Use Of Second-generation Antipsychotic Medications Research Articles

Prevalence and factors associated with overweight, obesity, and hypertension in a large clinical sample of adults with autism spectrum disorder

Adults with autism spectrum disorder (ASD) are at risk for excess bodyweight and hypertension, yet the prevalence of and clinical predictors for these health conditions remain unknown. The objective of this study was to assess the prevalence of overweight, obesity, and hypertension in a large clinical sample of adults with a confirmed diagnosis of ASD and to examine potential clinical predictors. This retrospective chart review study included adult subjects (≥ 20 years) with ASD who had been seen within the past 5 years at a multidisciplinary developmental disorders clinic. Data collected from the electronic health record included age, sex, race and ethnicity, cognitive ability, language ability, body mass index (BMI), hypertension, and use of second generation antipsychotic medications (SGAs). Of 622 adults with a confirmed diagnosis of ASD potentially eligible for the study, 483 (78%) had one or more notes in their records from the past 5 years. Those with recent notes were 23% female, 89% White, and had a mean (SD) age of 28.1 (7.1) years. Overall prevalence estimates for adults represented by this predominantly male, White, and young clinical sample were 28% (95% CI 24%, 32%) for overweight (BMI 25–29.9 kg/m2), 35% (95% CI 31%, 40%) for obesity (≥ 30 kg/m2), and 11% (95% CI 9%, 15%) for hypertension. Controlling for age and sex, intellectual disability (ID) was significantly associated with BMI (p = 0.003) but not hypertension (p = 0.69); those with moderate or more severe ID had a mean BMI that was 2.26 kg/m2 (95% CI 0.96, 3.57) lower than those with no ID. Controlling for age and sex, neither language ability, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) subtype of autism, nor past or current use of SGAs were significantly associated with BMI or hypertension. The study identified a high prevalence of overweight and obesity in adults with ASD consistent with the prevalence of these medical comorbidities in the U.S. population.

Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State–wide Psychiatric Hospital System

Individuals with serious mental illness are at increased risk of severe COVID-19 infection. Several psychotropic medications have been identified as potential therapeutic agents to prevent or treat COVID-19 but have not been systematically examined in this population. To evaluate the associations between the use of psychotropic medications and the risk of COVID-19 infection among adults with serious mental illness receiving long-term inpatient psychiatric treatment. This retrospective cohort study assessed adults with serious mental illness hospitalized in a statewide psychiatric hospital system in New York between March 8 and July 1, 2020. The final date of follow-up was December 1, 2020. The study included 1958 consecutive adult inpatients with serious mental illness (affective or nonaffective psychoses) who received testing for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction or antinucleocapsid antibodies and were continuously hospitalized from March 8 until medical discharge or July 1, 2020. Psychotropic medications prescribed prior to COVID-19 testing. COVID-19 infection was the primary outcome, defined by a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction or antibody test result. The secondary outcome was COVID-19-related death among patients with laboratory-confirmed infection. Of the 2087 adult inpatients with serious mental illness continuously hospitalized during the study period, 1958 (93.8%) underwent testing and were included in the study; 1442 (73.6%) were men, and the mean (SD) age was 51.4 (14.3) years. A total of 969 patients (49.5%) had laboratory-confirmed COVID-19 infection that occurred while they were hospitalized; of those, 38 (3.9%) died. The use of second-generation antipsychotic medications, as a class, was associated with decreased odds of infection (odds ratio [OR], 0.62; 95% CI, 0.45-0.86), whereas the use of mood stabilizers was associated with increased odds of infection (OR, 1.23; 95% CI, 1.03-1.47). In a multivariable model of individual medications, the use of paliperidone was associated with decreased odds of infection (OR, 0.59; 95% CI, 0.41-0.84), and the use of valproic acid was associated with increased odds of infection (OR, 1.39; 95% CI, 1.10-1.76). Clozapine use was associated with reduced odds of mortality in unadjusted analyses (unadjusted OR, 0.25; 95% CI, 0.10-0.62; fully adjusted OR, 0.43; 95% CI, 0.17-1.12). In this cohort study of adults hospitalized with serious mental illness, the use of second-generation antipsychotic medications was associated with decreased risk of COVID-19 infection, whereas the use of valproic acid was associated with increased risk. Further research is needed to assess the mechanisms that underlie these findings.

Berberine Alleviates Olanzapine-Induced Adipogenesis via the AMPKα-SREBP Pathway in 3T3-L1 Cells.

The aim of this study was to investigate the mechanisms underlying the inhibitory effects of berberine (BBR) on olanzapine (OLZ)-induced adipogenesis in a well-replicated 3T3-L1 cell model. Oil-Red-O (ORO) staining showed that BBR significantly decreased OLZ-induced adipogenesis. Co-treatment with OLZ and BBR decreased the accumulation of triglyceride (TG) and total cholesterol (TC) by 55.58% ± 3.65% and 49.84% ± 8.31%, respectively, in 3T3-L1 adipocytes accompanied by reduced expression of Sterol regulatory element binding proteins 1 (SREBP1), fatty acid synthase (FAS), peroxisome proliferator activated receptor-γ (PPARγ), SREBP2, low-density lipoprotein receptor (LDLR), and hydroxymethylglutaryl-coenzyme A reductase (HMGR) genes compared with OLZ alone. Consistently, the co-treatment downregulated protein levels of SREBP1, SREBP2, and LDLR by 57.71% ± 9.42%, 73.05% ± 11.82%, and 59.46% ± 9.91%, respectively. In addition, co-treatment reversed the phosphorylation level of AMP-activated protein kinase-α (AMPKα), which was reduced by OLZ, determined via the ratio of pAMPKα:AMPKα (94.1%) compared with OLZ alone. The results showed that BBR may prevent lipid metabolism disorders caused by OLZ by reversing the degree of SREBP pathway upregulated and the phosphorylation of AMPKα downregulated. Collectively, these results indicated that BBR could be used as a potential adjuvant to prevent dyslipidemia and obesity caused by the use of second-generation antipsychotic medication.

National trends in the community prescribing of second-generation antipsychotic medications in Australian children and youth: the incomplete story

The objective of this article is to examine national trends in prescribing second-generation antipsychotic (SGA) medications to Australian children and youth (0-24 years) and to report deficiencies in available data. We conducted a retrospective review of government data on all dispensed SGA prescriptions between 2002 and 2007. Scripts were converted to defined daily dose (DDD)/1000 population/day using census data. Trends in utilisation of dispensed SGAs were analysed by gender and age. The total amount of SGAs dispensed to children (0-14 years) remained stable over the five-year study period. In 2007, according to available data, total SGA medication dispensed to Australian children equated to fewer than three in 10,000 children receiving the equivalent of a standard adult dose of medication each day. In contrast to many other countries, the dispensed use of SGA medication in Australian children and youth has remained relatively stable. In our opinion, this is almost certainly because of limitations in data collection and accessibility. Given the safety concerns associated with SGAs prescribed to children and young people and the need to improve the quality use of medicines, it is essential that methods are developed in Australia to accurately capture prescribing of SGAs to Australian children and youth.

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Description of a healthy lifestyle intervention for people with serious mental illness taking second-generation antipsychotics

Weight gain and obesity has reached epidemic proportions, with the prevalence of metabolic syndrome (MetS) reaching 20-25% of the global population. MetS is a cluster of metabolic abnormalities, including weight gain, associated with an increased risk of cardiovascular disease, diabetes, and stroke. While individuals in the general population are at risk of physical conditions, such as MetS, people with mental illness are at even higher risk. The increased incidence of MetS for people with serious mental illness has been linked to the use of second-generation antipsychotic medication. This paper describes the content, structure, and development of 'Passport 4 Life', a healthy lifestyle intervention to maintain weight and prevent further weight gain for people with serious mental illness. While there are a number of diet and lifestyle programmes available for the general population, Passport 4 Life was specifically designed as an intervention to address the needs of people with serious mental illness taking second-generation antipsychotics. Passport 4 Life comprises 12 weekly group sessions that include the concepts and spirit of motivational interviewing, nutrition, and exercise education, combined with weekly exercise activity.

The Research Potential of Administrative Data From State Mental Health Agencies

Three data sets profiling the organization, financing, and services of state mental health agencies, compiled routinely for all states, were examined to assess their potential for use in mental health policy analyses. Strengths included standardized protocols for compiling data at the state level, a high degree of completeness in two of the data sets, consistency in data definitions over time, and built-in data integrity and editing procedures. Data are aggregated at the state level and lack user-friendly features that facilitate downloading to statistical software. However, potential use of these data as contextual factors in multilevel models makes them an important resource for consideration.

Changing Trends in Pediatric Antipsychotic Use in Florida's Medicaid Program

This study describes the changing trends in antipsychotic use among youths aged 18 years and younger and in age subgroups (zero to five, six to 12, and 13 to 18 years) in the Florida Medicaid program. The study used Florida Medicaid claims data associated with approximately 1.2 million children and adolescent enrollees per year to describe monthly antipsychotic use from July 2002 to December 2005. A preliminary examination of trends indicated that antipsychotic use might be different for the periods before May 2004 and after April 2004. For this reason, piecewise regression was used to compare the trends for these two periods. This study found significant increases in the use of antipsychotic medications for all three age groups from July 2002 to April 2004. The greatest rate of growth was for the 13- to 18-year age group, and the least rate of growth was for the zero- to five-year age group. From May 2004 to December 2005 antipsychotic utilization trends were flat for youths age 18 years and younger and for the six- to 12-year and the 13- to 18-year age groups. For preschool-age children (the zero- to five-year age group), there was a slight but significant decline in antipsychotic use. Significant changes were also observed in the specific second-generation antipsychotic agents prescribed. Although risperidone remained the most frequently prescribed antipsychotic, its use declined significantly from May 2004 to December 2005. Olanzapine use also declined during this period. On the other hand, aripiprazole use increased significantly throughout the study period, with usage among the 13- to 18-year age group almost equaling that of risperidone by December 2005. The lack of growth in antipsychotic prescribing after the spring of 2004 represents a significant departure from historical trends. Although some in-state policies may have affected these trends, it appears that the timing and extent of the changes occurred shortly after the Food and Drug Administration required warnings on second-generation antipsychotic medications related to weight gain, glucose levels, and diabetes. They appeared immediately after the black box warning for pediatric antidepressant medications, and they appeared shortly after the Joint American Diabetes and American Psychiatric Association Consensus Statement. These factors suggest the existence of a prescribing community that is responsive to evidence and to professional and regulatory actions based on it.

Improving Medical and Psychiatric Outcomes Among Individuals With Bipolar Disorder: A Randomized Controlled Trial

Improving Medical and Psychiatric Outcomes Among Individuals With Bipolar Disorder: A Randomized Controlled Trial

Prevalence and associations of the metabolic syndrome among patients prescribed clozapine

There is increasing concern that the use of second-generation antipsychotic medications in schizophrenia is associated with the development of metabolic syndrome. This study assessed the prevalence and clinical associations of metabolic syndrome among patients receiving clozapine within the catchment area of a mental health service in the west of Ireland. A total of 84 patients (96% response rate) taking clozapine were interviewed and thoroughly investigated using physical assessments, comprehensive laboratory testing and review of medical records. Of the patients, 46.4% taking clozapine fulfilled the criteria for metabolic syndrome. Male gender, high body mass index, high insulin level and receiving a concomitant antipsychotic medication were significantly associated with the presence of metabolic syndrome. Almost half of the patients receiving clozapine have metabolic syndrome and are consequently at risk of cardiovascular morbidity and mortality. Such patients should be closely monitored in order to facilitate interventions, which could alleviate the adverse health consequences of this syndrome.

The Art of Prescribing Pharmacological Management of Psychosis in Alzheimer's Disease: Clinical Challenges Associated With Second-Generation Antipsychotic Medications

QUESTION. There is growing concern about the use of second-generation or atypical antipsychotic medications in the management of psychosis in patients with Alzheimer's disease (AD). As a practicing advanced practice psychiatric nurse in a local nursing home, this issue is a frequent clinical challenge. Please discuss the most recent clinical findings concerning the pharmacological management of psychosis in patients with AD, specifically the second-generation antipsychotic medications and the implications for prescribing psychiatric nurses. DEBORAH ANTAI-OTONG REPLIES. You are correct about the growing concerns involving the use of second-generation antipsychotic medication in patients with AD. In fact, although these agents are widely used to treat neuropsychiatric disorders in older adults, many questions linger about the efficacy and safety, further complicating clinical decision-making. As our society ages, the number of individuals with psychosis increases. The rise in AD in the U.S. population makes this discussion especially timely and relevant to the safe and quality management of psychosis in persons with AD.

Mental Health Providers' Involvement in Diabetes Management

Back to table of contents Previous article Next article LetterFull AccessLetterRichard W. Goldberg Ph.D.Brian Cooke Ph.D.Ann Hackman M.D.Richard W. Goldberg Ph.D.Search for more papers by this authorBrian Cooke Ph.D.Search for more papers by this authorAnn Hackman M.D.Search for more papers by this authorPublished Online:1 Nov 2007https://doi.org/10.1176/ps.2007.58.11.1501AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Mental Health Providers' Involvement in Diabetes ManagementTo the Editor: Recent policy recommendations and practice guidelines call for improved integration and coordination of psychiatric and medical care. The extent to which psychiatrists and other mental health providers should assume responsibility for mental health consumers' medical conditions requires further consideration, particularly for medical conditions that occur as a result of psychiatric interventions and perhaps also for preventive monitoring, screening, and education in regard to medical conditions that disproportionately affect psychiatric consumers. Individuals with schizophrenia and other serious mental illnesses have rates of type 2 diabetes more than four times higher than the rate in the general population ( 1 ). The higher rates are likely attributable to a combination of lifestyle issues (including physical inactivity, poor nutrition, use of illicit substances, and smoking) and use of second-generation antipsychotic medications. We previously found that consumers with serious mental illness and diabetes had glycosylated hemoglobin (HbA1c) values that exceed those recommended by the American Diabetes Association; consumers for whom olanzapine was prescribed had higher HbA1c levels than those for whom other antipsychotic agents were prescribed ( 2 ). We also found that consumers in this cohort fell short of recommended goals for cholesterol levels and blood pressure control and evidenced lower quality of diabetes care as reflected by receipt of fewer recommended preventive and educational services ( 3 , 4 ). More effort may thus be required to provide optimal diabetes care to this vulnerable population. To address this issue we examined involvement of community mental health providers in diabetes care in a cohort of 201 adults with type 2 diabetes and serious mental illness. Study participants were asked four questions that focused on the coordination of medical and psychiatric care during the past six months regarding whether or not their mental health providers asked about diabetes medications and behaviors, provided them with diabetes-related education, and asked to speak directly to their diabetes doctor.Results indicate that mental health providers were engaged in some related care coordination. A total of 112 study participants (56%) reported at least one diabetes-related intervention by their mental health provider. Of these, 96 (48%) reported that mental health providers asked about diabetes behaviors and 78 (39%) reported being asked about diabetes medication. Given the poor diabetes outcomes related to HbA1C and the poor quality of care noted in this cohort, however, it is problematic that only 34 participants (17%) reported that their provider asked to speak with their diabetes doctor and 28 (14%) reported receiving any diabetes education. Although these self-reported findings are limited by the absence of chart verification, they nonetheless suggest that mental health providers fall short of providing basic care coordination and counseling for consumers living with both serious mental illness and diabetes. Therefore, we strongly support efforts to increase mental health providers' involvement in the coordination of the medical and psychiatric care of consumers. Such efforts are squarely in line with recent calls to integrate health promotion services into the mental health system ( 5 ). Acknowledgments and disclosuresThe authors report no competing interests.The authors are affiliated with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Goldberg is also affiliated with the Mental Illness Research, Education, and Clinical Center, Veterans Affairs Capitol Health Care Network, Baltimore.

ASHP Therapeutic Position Statement on the Use of Second-Generation Antipsychotic Medications in the Treatment of Adults with Psychotic Disorders

The American Society of Health-System Pharmacists (ASHP) recognizes that schizophrenia, schizoaffective disorder, and other psychotic disorders are serious mental illnesses that can significantly affect an individual’s perceptual, behavioral, affective, and cognitive functions. These conditions

Disparities in Use of Antipsychotic Medications Among Nursing Home Residents in Arkansas

Pilot work was conducted to determine whether there were racial disparities in the use of second-generation antipsychotic medications in a sample of 2,717 residents of nursing homes in Arkansas in 2001. Chi square analysis and a logistic regression model were used to examine the relationship between residents' race and likelihood of receiving a second-generation antipsychotic. Other independent variables included in the model were age, gender, and the location of the nursing home. The results indicated racial disparities in use of second-generation antipsychotics among the nursing home residents, with African-American residents less likely to receive these medications than residents from other racial or ethnic groups.

Second-generation antipsychotic medications in the treatment of mood disorders: Focus on aripiprazole

Second-generation antipsychotic medications offer a broader range of therapeutic efficacies than first-generation agents. Consequently, our field has witnessed a rapid expansion of the use of second-generation antipsychotic drugs for several conditions beyond psychosis. The use of second-generation antipsychotic medications has been most pronounced in mood disorders, especially in bipolar disorders. Information about the agents clozapine, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole in terms of their efficacy and tolerability in bipolar disorder is now available. Aripiprazole, a new agent whose proposed mechanism(s) of action differs from that of other agents, has been shown in placebo-controlled comparative trials in bipolar patients to be an effective and well tolerated treatment option for this patient group. The role of second-generation antipsychotic medications in the therapeutic armamentarium for bipolar disorders will be determined by clinical experience, by additional phase IV studies and by trials that compare second-generation antipsychotics with each other and also with mood-stabilizing medications. There is also a pressing need for additional information on the long-term efficacy and safety of each second-generation antipsychotic agent during maintenance therapy for bipolar disorders.

Other developments relevant to the use of second-generation antipsychotic medications

Other developments relevant to the use of second-generation antipsychotic medications

Racial differences in treatment of psychiatric inpatients.

The study examined several aspects of inpatient psychiatric treatment to determine if differences existed between treatment of African-American and white patients. Using a structured chart review, data were collected on 76 African-American and 88 white patients consecutively admitted to an acute inpatient setting with a principal axis I diagnosis of a major mood or psychotic disorder. Racial differences in treatment were examined using analysis of variance and logistic regression to assess the effects of diagnosis and socioeconomic status. Nonpsychotic African-American patients had shorter lengths of stay than white patients with similar disorders. White patients were more likely to be on one-to-one observational status. Clinicians were more likely to order urine drug screens for African-American patients with high socioeconomic status than for comparable white patients. African-American patients with schizophrenic disorders received higher neuroleptic dosages than white patients with similar diagnoses. Most racial differences cited in earlier studies of psychotic patients were not found or were not statistically significant once socio-economic status and diagnosis were accounted for. However, racial differences related to the detection, phenomenology, treatment, and course of psychotic disorders and the diagnosis and management of alcohol and drug use disorders and personality disorders were found.