Abstract
Second-generation antipsychotics are widely used to treat schizophrenia but their use could induce metabolic dysfunction. To balance efficacy and side effects, various guidelines recommend the use of therapeutic drug monitoring. Given the controversial relationship between olanzapine serum concentration and metabolic dysfunction, its use in clinical practice is still debated. To address this issue, we conducted a prospective cohort study to explore the associations in patients with schizophrenia. Specifically, first-episode drug-naive patients and patients with chronic schizophrenia were recruited. All participants received olanzapine monotherapy for 8 weeks. Anthropometric parameters and metabolic indices were tested at baseline and at week 8, and olanzapine serum concentration was tested at week 4. After 8 weeks of observation, body weight and BMI increased significantly in drug-naive patients. Moreover, triglycerides and LDL increased significantly in both drug-naive and chronic patients. Among chronic patients, those who have never used olanzapine/clozapine before had a significantly higher increase in weight and BMI than those who have previously used olanzapine/clozapine. Furthermore, olanzapine concentration was associated with changes in weight, BMI, and LDL levels in the drug-naive group and glucose, triglyceride and LDL levels in chronic patients who have not used olanzapine/clozapine previously. In conclusion, the metabolic dysfunction induced by olanzapine is more severe and dose-dependent in drug-naive patients but independent in patients with chronic schizophrenia. Future studies with a longer period of observation and a larger sample are warranted.
Highlights
Schizophrenia, one of the top ten causes of disability worldwide, is a psychiatric disorder characterized by positive symptoms of hallucinations, delusions, disorganized speech, negative symptoms and cognitive deficits that affects nearly 1% of the world’s population[1]
Second-generation antipsychotics are widely used in treating patients with schizophrenia
Spearman correlation analysis of all participants indicated that antipsychotic-related metabolic risk was significantly associated with changes in body weight (r = −0.479, p < 0.01), change of BMI (r = −0.463, p < 0.01) and change rate of BMI (r = −0.482, p < 0.01) after 8 weeks of olanzapine monotherapy (Supplement Table 1)
Summary
Schizophrenia, one of the top ten causes of disability worldwide, is a psychiatric disorder characterized by positive symptoms of hallucinations, delusions, disorganized speech, negative symptoms and cognitive deficits that affects nearly 1% of the world’s population[1]. Second-generation antipsychotics are widely used in treating patients with schizophrenia Metabolic dysfunction, such as hyperglycaemia and hyperlipidaemia, induced by some antipsychotics, such as clozapine and olanzapine, causes serious concerns[2,3]. Komossa et al compared olanzapine with other secondgeneration psychotics and found that olanzapine outperformed aripiprazole, quetiapine, risperidone and ziprasidone but not amisulpride and clozapine in improving general mental state; olanzapine induced more weight gain than other psychotics except for clozapine[10] The mechanisms underlying these side effects, with restrictions and conflicting results, are still poorly understood. Published in partnership with the Schizophrenia International Research Society antipsychotic medication adherence in acute treatment in drug-naive patients[33]. A recent study difference between chronic and drug-naive patients with schizophrenia in the association of olanzapine concentration from Clinical Antipsychotic Trials of Intervention Effectiveness and metabolic dysfunction. Supported the recommendation by suggesting that antipsychotic blood level below the reference range was related to treatment failure, with 50.8% of the participants with drug level under
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
