Display options
Share it on

Prim Care Companion J Clin Psychiatry. 2003 Feb;5(1):6-14. doi: 10.4088/pcc.v05n0103.

Metabolic Issues With Atypical Antipsychotics in Primary Care: Dispelling the Myths.

Primary care companion to the Journal of clinical psychiatry

Gary S. Kabinoff, Patrick A. Toalson, Kristine Masur Healey, Hillary C. McGuire, Donald P. Hay

Affiliations

  1. private practice, Jupiter, Fla.; and the Lilly Research Laboratories, Eli Lilly & Company, Lilly Corporate Center, Indianapolis, Ind.

PMID: 15156241 PMCID: PMC353028 DOI: 10.4088/pcc.v05n0103

Abstract

BACKGROUND: Recently, much attention has been focused on the increased rate of metabolic syndrome componen ts among psychiatric patients, including glucose intolerance, hyperglycemia, diabetes mellitus, hyperlipidemia, hypertension, and weight gain. Various reports have identified cases of newly diagnosed diabetes during treatment with atypical antipsychotic agents. However, the question remains whether there is a relationship between atypical antipsychotic use and the metabolic syndrome or whether there is a higher risk in this population irrespective of medication use. METHOD: Many articles on antipsychotics and metabolic issues are reviews of case reports or small, cross-sectional laboratory studies highlighting the suspected potential for differing rates of new-onset diabetes cases. We conducted a retrospective review of the literature from 1998 through 2002, using the MEDLINE database, and recent studies presented at major psychiatric medical conferences to create a broader perspective on the metabolic issues. RESULTS: We identified over 70 abstracts and published manuscripts, including case reports; cross-sectional lab studies; retrospective analyses of head-to-head, controlled clinical studies; retrospective database studies; pharmacoepidemiology studies; and prospective head-to-head studies presented in the past 4 years. Studies assessed differences in fasting plasma glucose, oral glucose tolerance tests (OGTT), modified OGTT, frequently sampled intravenous glucose tolerance tests, homeostasis model assessment-insulin resistance, odds or hazard ratios, prevalence, and incidence, as well as other elements of the metabolic syndrome. CONCLUSION: Data from this large body of scientific evidence indicate that the psychiatric patient population may be at a higher risk for the development of obesity, glucose homeostasis dysregulation, and hyperlipidemia compared with the general population. The available data do not demonstrate a consistent or clinically significant difference in the risk of new-onset diabetes during treatment with the various atypical antipsychotic agents.

References

  1. J Clin Psychiatry. 1999 Nov;60(11):767-70 - PubMed
  2. J Clin Psychiatry. 2001 Apr;62(4):231-8 - PubMed
  3. Compr Psychiatry. 1996 Jan-Feb;37(1):68-73 - PubMed
  4. Clin Neuropharmacol. 1998 Mar-Apr;21(2):139-40 - PubMed
  5. Am J Psychiatry. 1996 Oct;153(10):1368-9 - PubMed
  6. J Clin Psychiatry. 2001;62 Suppl 23:5-12 - PubMed
  7. Clin Neuropharmacol. 1998 Jul-Aug;21(4):245-50 - PubMed
  8. Pharmacotherapy. 1999 Sep;19(9):1099-101 - PubMed
  9. Am J Psychiatry. 1994 Oct;151(10):1520-1 - PubMed
  10. J Clin Psychiatry. 2000 Mar;61(3):179-84 - PubMed
  11. Eur Neuropsychopharmacol. 2001 Feb;11(1):25-32 - PubMed
  12. Diabetes. 2001 Feb;50(2):376-84 - PubMed
  13. Diabete Metab. 1990 Jan-Feb;16(1):11-5 - PubMed
  14. J Clin Psychiatry. 1997;58 Suppl 10:55-62 - PubMed
  15. Biol Psychiatry. 2001 Jul 15;50(2):148-9 - PubMed
  16. Lancet. 1989 Mar 4;1(8636):495 - PubMed
  17. Life Sci. 2002 Jun 7;71(3):239-57 - PubMed
  18. Am J Psychiatry. 1999 Sep;156(9):1471-2 - PubMed
  19. J Clin Psychiatry. 2002;63 Suppl 4:37-41 - PubMed
  20. J Clin Psychiatry. 2001;62 Suppl 23:23-9 - PubMed
  21. J Subst Abuse Treat. 2001 Dec;21(4):217-21 - PubMed
  22. Psychiatr Serv. 2001 Jul;52(7):967-9 - PubMed
  23. J Clin Psychiatry. 1999 Apr;60(4):215-20 - PubMed
  24. Acta Psychiatr Scand. 1999 Jul;100(1):3-16 - PubMed
  25. Nutrition. 2000 Oct;16(10):843-57 - PubMed
  26. Can J Psychiatry. 2001 Aug;46(6):549-55 - PubMed
  27. JAMA. 2002 Jan 16;287(3):356-9 - PubMed
  28. Pharmacol Biochem Behav. 1988 Sep;31(1):81-6 - PubMed
  29. Am J Psychiatry. 1999 Aug;156(8):1270-2 - PubMed
  30. J Clin Psychiatry. 1997 Mar;58(3):108-11 - PubMed
  31. Psychosomatics. 1973 May-Jun;14(3):176-81 - PubMed
  32. Int Clin Psychopharmacol. 2001 Mar;16(2):63-73 - PubMed
  33. J Clin Psychiatry. 1999 Jun;60(6):358-63 - PubMed
  34. J Clin Psychopharmacol. 2002 Jun;22(3):244-51 - PubMed
  35. J Clin Psychiatry. 2000 Oct;61(10 ):742-9 - PubMed
  36. Diabetes Care. 2002 Jan;25 Suppl 1:S1-147 - PubMed
  37. JAMA. 2001 May 16;285(19):2486-97 - PubMed
  38. Neurosci Biobehav Rev. 2000 May;24(3):341-53 - PubMed
  39. Med J Aust. 1997 Mar 3;166(5):278 - PubMed
  40. Diabetes Care. 2000 Jan;23 Suppl 1:S4-19 - PubMed
  41. Clin Cardiol. 1999 Jun;22(6 Suppl):II1-6 - PubMed
  42. Am J Cardiol. 2000 Nov 1;86(9):943-9 - PubMed
  43. Arch Gen Psychiatry. 2002 Apr;59(4):337-45 - PubMed
  44. J Clin Psychiatry. 2001;62 Suppl 23:45-66 - PubMed
  45. J Clin Psychiatry. 2001;62 Suppl 23:13-22 - PubMed
  46. J Psychiatry Neurosci. 1999 Nov;24(5):453-5 - PubMed
  47. Bipolar Disord. 2001 Aug;3(4):181-8 - PubMed
  48. J Clin Psychiatry. 1999 Aug;60(8):556-7 - PubMed
  49. Am J Psychiatry. 1999 Nov;156(11):1686-96 - PubMed
  50. J Clin Psychopharmacol. 2001 Aug;21(4):369-74 - PubMed
  51. J Clin Psychiatry. 2001;62 Suppl 7:22-31 - PubMed
  52. J Clin Psychiatry. 2001;62 Suppl 7:11-21 - PubMed
  53. J Clin Psychiatry. 2001;62 Suppl 7:4-10 - PubMed
  54. J Clin Psychiatry. 2001 Feb;62(2):92-100 - PubMed
  55. J Clin Endocrinol Metab. 2002 Jun;87(6):2918-23 - PubMed
  56. Can J Cardiol. 1997 Jan;13(1):75-80 - PubMed
  57. J Clin Psychopharmacol. 2001 Feb;21(1):110-1 - PubMed
  58. Circulation. 2000 Jun 20;101(24):2777-82 - PubMed
  59. Biol Psychiatry. 1998 Oct 15;44(8):778-83 - PubMed
  60. Clin Neuropharmacol. 1999 Mar-Apr;22(2):98-101 - PubMed
  61. Psychosomatics. 2000 Jul-Aug;41(4):369-70 - PubMed
  62. J Clin Psychiatry. 2002 May;63(5):425-33 - PubMed
  63. Schizophr Bull. 2000;26(4):903-12 - PubMed
  64. J Clin Hosp Pharm. 1986 Aug;11(4):297-9 - PubMed
  65. J Am Acad Child Adolesc Psychiatry. 2001 Feb;40(2):133 - PubMed
  66. J Cardiovasc Risk. 2000 Oct;7(5):339-45 - PubMed
  67. Am J Psychiatry. 2002 Apr;159(4):561-6 - PubMed

Publication Types