Abstract
Introduction: There is an increased risk of adverse metabolic effects of some modern antipsychotic drugs, and concern that long-acting, injected preparations of them may increase such risk. We now report on clinical and metabolic outcomes in patient-subjects diagnosed with affective and non-affective psychotic disorders following exposure to psychoeducation on metabolic risks of modern antipsychotics followed by treatment with long-acting atypical injected antipsychotics over 6-months.Materials and Methods: 85 psychotic disorder outpatients (42 affective [AP]; 43 non-affective [NAP]) at the University of Foggia were treated with long-acting, injected, second-generation antipsychotics in association with a set of psychoeducational sessions concerning general health and potential effects of antipsychotic drug treatments. They were evaluated at baseline and six months.Results: Initially, NAP subjects reported higher ratings of positive and negative symptoms than AP subjects, were more likely to receive risperidone or paliperidone, with higher CPZ-eq doses of antipsychotics (294.0 ± 77.8 vs. 229.3 ± 95.8 mg/day), and shorter QTc electrocardiographic recovery intervals. During the 6-month follow-up, ratings of treatment-adherence improved through overall (+8.75%), and symptom-ratings decreased (−7.57%) as did Body-Mass Index (−2.40%; all p ≤ 0.001). Moreover, serum levels of fasting glucose, hemoglobin glycosylation, cholesterol and prolactin concentrations all decreased, with little difference between subjects with AP vs. NAP.Discussion and Conclusions: A psychoeducational program was associated with consistent improvement in psychotic symptoms and several metabolic and physiological measures, as well as with treatment-adherence during six months of treatment with long-acting, injected, second-generation antipsychotics, in association with both affective and non-affective psychotic disorders.
Highlights
There is an increased risk of adverse metabolic effects of some modern antipsychotic drugs, and concern that long-acting, injected preparations of them may increase such risk
It has been largely described that the prevalence of metabolic syndrome in patients treated with antipsychotics is approximately 40% (33.8–42.1%) in contrast to rates of 10.4–12.2% among psychosis un-medicated patients: some atypical antipsychotics such as olanzapine and risperidone were associated to higher weight gain among non-clozapine second generation antipsychotics, as well as risperidone and amisulpride were responsible for increasing serum prolactin [7]
We describe the impact of a repeated, systematic, prospective psycho- educational intervention on clinical and metabolic outcomes of patients affected by stable affective (APs) and nonaffective psychoses (NAPs) treated with long-acting atypical antipsychotics over 6-months
Summary
There is an increased risk of adverse metabolic effects of some modern antipsychotic drugs, and concern that long-acting, injected preparations of them may increase such risk. The prevalence of metabolic syndrome (MS) among schizophrenia patients may range 37-63% with a relative risk (RR) of 2–3 in patients compared to general population, as well as MS in bipolar disorder patients ranges 30–49% with a RR of 1.5-2 [2] It has been largely described an increased risk of death from medical causes in schizophrenia and 20% (10–15 years) shorter lifespan [2, 3]; affective psychoses are associated with higher standardized mortality ratios from medical causes than general population ranging 1.9-2.1 [2, 3]. It has been largely described that the prevalence of metabolic syndrome in patients treated with antipsychotics is approximately 40% (33.8–42.1%) in contrast to rates of 10.4–12.2% among psychosis un-medicated patients: some atypical antipsychotics such as olanzapine and risperidone were associated to higher weight gain among non-clozapine second generation antipsychotics, as well as risperidone and amisulpride were responsible for increasing serum prolactin [7]
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