title: Using structural equations to test for a direct effect of some antipsychotics on triglyceride levels in drug-naïve first-episode psychosis patients.
abstract: Some antipsychotics probably increase the risk of metabolic syndrome. Antipsychotics may differentially influence some elements of metabolic syndrome (obesity, hyperlipidemia, hyperglycemia or hypertension) through various pharmacological mechanisms. In a published study of all first psychotic episodes in a Spanish hospital's catchment area population in Cantabria (Spain), patients were randomly assigned to receive haloperidol (3-9 mg/day), olanzapine (5-20mg/day) or risperidone (3-6 mg/day). In this article, a structural-equation modeling approach tested the mechanistic hypothesis that olanzapine directly (without the mediation of weight gain) increases triglyceride levels, whereas risperidone and haloperidol do not have these effects. A structural equation model was built using the 110 patients whose assigned antipsychotic was not changed during the first 3 months of treatment, and who provided both triglyceride and body mass index (BMI) measurements at baseline and at the end of the 3rd month of treatment. A second structural equation included 72 patients whose antipsychotic was not changed during the first year. After 3 months and controlling for confounders, olanzapine patients had triglyceride levels that were 29.2mg/dL higher [95% confidence interval, (10.9, 47.5)] than those of risperidone patients with comparable baseline triglyceride levels. After 12 months, they were 63.1mg/dL higher (18.6, 107.6) than those of patients with a comparable history of triglyceride values during the first 3 months. Haloperidol effects on triglyceride levels and BMI were no different from those of risperidone. In conclusion, olanzapine increased triglyceride levels without the mediation of weight gain during a one-year study in naïve patients.
authors: Department of Biostatistics, The University of Kansas Medical Center, Kansas City, KS, USA.
authors: Francisco J
authors: FJ
authors: Diaz
authors: Rocio
authors: R
authors: Perez-Iglesias
authors: Ignacio
authors: I
authors: Mata
authors: Obdulia
authors: O
authors: Martínez-Garcia
authors: José L
authors: JL
authors: Vázquez-Barquero
authors: Jose
authors: J
authors: de Leon
authors: Benedicto
authors: B
authors: Crespo-Facorro
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015233:Models, Statistical; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000378:metabolism*; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014280:Triglycerides / Q000378:metabolism*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D014280:Triglycerides