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Safe Antipsychotics In Diabetes

Update On The Safety Of Second Generation Antipsychotics In Youths: A Call For Collaboration Among Paediatricians And Child Psychiatrists

Update On The Safety Of Second Generation Antipsychotics In Youths: A Call For Collaboration Among Paediatricians And Child Psychiatrists

Update on the safety of second generation antipsychotics in youths: a call for collaboration among paediatricians and child psychiatrists Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131 Naples, Italy Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131 Naples, Italy Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131 Naples, Italy Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Universit di Milano, 20157 Milan, Italy Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131 Naples, Italy Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L Sacco, L. Sacco University Hospital, Universit di Milano, 20157 Milan, Italy Faculty of Education Science, University Suor Orsola Benincasa of Naples, Naples, Italy Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, 80131, Naples, Italy Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, S. Giovanni di Dio and Ruggi dAragona Hospital, University of Salerno, Fisciano, Italy Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131 Naples, Italy Child Neurology and Psychiatry Unit, Center for Rare Diseases, Department of Pediatrics, Cathol Continue reading >>

Hyperglycemia And Antipsychotic Medications.

Hyperglycemia And Antipsychotic Medications.

Hyperglycemia and antipsychotic medications. Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110, USA. J Clin Psychiatry. 2001;62 Suppl 27:15-26; discussion 40-1. Type 2 diabetes mellitus and impaired glucose tolerance are associated with antipsychotic treatment. Risk factors for type 2 diabetes and impaired glucose tolerance include abdominal adiposity, age, ethnic status, and certain neuropsychiatric conditions. While impaired glucose metabolism was first described in psychotic patients prior to the introduction of antipsychotic medications, treatment with antipsychotic medications is associated with impaired glucose metabolism, exacerbation of existing type 1 and 2 diabetes, new-onset type 2 diabetes mellitus, and diabetic ketoacidosis, a severe and potentially fatal metabolic complication. The strength of the association between antipsychotics and diabetes varies across individual medications, with the largest number of reports for chlorpromazine, clozapine, and olanzapine. Recent controlled studies suggest that antipsychotics can impair glucose regulation by decreasing insulin action, although effects on insulin secretion are not ruled out. Antipsychotic medications induce weight gain, and the potential for weight gain varies across individual agents with larger effects observed again for agents like chlorpromazine, clozapine, and olanzapine. Increased abdominal adiposity may explain some treatment-related changes in glucose metabolism. However, case reports and recent controlled studies suggest that clozapine and olanzapine treatment may also be associated with adverse effects on glucose metabolism independent of adiposity. Dyslipidemia is a feature of type 2 diabetes, and antipsychotics such as clozapine and olanzapine have als Continue reading >>

Antipsychotic-induced Diabetes Mellitus

Antipsychotic-induced Diabetes Mellitus

Joshua J. Neumiller, PharmD, CDE, CGP, FASCP ABSTRACT: Several metabolic consequences ofantipsychotic use have been described within the literature, includingweight gain, hyperglycemia, and dyslipidemia. While the exact mechanismsof antipsychotic-induced metabolic dysfunction are unknown, there are avariety of proposed mechanisms. Since weight gain is considered aprecipitating factor for the development of diabetes and dyslipidemia,monitoring of weight changes with antipsychotic treatment is animportant screening measure. As some antipsychotic agents are lesslikely to contribute to weight gain, such as aripiprazole andziprasidone, it seems prudent to choose a lower-risk antipsychotic inpeople who are at high risk for or have a preexisting diagnosis ofdiabetes or in whom hyperglycemia, dyslipidemia, and/or substantialweight gain develops. Diabetes mellitus (DM) is the seventh leading cause ofdeath in the United States and is a major cause of renal failure, newonset blindness, and nontraumatic limb amputations.1 DMadditionally places people at risk for adverse cardiovascular outcomesand is a major contributor to the incidence of stroke and heart disease.National estimates indicate that DM affects 8.3% of the U.S.population, which equates to a staggering 25.8 million people, and theincidence of DM is continuing to grow at an alarming rate.1 While the health and economic consequences of type 2 DM(T2DM) are widely known, the contribution of medications to thedevelopment of T2DM is sometimes less well recognized. One class ofdrugs for which there are large amounts of clinical data to substantiatea link between their use and the development of T2DM is antipsychoticmedications. This article will provide an overview ofantipsychotic-induced DM and current recommendations pertain Continue reading >>

Antipsychotics Tied To Diabetes In Kids And Teens

Antipsychotics Tied To Diabetes In Kids And Teens

Antipsychotics tied to diabetes in kids and teens NEW YORK - Children and young adults who are prescribed antipsychotic drugs have a three-fold risk of developing diabetes, compared to youths who take other psychotropic drugs, suggests a new study. The study's senior researcher said the findings should give doctors pause before prescribing antipsychotics to children and teens. "If it turns out that the child does ultimately need an antipsychotic, they should be carefully monitored for metabolic effects and the dose should be as low as possible for the shortest amount of time," Wayne Ray, a health policy researcher at Vanderbilt University in Nashville, told Reuters Health. Antipsychotics include Risperdal, known generically as risperidone, Zyprexa (olanzapine), Seroquel (quetiapine) and Abilify (aripiprazole). The drugs are used to treat conditions like bipolar disorder, schizophrenia and irritability and aggression in children with autism. Ray and his colleagues cannot prove the drugs caused diabetes, but their study adds to growing evidence linking antipsychotics to the development of obesity, insulin resistance and type 2 diabetes. In 2011, a large study from the University of Massachusetts found kids who took antipsychotic drugs were four times more likely to develop diabetes than their peers who were not taking the medications (see Reuters Health story of November 22, 2011 here: reut.rs/MtH5dB.) Also that year, a US Food and Drug Administration advisory board raised concerns about the drugs and urged the agency to monitor weight gain and other metabolic diseases in children taking antipsychotics (see Reuters story of September 22, 2011 here: reut.rs/MtHCwe.) And last year, a study found that the number of antipsychotic drugs prescribed to kids and teens during psy Continue reading >>

Development Of Diabetes Mellitus Associated With Quetiapine: A Case Series

Development Of Diabetes Mellitus Associated With Quetiapine: A Case Series

Patients with schizophrenia are at risk of metabolic disorders such as weight gain, hyperglycemia, and diabetes mellitus. [1] Previous studies have shown the relationship between these metabolic disorders and a sedentary lifestyle or unhealthy diet. Genetic factors are also associated with glucose intolerance as shown in a study of drug-nave patients with schizophrenia and in a study of the genetic relationship between schizophrenia and type 2 diabetes. [2,3] Newer antipsychotic medications have been widely accepted in clinical use because of fewer side effects such as extrapyramidal symptoms. [4] However, it has been observed that these atypical antipsychotics could lead to metabolic dysfunction including diabetes mellitus. [5,6] Previous studies have shown that the rate of diabetes in patients with schizophrenia was 6.2% to 8.7% compared with 1.1% in males without schizophrenia. [7] A large-scale observational study using an administrative database showed that 18% of patients with schizophrenia who received antipsychotics also had a diagnosis of diabetes. Moreover, patients who received atypical antipsychotics had significantly higher likelihood of developing diabetes than those who received typical antipsychotics (odds ratio: 1.09; 95% confidence interval: 1.031.15). [8] Quetiapine, a second-generation antipsychotic drug, is commonly used for the treatment of schizophrenia. Previous studies have shown that quetiapine also induced weight gain, hyperlipidemia, and diabetes, similarly to other atypical antipsychotics such as olanzapine and clozapine which exert more influence on glucose tolerance. [9,10] In contrast, it has been reported that the risk for diabetes caused by quetiapine was not significantly different from that caused by conventional antipsychotics. [11, Continue reading >>

An Overview Of Diabetes Management In Schizophrenia Patients: Office Based Strategies For Primary Care Practitioners And Endocrinologists

An Overview Of Diabetes Management In Schizophrenia Patients: Office Based Strategies For Primary Care Practitioners And Endocrinologists

An Overview of Diabetes Management in Schizophrenia Patients: Office Based Strategies for Primary Care Practitioners and Endocrinologists 1Departments of Psychiatry and Internal Medicine, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA 2Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA Received 5 January 2015; Revised 11 March 2015; Accepted 12 March 2015 Copyright 2015 Aniyizhai Annamalai and Cenk Tek. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetes is common and seen in one in five patients with schizophrenia. It is more prevalent than in the general population and contributes to the increased morbidity and shortened lifespan seen in this population. However, screening and treatment for diabetes and other metabolic conditions remain poor for these patients. Multiple factors including genetic risk, neurobiologic mechanisms, psychotropic medications, and environmental factors contribute to the increased prevalence of diabetes. Primary care physicians should be aware of adverse effects of psychotropic medications that can cause or exacerbate diabetes and its complications. Management of diabetes requires physicians to tailor treatment recommendations to address special needs of this population. In addition to behavioral interventions, medications such as metformin have shown promise in attenuating weight loss and preventing hyperglycemia in those patients being treated with antipsychotic medications. Targeted diabetes prevention and treatment is critical in patients with schizophrenia and evidence-based interventions should be considered Continue reading >>

Atypical Antipsychotic-induced Type 2 Diabetes

Atypical Antipsychotic-induced Type 2 Diabetes

Atypical Antipsychotic-Induced Type 2 Diabetes Jennifer Berg, PharmD, Gregory Stajich, PharmD, and Martin Zdanowicz, PharmD Patients with schizophrenia and other disorders who take atypical antipsychotics should be monitored for an increased risk for diabetes. Reducing the Risk for Metabolic Disorders Begins with Choosing the Right Treatment Patients taking antipsychotic agents, and particularly those with schizophrenia, are at risk for developing more detrimental conditions that can lead to increased susceptibility to cardiovascular disease and hyperlipidemia. Since 2002, coinciding with the addition of the newer generation of atypical antipsychotic drugs, patients have also been prone to an increase in weight gain and the subsequent metabolic effects leading to a predilection to type 2 diabetes. According to the National Institute of Mental Health, in 2008, 2.4 million people in the United States were living with schizophrenia.1 Schizophrenia is a mental disorder characterized by positive symptoms like delusions, hallucinations, and disorganization of thought, and negative symptoms such as flat affect, avolition, alogia, anhedonia, and social inattention.2,3 In addition to the mental complications of the disorder, studies have shown that patients with schizophrenia are 2 to 3 times more likely to develop type 2 diabetes.4 There is not a clear understanding why schizophrenic patients are at an increased risk for developing type 2 diabetes. Schizophrenic patients have a number of risk factors for type 2 diabetes, including family history, increased body mass index (BMI), sedentary lifestyle associated with the disorder, and the use of atypical antipsychotic medications.5 In 2004, the FDA required that a warning be placed in the package inserts of all atypical antipsych Continue reading >>

Diabetes And Antipsychotic Drugs

Diabetes And Antipsychotic Drugs

Aust Prescr 2004;27:118-91 Oct 2004DOI: 10.18773/austprescr.2004.098 There is an increased risk of diabetes in patients with schizophrenia and this risk is elevated by some antipsychotic medications. The risk is greater with the atypical drugs clozapine and olanzapine and the low potency conventional antipsychotics than with risperidone or high potency conventional drugs. While weight gain may be a mechanism for the development of diabetes, a direct effect of these drugs on insulin action in muscle may also be an important contributor. Patients with major psychosis should be managed in the same way as other patients with diabetes, but difficulties in complying with diet, exercise and taking medication should be kept in mind. Treating cardiovascular risk factors is important. An impaired action of insulin (insulin resistance) in patients with schizophrenia was reported over 55 years ago and later confirmed in Australia. 1 The prevalence of diabetes in patients with schizophrenia was found to be higher than in the general population even before the widespread use of antipsychotic medication. The mechanisms underlying the relationship between schizophrenia and diabetes remain unknown. It is now clear that some antipsychotic medications increase the risk of diabetes in patients with schizophrenia. Rarely, this may present as diabetic ketoacidosis. The atypical medications (Table 1) have become widely used because of their lower rate of extra pyramidal adverse effects compared to older classes of medication such as the phenothiazines and the butyrophenones. However, while some of the atypical drugs are better tolerated, they also increase the incidence of diabetes. In patients younger than 40 years of age, the odds ratio for developing diabetes is 1.63 if they are taking an Continue reading >>

Antipsychotic Medications That Dont Cause Diabetes Type Ii

Antipsychotic Medications That Dont Cause Diabetes Type Ii

Q. My son is diagnosed bipolar 2, and is currently on abilify (a specific for bipolar 1, and an increased risk for diabetes) and effexor. Can you suggest other medications specific for bipolar 2 that do not increase his diabetes risk that I might research? A. The problem is that most of the atypical antipsychotic medications (which is the type of medication that Ability is classified as) tend to increase an individuals risk for type II diabetes, known formally as adult onset diabetes. Some medications are thought to be better than others. Recently, a panel of endocrinologists and psychiatrists published a rank ordered list of atypical antipsychotic medications. They ranked them in order from greatest to the least risk on metabolic effects. Olanzapine (Zyprexa) was thought to have the greatest effect on metabolic health, followed by quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon). Aripiprazole (Abilify) was thought to pose the least risk to metabolic health. You can find out more by visiting : There is no evidence that atypical antipsychotic medications cause diabetes type II but there does seem to be a link, albeit an unclear link. Individuals who take atypical antipsychotic medications should take them only under the supervision of a trained psychiatrist or physician who is committed to monitoring a patients metabolic health. If you or your son notices that Abilify is causing him to gain weight or experience an increase in his insulin levels then it may be time to consider a medication switch. There is a new atypical antipsychotic medication available called Invega. I am not sure, however, if this medication has been approved for the treatment of bipolar type II. There is not much data available on this medication yet but I have worked with in Continue reading >>

Antipsychotic Medication Safe For Pregnant Women, Study Suggests

Antipsychotic Medication Safe For Pregnant Women, Study Suggests

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Antipsychotic medication safe for pregnant women, study suggests Antipsychotic medication does not put pregnant women at risk of developing gestational diabetes, according to new research. Antipsychotics are a powerful class of medication which can treat behavioural and mental health disorders, such as schizophrenia and bipolar disorder. The use of antipsychotics is increasing during pregnancy and to treat other conditions such depression, but little research previously existed as to how the medication affected maternal health and birth outcomes. A study conducted at the Institute for Clinical Evaluative Sciences, Canada compared 1,021 pregnant women take antipsychotics during pregnancy to 1,021 women with similar age, mental health and medical characteristics who werent on medication. The researchers observed no significant differences in risk for gestational diabetes between the groups, or other medical conditions such as gestational hypertensive disorders. There were also no differences in risk for extremely high or low birth weights or preterm delivery, but women taking antipsychotics during pregnancy were more likely to require labour induction. This study is believed to the largest to date that examines possible links between pregnancy and the impact of antipsychotic medications such as quetiapine, olanzapine and risperidone. Dr. Simone Vigod, study author and adjunct scientist with ICES, said: "Our results are reassuring for women who require antipsychotic medication to maintain their mental health stability during pregnancy, at least with respect to short term maternal and infant outcomes. "Research into longer term child outcomes will be need Continue reading >>

Diabetes Risk For Children, Young Adults On Second-generation Antipsychotics

Diabetes Risk For Children, Young Adults On Second-generation Antipsychotics

Diabetes Risk for Children, Young Adults on Second-Generation Antipsychotics Diabetes Risk for Children, Young Adults on Second-Generation Antipsychotics The risk for type 2 diabetes (T2DM) is greater with second-generation antipsychotics (SGAs) than with non-SGA psychotropic medications for patients aged 6 to 25 years, researchers report in the Journal of Child and Adolescent Psychopharmacology. Their study included 45,289 SGA users and 932,336 non-SGA psychotropic users and showed a 1.7 times higher hazard for developing T2DM among the SGA users (hazard ratio, 1.71; 95% CI, 1.33-2.20). The median time to a diagnosis of diabetes or prescription of an antidiabetic medication was less than 1 year. The retrospective study had a new-user design: children and young adults in the age range were entered after a 180 nonpsychotropic drug period, when they filled a new prescription for a SGA or a non-SGA psychotropic (antidepressant, anxiolytic, hypnotic, or mood stabilizer) between July 1, 2009, and December 30, 2013. The young whose records were examined were included if they had no history of diabetes or of taking an antidiabetic medication within the 180-day period preceding the first prescription for an SGA or non-SGA psychotropic. Nor could they have a history of conditions at baseline that tend to be associated with development of diabetes. Patients chronically receiving steroids, a risk factor for T2DM, were excluded if they used steroids within 60 days of getting a new prescription for an antipsychotic . All patients had a mental healthy diagnosis at baseline. A total of 141 of the SGA users, who were propensity score matched to the non-SGA psychotropic users at a 1:1 ratio, developed T2DM (33 cases per 10,000 patient-years). Of the non-SGA users, 110 developed T2DM (1 Continue reading >>

Which Atypical Antipsychotics Carry The Highest Risk For Diabetes?

Which Atypical Antipsychotics Carry The Highest Risk For Diabetes?

Which Atypical Antipsychotics Carry the Highest Risk for Diabetes? If you are unfamiliar with antipsychotics, my article, Psychosis 101 , has a detailed description of the medications and how they work. The following information on diabetes risk in antipsychotic medications comes from two papers from the Journal of Clinical Psychiatry: Antipsychotic Medications: Metabolic and Cardiovascular Risk by Dr. John W. Newcomer and Switching Antipsychotics as a Treatment Strategy for Antipsychotic-Induced Weight Gain by Dr. Peter J. Weiden. Both researchers show conclusive evidence that the risk of diabetes from certain antipsychotics is high and must be addressed immediately within the entire healthcare community. There are six atypical antipsychotics in use today: (a newer antipsychotic called Saphris was not a part of the metabolic syndrome studies cited in the article.) Numerous and well-documented studies have shown a serious and potentially dangerous connection between certain second generation antipsychotics and the risk of diabetes because of their connection to metabolic syndrome. Those atypical antipsychotics with the highest risk for developing diabetes are: In a major NIMH study (the CATIE project), Zyprexa was associated with relatively severe metabolic effects. Subjects taking Zyprexa showed a major weight gain problem and increases in glucose, cholesterol, and triglycerides. The average weight gain over the 18-month study period was 44 pounds. Abilify and Geodon do not have a significant risk of metabolic syndrome and thus are not considered a diabetes risk (although the FDA has ordered all makers of antipsychotic drugs to include a warning about a possible link with diabetes on their product label). The term high-risk antipsychotics used throughout this article Continue reading >>

Antipsychotic Drugs May Triple Kids' Diabetes Risk

Antipsychotic Drugs May Triple Kids' Diabetes Risk

Antipsychotic Drugs May Triple Kids' Diabetes Risk This class of drugs is increasingly used to treat children with ADHD, depression WEDNESDAY, Aug. 21 (HealthDay News) -- Antipsychotic medications such as Seroquel , Abilify and Risperdal can triple a child's risk of developing type 2 diabetes within the first year of usage, according to a new study. Powerful antipsychotics traditionally were used to treat schizophrenia . Now the majority of prescriptions for antipsychotic medications are for treatment of bipolar disorder , ADHD and mood disorders such as depression , according to prior research. But antipsychotic drugs make a child much more likely to develop type 2 diabetes than the medications typically prescribed for these other psychiatric conditions, said corresponding author Wayne Ray, director of the division of pharmacoepidemiology at the Vanderbilt University School of Medicine, in Nashville, Tenn. "We found that children who received antipsychotic medications were three times as likely to develop type 2 diabetes ," Ray said. "It's well known that antipsychotics cause diabetes in adults, but until now the question hadn't been fully investigated in children." Antipsychotics appear to increase diabetes risk by causing dramatic weight gain in children and by promoting insulin resistance , Ray said. The boom in the use of antipsychotic medication has been particularly dramatic among children. Antipsychotic prescriptions have increased sevenfold for kids in recent years and nearly fivefold for teens and young adults aged 14 to 20, according to a 2012 study from Columbia University. For the current study, which was published Aug. 21 in the journal JAMA Psychiatry , the researchers reviewed the records of nearly 29,000 kids aged 6 to 24 in the Tennessee Medicaid prog Continue reading >>

Antipsychotic Treatment Benefits For Dm Population

Antipsychotic Treatment Benefits For Dm Population

Home / Specialties / Mental Health / Antipsychotic Treatment Benefits for DM Population Antipsychotic Treatment Benefits for DM Population New study shows that taking anti-psychotic medications decreased diabetic complications. It is known that most patients with schizophrenia are more than likely to develop diabetes, which ultimately can lead to a considerable risk of high cardiovascular complications. It is well established that patients who are taking antipsychotic agents, especially those with schizophrenia, are at an increased risk for developing more detrimental conditions, which ultimately can lead to increased susceptibility to cardiovascular disease and hyperlipidemia. The newer generation of atypical antipsychotic medications have been strongly associated with increases in weight and subsequent metabolic effects. Though its not clear why schizophrenia patients are at an increased risk for developing type 2 diabetes, there are a number of risk factors that make them more susceptible, including: family history, increased body mass index, a sedentary lifestyle and of course, the use of antipsychotic medications. However, a new study performed at the Taiwan National Health Insurance Research Database investigated the relationship between antipsychotic treatment and the consequences for patients with diabetes. The research focused on the effects of switching antipsychotic treatment on the reduction of diabetic complications in recently diagnosed diabetics. According to their findings, in comparison to patients who had no antipsychotic therapy in the six-month trial period, patients who were consistent with their use of the medications had an overall lower risk of diabetic complications and decreased risk of macrovascular complications, ultimately associated with l Continue reading >>

Antipsychotics And Diabetes: Observational Data

Antipsychotics And Diabetes: Observational Data

Antipsychotics and diabetes: observational data A link between schizophrenia and diabetes mellitus was postulated in the 1920s, prior to the development of antipsychotic medications [1] , however, a temporal association between first-generation (typical) antipsychotic drug treatment and hyperglycemia was first reported in the 1950s [2] , and current wisdom is that exposure to some second-generation (atypical) antipsychotics can considerably increase the risk of development of diabetes mellitus. The American Diabetes Association/American Psychiatric Association consensus statement on antipsychotic drugs and obesity and diabetes notes that aripiprazole and ziprasidone are the two second-generation antipsychotic agents with the lowest risk for metabolic disturbances, although data are limited [3] . Research demonstrates that people with schizophrenia are at a higher risk of developing diabetes mellitus than the general population, and that prevalence is on the increase. For example, in a report on the New York State Office of Mental Health psychiatric hospital system, the prevalence of people with diabetes mellitus doubled from 6.9% of 10,091 patients in 1997 to 14.5% of 7,420 patients in 2004 irrespective of antipsychotic use [4] . Several theories about the linkage between schizophrenia and diabetes have emerged, including a potential genetic link between the heritability of diabetes and the heritability of schizophrenia. Persons with schizophrenia have a higher rate of family history of diabetes than the general population [5] [6] and a positive family history of diabetes may increase the risk of developing diabetes in individuals with schizophrenia and other serious and persistent mental illnesses up to threefold [7] . Insulin resistance can take more than a decade to Continue reading >>

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