조현병 환자에서 비전형항정신병약물 사용시 대사지표에 미치는 영향 조사 : 3년 추적연구
The Effects on Metabolic Syndrome Parameters of Atypical Antipsychotic Agents in Schizophrenics Patients : 3 Years Retrospective Follow Up
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Objectives : Pharmacological treatment is critical on relapse prevention in patients with schizophrenia. However, atypical antipsychotic agents are known to cause weight gain more than typical agents despite their various effects. In addition, they are known to affect blood sugar, blood pressure, cholesterol, cardiac function, and sexual function. This study was designed to examine the effects on metabolic parameters when schizophrenic patients have been taken atypical antipsychotic agents. Methods : This was a trial in 137 patients with DSM-IV-TR schizophrenia who were admitted or treated in mental hospital. Anthropometric measurement and blood testing were conducted at baseline, 12 month, 36 month, and sociodemographic and treatment history were collected from medical records. We conducted height, weight, waist circumference, blood pressure, FBS, total cholesterol, HDL, triglyceride, and QTc interval. Metabolic syndrome was diagnosed by ATPIIIa criteria. Results : Aripiprazole showed the significant difference in the impact on weight, blood pressure, waist circumference, total cholesterol, HDL, triglyceride than paliperidone and olanzapine at 1-year and 3-year period. Olanzapine showed the significant increase of weight and triglyceride than paliperidone at 3-year period. The prevalence of metabolic syndrome increased in paliperidone at 1-year and in olanzapine at 3-year period compared to aripiprazole significantly. Conclusion : We concluded that aripiprazole has less impact on the abdominal obesity, FBS, blood pressure, and cholesterol than paliperidone and olanzapine. Olanzapine showed the increase of long-term metabolic risk than other agents. There was needed the routine screening and multidisciplinary management of medical problems in schizophrenic patients for the prevention of metabolic syndrome.
Abstract
Objectives : Pharmacological treatment is critical on relapse prevention in patients with schizophrenia. However, atypical antipsychotic agents are known to cause weight gain more than typical agents despite their various effects. In addition, they are known to affect blood sugar, blood pressure, cholesterol, cardiac function, and sexual function. This study was designed to examine the effects on metabolic parameters when schizophrenic patients have been taken atypical antipsychotic agents. Methods : This was a trial in 137 patients with DSM-IV-TR schizophrenia who were admitted or treated in mental hospital. Anthropometric measurement and blood testing were conducted at baseline, 12 month, 36 month, and sociodemographic and treatment history were collected from medical records. We conducted height, weight, waist circumference, blood pressure, FBS, total cholesterol, HDL, triglyceride, and QTc interval. Metabolic syndrome was diagnosed by ATPIIIa criteria. Results : Aripiprazole showed the significant difference in the impact on weight, blood pressure, waist circumference, total cholesterol, HDL, triglyceride than paliperidone and olanzapine at 1-year and 3-year period. Olanzapine showed the significant increase of weight and triglyceride than paliperidone at 3-year period. The prevalence of metabolic syndrome increased in paliperidone at 1-year and in olanzapine at 3-year period compared to aripiprazole significantly. Conclusion : We concluded that aripiprazole has less impact on the abdominal obesity, FBS, blood pressure, and cholesterol than paliperidone and olanzapine. Olanzapine showed the increase of long-term metabolic risk than other agents. There was needed the routine screening and multidisciplinary management of medical problems in schizophrenic patients for the prevention of metabolic syndrome.
참고문헌 (35)
- Ventriglio A, "Metabolic issues in patients affected by schizophrenia: clinical characteristics and medical management", Front Neurosci, 9, pp.297~303 (2015)
- Boke O, "Prevalence of metabolic syndrome among inpatients with schizophrenia", Int J Psychiatry Med, 38, pp.103~112 (2008)
- Falissard B, "The METEOR study: frequency of metabolic disorders in patients with schizophrenia. Focus on first and second generation and level of risk of antipsychotic drugs", Int Clin Psychopharmacol, 26, pp.291~302 (2011)
- Papanastasiou E, "The prevalence and machanisms of metabolic syndrome in schizophrenia: a review", Ther Adv Psychopharmacol, 3, pp.33~51 (2013)
- Stahl SM, "Essential Psychopharmacology" (2013), Cambridge University Press
- De Hert M, "Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC)", Eur Psychiatry, 4, pp.412~424 (2009)
- Daumit GL, "Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study", Schizophr Res, 105, pp.175~187 (2008)
- Schreiner A, "Metabolic effects of paliperidone extended release versus oral olanzapine in patients with schizophrenia: a prospective, randomized, controlled trial", J Clin Psychopharmacol, 32, pp.449~457 (2012)
- Centorrino F, "Metabolic syndrome in psychiatrically hospitalized patients treated with antipsychotics and other psychotropics", Hum Psychopharmacol, 27, pp.521~526 (2012)
- Gami AS, "Metabolic syndrome and risk of incidence cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies", J Am Coll Cardiol, 49, pp.403~414 (2007)
- Mottillo S, "The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis", J Am Coll Cardiol, 56, pp.1113~1132 (2010)
- Vancampfort D, "Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis", World Psychiatry, 14, pp.339~347 (2015)
- Hasnain M, "QTc Interval prolongation and torsade de pointes associated with second-generation antipsychotics and antidepressants:a comprehensive review", CNS Drugs, 28, pp.887~920 (2014)
- Mitchell AJ, "Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders-a systematic review and meta-analysis", Schizophr Bull, 39, pp.306~318 (2013)
- Mitchell AJ, "Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders-a systematic review and meta-analysis", Schizophr Bull, 39, pp.306~318 (2013)
- Ifteni P, "Sudden unexpected death in schizophrenia: autopsy findings in psychiatric inpatients", Schizophr Res, 155, pp.72~76 (2014)
- Sugawara N, "Attitudes toward metabolic adverse events among patients with schizophrenia in Japan", Neuropsychiatr Dis Treat, 12, pp.427~436 (2016)
- American Psychiatric Association, "The diagnostic and statistical manual of mental disorder" (1994), American Psychiatric Press
- McLaughlin T, "Use of metabolic markers to identify overweight individuals who are insulin resistant", Ann Intern Med, 139, pp.802~809 (2003)
- Grundy SM, "Diagnosis and management of the metabolic syndrome: an American Heart Association", National Heart, Lung, and Blood Institute Scientific Statement, 2005, pp.25, 2735~2752
- Alberti KG, "Harmonizing the metabolic syndrome. A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation;International Atherosclerosis Society; and International Association for the Study of Obesity", Circulation, 120, pp.1640~1645 (2009)
- Koponen H, "Schizophrenia and sudden cardiac death: a review", Nord J Psychiatry, 62, pp.342~345 (2008)
- Meyer JM, "The effects of antipsychotic therapy on serum lipids: a comprehensive review", Schizophr Res, 70, pp.1~17 (2004)
- McQuade RD, "A comparison of weight change during treatment with olanzapine or aripiprazole: results from a randomized, double-blind study", J Clin Psychiatry, 65, pp.47~56 (2004)
- Casey DE, "Metabolic issues and cardiovascular disease in patients with psychiatric disorders", Am J Med, 118, pp.15~22 (2005)
- Fleischhacker WW, "A double-blind, randomized comparative study of aripiprazole and olanzapine in patients with schizophrenia", Biol Psychiatry, 65, pp.510~517 (2009)
- Allison DB, "Antipsychotic-induced weight gain: a review of the literature", J Clin Psychiatry, 62, pp.22~31 (2001)
- Saravane D, "Drawing up guidelines for the attendance of physical health of patients with severe mental illness", Encephale, 35, pp.330~339 (2009)
- McEvoy JP, "Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III", Schizophr Res, 80, pp.19~32 (2005)
- 고유경, "The Prevalence of Metabolic Syndrome in Schizophrenic Patients Using Antipsychotics", Clinical Psychopharmacology and Neuroscience, 11(2), pp.80~88 (2013), 대한정신약물학회
- Newman SC, "Mortality in a cohort of patients with schizophrenia: a record linkage study", Can J Psychiatry, 36, pp.239~245 (1991)
- 김동희, "무증상 성인 한국인에서 관상동맥 석회 수치의 연령 및 성별 분포와 특성: 심혈관 질환의 위험요인 및 대사 증후군과의 관계", Korean Circulation Journal, 38(1), pp.29~35 (2008), 대한심장학회
- Lim S, "Increasing prevalence of metabolic syndrome in Korea; The Korean national health and nutrition examination survey for 1998-2007", Diabetes Care, 34, pp.1323~1328 (2011)
- Goldstein BJ, "Insulin resistance: from benigh to type 2 diabetes mellitus", Rev Cardiovasc Med, 4, pp.S3~S10 (2003)
- Haupt DW, "Different metabolic effects of antipsychotic treatments", Eur Neuropsychopharmacol, 16, pp.149~155 (2006)