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Table 1.  

Drug Weight Gain Risk for Diabetes Worsening Lipid Profile
Clozapine +++ + +
Olanzapine +++ + +
Risperidone ++ 0 0
Quetiapine ++ 0 0
Aripiprazole* ± - -
Ziprasidone* ± - -

Table 1. Second-Generation Antipsychotics and Metabolic Abnormalities

+ = increase effect
- = no effect
0 = discrepant results
* = newer drugs with limited long-term data
Copyright ©2004 American Diabetes Association
From Diabetes Care. Vol 27, 2004:596-601. Reprinted with permission from The American Diabetes Association

Table 2.  

Baseline 4 Weeks 8 Weeks 12 Weeks Quarterly Annually Every 5 Years
family history
Weight (BMI) X X X X X
Waist circumference X X
Blood pressure X X X
Fasting plasma glucose X X X
Fasting lipid profile X X X

Table 2. Monitoring Protocol for Patients on Atypical Antipsychotics*

BMI = body mass index
*More frequent assessments may be warranted based on clinical status.
Copyright ©2004 American Diabetes Association
From Diabetes Care. Vol 27, 2004:596-601. Reprinted with permission from The American Diabetes Association

Metabolic Disorders in Schizophrenia: Relationship to Atypical Antipsychotic Treatment

Authors: Henry A. Nasrallah, MD; Martin L. Korn, MDFaculty and Disclosures



Even prior to the introduction of neuroleptic medications in the 1950s, there was evidence that individuals with schizophrenia suffered from a variety of medical and metabolic disorders at rates higher than the general population. Investigators in the early 1900s observed that patients with dementia praecox had increased rates of abnormal glucose tolerance tests,[1-3] and more recent studies have found an increased rate of type 2 diabetes in schizophrenic patients compared with the general population.[4] Studies have shown that first-episode, never-medicated schizophrenia patients have increased visceral adiposity,[5,6] impaired fasting glucose tolerance, and are more insulin resistant than healthy comparison controls.[7] Other factors such as increased smoking,[8] sedentary lifestyle, and lack of self care increase the risk even further. Therefore, due to a confluence of health and lifestyle factors, individuals with schizophrenia are at high risk for a variety of untoward health consequences.

Although the introduction of the atypical neuroleptics has resulted in significant clinical advances, several of these agents have a variety of significant metabolic health risks associated with them. Concern for these side effects recently prompted the US Food and Drug Administration (FDA) to issue a warning for all of the atypical neuroleptics, indicating that hyperglycemia and diabetes may result from the atypical neuroleptics. Although the warning was for all of the currently available medications, there is substantial evidence indicating that some of the agents place the individual at a greater risk than others. The clinician should therefore carefully consider the ethical and health risks associated with psychopharmacologic interventions, utilizing first those agents that maximize clinical response while minimizing health risks in the already vulnerable individual.