Objectives

1
Objectives

• Define the metabolic syndrome
• Describe prevalence of metabolic changes with
  second generation antipsychotics in VA
• Discuss strategies for monitoring
• Describe challenges treatment options for
  managing patients who develop metabolic changes

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Metabolic Syndrome Markers
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First Generation Antipsychotics

• Extrapyramidal side effects and Tardive Dyskinesia

Second Generation Antipsychotics

• Metabolic side effects

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Atypical Antipsychotic Agents

• Clozapine (Clozaril)
• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)
• Aripiprazole (Abilify)

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Short-Term Studies Weight Gain
Percentage of Patients with ? 7 Weight Gain
Tandon et al. J Ser Res. 19974159-177
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Long-Term Studies Weight Gain

• Clozapine-treated patients
• Gained more than 40 lbs
• More than 30 of patients gained 10 or more of
  their initial body weight
• Long-term data
• 56 of patients on olanzapine gained more than 7
  of their body weight

Psychiatric Clinic North Am 2003 26(1)165-90.
7
Hyperglycemia/Diabetes

• Clozapine olanzapine numerous reports
• Risperidone quetiapine- few reports

J Clin Psychiatry 199960783-791 Psychosomatics
199940438-443 Psychiatric Clinic North Am.
2003 26(1)165-90
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Dyslipidemias

• Retrospective study clozapine ? TGs
• 48 (184 to 273mg/dL) in men
• 35 (165 to 223 mg dL) in women
• Case series TGs
• ? 37 (162 to 222 mg/dl)

Psychiatric Clinic North Am. 2003
26(1)165-90 Am J Psychiatry 199915614714-1472.
Am J Psychiatry 1999156(8) 1270-1272.
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Weight Gain, Diabetes, and Dyslipidemias

• Atypical Antipsychotic Agents
• Clozapine gt Olanzapine gt Quetiapine
• Risperidone gt Ziprasidone Aripiprazole

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Atypical Antipsychotic Agents

• FDA mandates changes in labeling in 2004
• Warnings for hyperglycemia and diabetes
• Affects all atypical antipsychotics
• Consensus Development Conference on Antipsychotic
  Drugs Obesity Diabetes
• Aripiprazole and ziprasidone
• Little/no weight gain
• Little/no diabetes
• Little/no dyslipidemia

Diabetes Care 2004 27596-601.
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Clinical Data Warehouse
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Demographics
106,729 66.5 95
5,808 57.4 93
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VISN-21 Regional Findings
Chi Squared 68.7, df 1
Chi squared 18.5, df 1
Population Group
Chi
2nd Generation Antipsychotic Treatment Group
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VISN-21 Regional Findings
Prevalence () Diabetes by Age
p0.009
Treatment Group
Population Group
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VISN-21 Regional Findings
Prevalence () Metabolic Syndrome by Age
plt0.001
plt0.001
plt0.001
Treatment Group
Population Group
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VISN-21 Regional Findings
Prevalence of Diabetes in Patients on Second
Generation Antipsychotics by Individual Drug
28
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VISN-21 Regional Findings
Prevalence of Metabolic Syndrome in Patients
on Second Generation Antipsychotics by Individual
Drug
39
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VA Sierra NV- Local Findings
Wilcox signed rank p lt 0.001
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American DiabetesAssociation Recommendations

• Personal/family Hx BL, annually
• Weight (BMI) BL, 4 wks, 8 wks, 12 wks,
  quarterly
• Waist circumference BL, annually
• Blood Pressure BL, 12 wks, annually
• Fasting plasma glucose BL, 12 wks, annually
• Fasting lipid profile BL, 12 wks, generally
  every 5 years

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VISN-21 Regional Findings
Atypical Antipsychotics By Indication
Other Bipolar (Off Label)
Other Use (Off Label)
PTSD (Off Label)
Psychosis and other appropriate indications
Schizophrenia
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Metabolic Syndrome Report
Left side
Right side
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Recommendations for Monitoring

• Patient education and behavior modification
• Monitor weight changes
• Obtain Labs

Psychiatric Clinic North Am. 2003 26(1)165-90.
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VANTS CallJune 29, 2005200 PM
ET1-800-767-1750Access code 95744