardiovascular risks associated with antipsychotics.

He continues with a discussion on metabolic changes with medication over time and how patients can have metabolic problems despite being of normal weight.

 

Discussing the relevance of body weight change, Prof Correll highlights which drugs have a lower risk of weight gain and how polypharmacy may have protective effects.

 

He moves on to discuss the power of switching drugs and provides advice on how to do this safely and ends his presentation with a demonstration of how weight gain and BMI may adversely impact psychiatric outcomes.

 

Prof Correll ends this presentation with an emphasis on the need to monitor patients for cardiovascular risk factors not visible to the eye, and to get people into a target lifestyle zone as determined by the Health Active Life Group.

 

Take Home Messages:

  • Healthy lifestyle can be adversely affected by sedation
  • Antipsychotic medication with no increased risk of weight gain in the short term compared with placebo should be considered as initial treatments
  • There may be protective effects with polypharmacy where some of the side effects are reduced or neutralised

 Quiz:

 

References:

  1. Fleischhacker WW, Siu CO, Bodén R, et al. Metabolic risk factors in first-episode schizophrenia: baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial. Int J Neuropsychopharmacol. 2013 Jun;16(5):987-95.
  2. Pillinger T, Beck K, Stubbs B, Howes OD. Cholesterol and triglyceride levels in first-episode psychosis: systematic review and meta-analysis. Br J Psychiatry. 2017 Dec;211(6):339-349.
  3. Snigdha S, Thumbi C, Reynolds GP, Neill JC. Ziprasidone and aripiprazole attenuate olanzapine-induced hyperphagia in rats. J Psychopharmacol. 2008 Jul;22(5):567-71.
  4. Stahl SM, Cucchiaro J, Simonelli D, Hsu J, Pikalov A, Loebel A. Effectiveness of lurasidone for patients with schizophrenia following 6 weeks of acute treatment with lurasidone, olanzapine, or placebo: a 6-month, open-label, extension study. J Clin Psychiatry. 2013 May;74(5):507-15.

 

 

 

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