Metabolic changes in first-episode early-onset schizophrenia with second-generation antipsychotics

Early Interv Psychiatry. 2014 Aug;8(3):276-80. doi: 10.1111/eip.12083. Epub 2013 Aug 22.

Abstract

Aim: Individuals with a diagnosis of schizophrenia have a reduced life expectancy compared with the general population and cardiovascular disease is the major contributor to this early mortality. The use of second-generation antipsychotic (SGA) medications is associated with significant weight gain and metabolic side effects; however, there is limited knowledge in certain diagnostic groups, specifically early-onset schizophrenia (EOS). This study aimed to investigate the metabolic side effects of SGAs, specifically olanzapine, risperidone and quetiapine, in a cohort of drug-naïve children and adolescents with first-episode EOS.

Method: Body mass index (BMI), serum cholesterol and triglycerides were measured at baseline and a median of 7 months of follow up in drug-naïve children and adolescents with EOS.

Results: A total of 49 children and adolescents received a diagnosis of first-episode EOS and we had complete follow-up data for 74% (N = 36). A significant increase in BMI, serum triglycerides and cholesterol was observed in the unselected cohort after commencement of SGAs. One-third of children and adolescents had abnormal serum triglycerides and cholesterol; however, a dose-response was not demonstrated. Olanzapine and quetiapine had a greater increase in serum triglycerides.

Conclusions: In addition to highlighting the need for routine screening for metabolic side effects in EOS, interventions to prevent and treat obesity and the metabolic syndrome are indicated.

Keywords: antipsychotic; early-onset schizophrenia; medication side effect; metabolic syndrome; psychosis.

MeSH terms

  • Adolescent
  • Age of Onset
  • Antipsychotic Agents / adverse effects*
  • Benzodiazepines / adverse effects
  • Body Mass Index*
  • Cholesterol / blood*
  • Dibenzothiazepines / adverse effects
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Metabolic Syndrome / chemically induced*
  • Metabolic Syndrome / complications
  • Olanzapine
  • Quetiapine Fumarate
  • Risperidone / adverse effects
  • Schizophrenia / blood
  • Schizophrenia / drug therapy*
  • Schizophrenia / epidemiology
  • Schizophrenia / metabolism*
  • Triglycerides / blood*
  • Victoria / epidemiology

Substances

  • Antipsychotic Agents
  • Dibenzothiazepines
  • Triglycerides
  • Benzodiazepines
  • Quetiapine Fumarate
  • Cholesterol
  • Risperidone
  • Olanzapine