Metabolic dysregulation in early onset psychiatric disorder before and after exposure to antipsychotic drugs

Rehmat Shah,Qasim Riaz Khan,Gowhar Ali,Hussain Ahmad,Sami Ullah,Ihsan Ullah,Matiul Haq,Fazal Subhan,Syed Muhammad Sultan

doi:10.1590/s2175-97902019000117825

Abstract

Antipsychotic Drugs (APDs) are being widely prescribed to treat various disorders, including schizophrenia and bipolar disorder; however, abnormal glucose metabolism and weight gain have been reported with Atypical Anti-Psychotic drugs (AAPDs) that can lead to insulin-resistance and type 2 diabetes mellitus. The study was designed to assess various biochemical parameters including insulin and blood sugar before and after exposure to APDs in order to exclude the involvement of psychiatric disorders and certain other factors in metabolic dysregulations. Fifty seven APDs-naive patients with first episode psychosis were divided into six groups who received olanzapine, quetiapine, risperidone, aripiprazole, haloperidol or combination of olanzapine with escitalopram and haloperidol. The serum samples were taken before the intake of the first dose and then on follow-up. Decrease in the level of elevated insulin and glucose was observed post-treatment in some patients, while others were observed whose insulin and glucose levels increased post-treatment, yet some patients did not show any disturbance in the insulin and glucose levels. It is concluded that psychiatric disorders by itself, narcotics, cigarette smoking and use of oral snuff may be also be implicated in metabolic dysregulations. The effects of APDs on insulin and glucose in healthy volunteers might be different than in patients with psychiatric disorders.

Highlights

Psychosis is a broad term that relates to a person not in touch with reality. as patient cannot distinguish between factual and fictional
Hyperglycemia and weight gain are reported with Atypical Antipsychotic Drugs (AAPDs) that can lead to insulin-resistance and type 2 diabetes mellitus (Baptista, Parada, Hernandez, 1987)
To evaluate changes in glucose homeostasis among Antipsychotic Drugs (APDs)-naïve patients with first episode psychosis after use of olanzapine, quetiapine, risperidone, aripiprazole, haloperidol and a combination of olanzapine with escitalopram, diazepam and haloperidol, we studied the effect of these drugs on pancreatic beta cells thereby determining blood glucose, insulin, insulin resistance,% β cells function and c-peptide levels in addition to body weight

Summary

Introduction

Psychosis is a broad term that relates to a person not in touch with reality. as patient cannot distinguish between factual and fictional. The antipsychotic drugs have been documented as a considerable cause of excess mortality rate in psychotic patients (Mitchell, Lord, 2010; Vancampfort et al, 2013). Hyperglycemia and weight gain are reported with AAPDs (clozapine, olanzapine, quetiapine, risperidone and aripiprazole) that can lead to insulin-resistance and type 2 diabetes mellitus (Baptista, Parada, Hernandez, 1987). It is still controversial whether the metabolic abnormalities are associated with the psychiatric disorder(s) or the antipsychotic drugs (AAPDs) (Ballon et al, 2014; Baptista, Parada, Hernandez, 1987; Cope et al, 2005; Goldstein, 1999). Several mechanisms of AAPDs to disturb glucose homeostasis have been hypothesized including blockade of

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