title: Ziprasidone's effect on metabolic markers in patients with diabetes and chronic schizophrenia.
abstract: BACKGROUND
  Despite numerous studies of diabetes mellitus type II (DM-II) in schizophrenia and schizoaffective disorder, there have been no studies on the glycemic effects of switching patients with long-standing symptomatic DM-II from their current antipsychotic regimen to ziprasidone.
  
  
  METHODS
  An open-label, prospective inpatient study was conducted with 26 suboptimally responding inpatients with DSM-IV diagnoses of schizophrenia or schizoaffective disorder and comorbid DM-II who were switched to ziprasidone monotherapy and followed for 8 weeks. Outcome measures were fasting glucose, triglycerides, cholesterol, insulin levels, capillary blood glucose levels and weight. After a 3-week cross-titration period, patients were treated with ziprasidone up to a dose of 320 mg daily.
  
  
  RESULTS
  Of the 26 study participants, 16 completed the entire study period of 63 days and 10 (38.46%) discontinued participation, primarily due to psychotic relapse. There was a statistically significant reduction in fasting glucose (F=4.43, p=0.05; 14.68 mg/dL mean reduction), capillary blood glucose levels (F=8.90, p=0.01; 25.36 mg/dL mean reduction), weight (F=4.46, p=0.05; 4.68 lb mean weight loss) and Body Mass Index (F=4.40, p=0.05; 3.62 kg/m(2) mean reduction). There was also a reduction in the use of antidiabetic medications after the switch to ziprasidone. Nine (34.62%) patients met criteria for metabolic syndrome (MetS) at baseline, as compared to 4 (15.38%) at endpoint. No change was observed in positive symptoms (F=0.62, p=0.44), negative symptoms (F=1.47, p=0.24) and in total PANSS score (F=0.12, p=0.74).
  
  
  CONCLUSIONS
  This study suggests significant improvement in metabolic side effects and MetS in the subset of the patients who were able to tolerate switching from a polypharmacy regimen to ziprasidone. There was a large discontinuation rate, which limited the sustained beneficial effects of ziprasidone. The decision to switch to ziprasidone in patients with prior suboptimal response has to balance the potential metabolic benefits and the potential relapse risks of the individual patient first and foremost.
authors.affiliation: Department of Psychiatry, New York University School of Medicine, New York, NY, USA. lindenmayer@nki.rfmh.org
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Lindenmayer
authors.forename: Frank
authors.initials: F
authors.lastname: Tedeschi
authors.forename: Anna
authors.initials: A
authors.lastname: Yusim
authors.forename: Anzalee
authors.initials: A
authors.lastname: Khan
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kaushik
authors.forename: Robert C
authors.initials: RC
authors.lastname: Smith
authors.forename: Mohan
authors.initials: M
authors.lastname: Parakadavil
mesh_terms: D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000097:blood* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome; D008875:Middle Aged; D010879:Piperazines / Q000097:blood* / Q000627:therapeutic use; D019338:Polypharmacy; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D013844:Thiazoles / Q000097:blood* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D008055:Lipids; D010879:Piperazines; D013844:Thiazoles; C092292:ziprasidone