Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: a retrospective chart review.
The presence of the metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and diabetes. There are limited data on the prevalence of MetS in patients with schizophrenia at the onset of the disorder and specifically no data on patients treated in the era when only first-generation antipsychotics were available.


METHODS
Data from a historic cohort of consecutively admitted first-episode patients with schizophrenia treated with first-generation antipsychotics (FGAs) were compared with an age and sex matched series of consecutive first-episode patients treated only with second-generation antipsychotics (SGAs). Rates of MetS were compared at baseline and after on average 3 years of treatment exposure.


RESULTS
At first episode there was no difference in the prevalence of MetS between the historic and the current cohort. Rates of MetS increased over time in both groups, but patients started on SGAs had a three times higher incidence rate of MetS (Odds Ratio 3.6, CI 1.7-7.5). The average increase in weight and body mass index was twice as high in patients started on SGA. The difference between the FGA and SGA group was no longer significant when patients started on clozapine and olanzapine were excluded.


CONCLUSIONS
Rates of MetS at the first episode of schizophrenia today are not different from those of patients 15 to 20 years ago. This finding counters the notion that the high rates of metabolic abnormalities in patients with schizophrenia currently reported are mainly due to lifestyle changes over time in the general population. Some SGAs have a significantly more negative impact on the incidence of MetS compared to FGAs in first-episode patients.
De Hert
Marc
M
University Psychiatric Center Katholieke Universiteit Leuven, Leuvense Steenweg 517, 3070 Kortenberg, Belgium. marc.de.hert@uc-kortenberg.be
Schreurs
Vincent
V
Sweers
Kim
K
Van Eyck
Dominique
D
Hanssens
Linda
L
Sinko
Sebastjan
S
Wampers
Martien
M
Scheen
Andre
A
Peuskens
Joseph
J
van Winkel
Ruud
R
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000145:classification*; D002593:Cetrimonium Compounds; D015331:Cohort Studies; D004338:Drug Combinations; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D009226:Myristates; D009539:Nicotinic Acids; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D012841:Simethicone; D013229:Stearic Acids
D014150:Antipsychotic Agents; D002593:Cetrimonium Compounds; D004338:Drug Combinations; D009226:Myristates; D009539:Nicotinic Acids; D013229:Stearic Acids; C058060:Prevasore; D012841:Simethicone