A Tail with a Thorn in it: Second-Generation Antipsychotics Hand in Hand with Statins

Abstract

Schizophrenia is a chronic, severe, and disabling mental disorder characterized by deficits in thought processes, perceptions, and emotional responsiveness. Its prevalence in the USA is estimated at 1.1 % by the American Institute of Mental Health [1]. Left untreated, patients with schizophrenia will suffer from severe and prolonged psychotic episodes, causing them to become more and more removed from reality and from the ability to cope with their social and occupational environment. The introduction of chlorpromazine, the first effective anti-psychotic agent, heralded a new era in psychiatry. For the first time a drug that modified the course of the disease became available [2]. Traditionally, antipsychotic agents have been classified into 2 major groups: first-generation (conventional) agents and second generation (atypical) agents. The atypical agents differ pharmacologically from previous antipsychotic agents in their lower affinity for dopamine D2 receptors and higher affinities for other neuroreceptors, including those for serotonin (5-hydroxytryptamine 1A, 2A, 2C, 3, 6, and 7) and norepinephrine (α1 and α2) [3]. First generation antipsychotic agents cause extrapyramidal symptoms. These are manifested by Parkinsonism (hand tremor, rigidity, and reduced facial expression) and repetitive movements (tardive dyskinesia, dystonias, and akathisia), which add to patients’ morbidity and awkwardness. Second generation antipsychotics, owing to their lower affinity for dopaminergic receptors, cause significantly fewer extrapyramidal symptoms. Because of their more favorable side-effect profile second generation antipsychotics became very popular, even though they were not proven to be more effective than typical antipsychotics in controlling psychotic symptoms [2, 4]. Schizophrenic patients have reduced life expectancies compared with the general population [5–7]. From the earliest reports it became increasingly clear that the higher death rate could not be attributed exclusively to unnatural death causes such as trauma and suicide [8]. Other major causes include cancer and cardiovascular diseases. The greatly increased risk of cardiovascular disease in schizophrenic patients is mainly attributable to a high prevalence of conventional risk factors. Smoking rates among these patients are 3 to 5 times higher than in the general population. Furthermore, schizophrenic smokers take in more nicotine per cigarette than smokers without this disorder [9, 10]. Access to physical health care for people with schizophrenia is hindered by both the structure and the underfunding of publicly supported systems of physical health and behavioral health care. Schizophrenic patients often lack the resources for private medical providers, and coordination between health care and behavioral health care systems is usually poor. Research also suggests that schizophrenic patients frequently face discrimination in accessing R. Durst : E. Leitersdorf (*) Center for Research Prevention and Treatment of Atherosclerosis, Hadassah Hebrew University Medical Center, Jerusalem, Israel e-mail: eranl@hadassah.org.il