Metabolic Abnormalities in Early Psychosis - Article Example

? Case Study and review on metabolic abnormalities in early psychosis                              Date: Abstract Psychosis and other related conditions have been treated by typical and atypical antipsychotics for a long time. The later have acquired favour in use because they are more effective and pose fewer side-effects. However, the atypical antipsychotics also present side-effects such as clinically significant weight gain, abnormal lipid levels and a relatively higher risk of diabetes than the typical antipsychotics. These side-effects pose a challenge because of the extra risk that they bring in as well as the possible non-compliance to prescription that may result when patients fear to take the medications because of their associated effects. The review looks at various research articles that seek to understand the effect of antipsychotics in order to understand their relative effects and possible side-effects. The article reviews are also used in making decisions with regard to a case study of a patient under first-episode psychosis treatment using atypical antipsychotics and already showing side-effects. Introduction Psychosis treatment has relied on antipsychotics for a very long time. The first generation antipsychotics (FGAs) fell out of favoured use due to less effectiveness and a number of associated side-effects. They were replaced by second generation antipsychotics (SGAs), which are more effective. The FGAs were linked to a number of side-effects including extrapyramidal reactions such as akathasia, tachycardia, tardive dyskinesia, impotence and seizures among many other. These side-effects have necessitated the use of other drugs such as anticholinergics in order to handle the resultant side-effects such as motor side effects. The atypical antipsychotics present a better solution in treating first-episode psychosis (FEP) because they have greater effectiveness in improving functional outcome and treatment response. However, they too have been found to present a number of side-effects. SGAs present health challenges in terms of weight gain and the cause of abnormalities in lipid and glucose metabolism. As such, SGAs have been cited as potential developers of vulnerability to diabetes and other cardiovascular conditions. A number of researches have been conducted to determine the effects of atypical antipsychotics on abnormalities in lipid and glucose metabolism as well as weight gain, otherwise known as metabolic syndrome (MetS). The MetS denotes a combination of increased waist circumference and any of the following two abnormal conditions-a low high density lipoprotein level, hypertension, and high levels of serum triglycerides and/or fasting blood glucose. The fact that both generations of drugs present various side-effects poses greater challenge for practitioners trying to make decisions on which medication to apply in FPP cases. The dilemma on typical versus atypical antipsychotics; as well as whether to use atypical psychotics in FEP considering their potentially negative effects on diabetes and cardiovascular conditions makes this an interesting choice for review. The case study and articles’ review specifically reviews three research articles in relation to the case study in question. The first article reviews the development of metabolic abnormalities as a result of atypical antipsychotics on patients receiving these drugs for FEP through a cross sectional, naturalistic retrospective study. The article’s objective is to develop recognition of the impact of atypical antipsychotics in developing metabolic abnormalities in young patients under FEP treatment. The second article examines results from a naturalistic and prospective study in which the effects of antipsychotic drugs on the development of MetS are monitored through the measurement of weight and serum levels of insulin, glucose and lipids. The third article delves into the issue of providing evidence that can support or discredit the belief that rising prevalence of diabetes in patients under antipsychotics is linked to the treatment, especially that which uses atypical antipsychotics. The article sought to develop some association evidence, because there has been no systematic review of evidence on the issue. Introduction and relevance identification: The first article under review is titled “Metabolic abnormalities in an early psychosis service: a retrospective, naturalistic cross-sectional study.” The research article highlights results from a study seeking to establish the prevalence of metabolic abnormalities among young people undergoing FPP treatment using atypical antipsychotics. The article was authored by Ward, B. P. Samaras, K. Newal, H. Watkins, A. Henry, C. and Curtis, J. The 2011 article appeared in the Early Intervention on Psychiatry Journal, volume 5, in issue number 1. The article is insightful in developing an understanding of the influence of atypical antipsychotics on young subjects undergoing FPP treatment in relation to MetS development. A clear understanding of the side-effects of atypical antipsychotics is necessary in the making of decisions with regard to the treatment of FPP among young people (Ward, 2011, p. 108). Background: Hyperglycaemia, dyslipidaemia and obesity have been established as common health challenges among young patients receiving atypical antipsychotics for FEP treatment (Ward, 2011, p. 108). According to previous studies significant gain in weight has been observed in 23%-61% of patients under SGAs’ treatment in the initial 10-16 weeks. This rate has been observed to rise to 58%-100% within 1-2 years of medication. Dyslipidaemia has also been shown to develop in the first three months and possible insulin resistance in about a year. The resultant gain in weight and metabolic abnormalities make the management of FEP a little complicated, because the patients become susceptible to diabetes and MetS which further exposes them to cardiovascular disorders. The weight gain also brings about a deleterious effect on treatment because it is likely to lead to the development of a low self-esteem which has negative psychosocial effects (Ward, 2011, p. 108). Overview: The findings from the study show that both genders experience weight disorders with the prevalence of disorders being higher among male subjects (male 55% and female 42%). However, the prevalence of morbid obesity is higher among females than males. Out of the 55% males only 15% were obese, whereas; 30% out of the 42 females had morbid obesity (Ward, 2011, p. 111). Females were also observed to have an abnormally bigger waist circumference as compared to the males. An increase in weight circumference was observed in 40% of the whole sample, thus implying that 40% of them were at risk and could acquire MetS. An estimated 25% showed evidence of raised triglycerides and hypertension. Hypertension was found to be prevalent among the male subjects more than the female subjects. Prevalence on the number that met the MetS criteria stood at 12.5% (Ward, 2011, p. 112). A majority of these subjects were hypertensive (75%) and their BMI ranged between 28.1 kg m 2 and 43.1 kg m 2. The subjects also had abnormal lipid levels-high triglyceride (87%) and low high density lipids (75%), (Ward, 2011, p. 111). Analysis and Discussion: The prevalence of those that met the MetS criteria at 12.5% shows that the prevalence of MetS is high in FEP (Ward, 2011, p. 112). This implies that it also has a high significance for a number of resultant cases of morbidity and mortality. The differences in various variables imply that both groups are at risk of developing MetS. The female subjects were at a higher risk of developing morbid obesity than their male counterparts. On the other hand, the male subjects showed raised hypertension that could expose them to more cardiopulmonary conditions as compared to the females. Therefore, hypertension, abnormal lipid levels and weight gain were common side effects that could be associated with SGAs. Critique and Evaluation: The findings from this research show significant side-effects related to weight gain, lipid levels and hypertension. The high percentages indicating high abnormal lipids (87% and 75%) as well as the high percentage (75%) of hypertensive cases shows a significant effect on the users of SGAs which calls for closer metabolic screening and monitoring (Ward, 2011, p. 111). The conducting of the research failed to take into account other potential influencing factors such as life style and eating habits, which could significantly affect results. The research also failed to look into the possibility of insulin resistance development, probably due to restrictions on its scope. Except for the highlight on Clozapine and mood stabilizers, the overall findings show an overview of SGAs in general but fail to offer insight into the differential effects of specific pharmacologic combinations. As such, the information may not be helpful in prescriptive terms, however; it helps in understanding the potential complications that may arise. Conclusion: The results conclusively show that over 70% of young subjects undergoing FEP treatment with SGAs had MetS or showed some form of metabolic disorders. The rate of prevalence is very high and the results reaffirm findings from previous researches. The duration of treatment also showed significant influence on effect and medication type also had significance with the highlight to Clozapine and mood stabilizers showing significant effect in weight gain. The female users of SGAs for FEP are at greater risk of morbid obesity than males, whereas; males are at a higher risk of being hypertensive than their female counterparts. The effects of the SGAs call for early intervention through lifestyle or drug changes. Implications: The findings show that there is a greater need for conducting metabolic screening and regular monitoring of cardio-metabolic parameters (Ward, 2011, p. 113). The use of SGAs in FEP among young people should also be accompanied information on lifestyle so as to counteract the side-effects of SGAs that may lead to further harmful conditions such as morbid obesity, diabetes and cardiopulmonary problems. There is also a need for future analysis of individual drugs and their effects as well as the combinational effects of different pharmacologic regimes in FEP. Introduction and relevance identification: The second article under review is titled “Effect of treatment on weight gain and metabolic abnormalities in patients with first-episode-Psychosis.” The article reveals findings of a naturalistic and prospective study that looks into the effects of SGAs on the young populace under FEP treatment. The article was authored by Poon, Y. L. Subramaniam, M. Liew, A. and Verma, S. The 2009 article appeared in the Australian and New Zealand Journal of Psychiatry, volume 43, in issue 1. The research findings presented through the article offer insight into how SGAs affect weight gain and serum levels of insulin, lipids and glucose (Poon, 2009, p. 812). Background: FEP patients have shown good response and positive functional outcomes from SGA treatment, and as such SGAs remain the main pharmacologic treatment in use (Poon, 2009, p. 812). However, the FEP patients are more sensitive to their effects which are negative in nature. The SGAs present challenges in lipid and glucose metabolism as well as weight gain to the young users that may have to use the drugs for a longer time in to the future. As such, psychiatrists find that they are challenged with a multifaceted problem when using these drugs. The drugs introduce a new problem to the psychiatrists-patients begin worrying about their weight and image as well as possible rejection due to being overweight (Poon, 2009, p. 812). This doubles their worry, because they are both psychotic and overweight-a combination that could further lowers their self-esteem and worsens their physical and psychosocial condition. This dilemma has at times led to non-compliance because patients fear gaining weight and as such end up compromising the overall treatment. As such, it becomes not only necessary to review the occurrence of these conditions, but also their effects. Overview: The overall results showed an increase in total serum cholesterol, low density lipids and triglycerides within the first six months of treatment. There were no observed insulin and glucose levels. 12.6% of participants lost weight, 5.4% had no changes and 79.2% experienced gains on weight (Poon, 2009, p. 812). The overall mean increase in weight was 6.297%. Out of the gainers 65% showed clinically significant weight gains. Logistical regression analysis showed that gender, initial Body Mass Index (BMI), age and triglyceride levels were significant predictors of weight gain (Poon, 2009, p. 814). Analysis and Discussion: The changes in serum lipid levels and weight recorded at six months after baseline was significant in clinical terms and as such, a point of concern. The 79.2% weight gain for patients shows that both FGAs and SGAs cause significant gains in weight (almost half of the participants were on SGAs, whereas the rest were on FGAs) (Poon, 2009, p. 814). The percentage of participants that gained clinically significant weight stood at 65%, and this implies that the outcome is significant and a cause for worry, if most of such participants were to go non-compliance because of fear of the side-effects. The observed lipid level changes were not significant clinically because they fell within normal limits, but this change should also be a cause of concern because it only occurred within 6 months only. This implies that the effect may be significant in the long run. Critique and Evaluation: The 79.2% overall weight gain and 65% clinically significant weight gain is a portrayal of the great potency of both SGAs and FGAs causing weight gain in FEP patients. However, the research failed to have a clear separation between SGA treated and FGA treated groups so as to develop a comparative view of the findings. There should have been a statistical analysis to determine whether there was significant differential influence between the two. Similarly, differences in prescription should have also been incorporated, because some psychiatrists may prescribe antipsychotics with less weight-changing effects to patients perceived to be overweight, and this may finally have affected the results (Poon, 2009, p. 815). The lack of a control group did not also allow the monitoring of ‘normal’ weight gain (Poon, 2009, p. 816. Conclusion: The results from this research show that there is no significant effect of antipsychotics on insulin and glucose levels. However, both generations of antipsychotics are found to be significant causes of weight gain and elevation of lipid levels in blood serum. Therefore, despite the antipsychotic generation under use, all patients are at a significant risk of acquiring MetS syndrome and other related problems such as morbid obesity. Implications: The findings show that there should be regular metabolic screening for all patients in order to monitor the effects of this regime of drugs. The administration of all antipsychotics should thus be followed by advice to patients on how to adjust their lifestyle accordingly so as to avert the challenges posed by the antipsychotics. Introduction and relevance identification: The second article under review is titled “First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis.”The article was authored by Ismail, K. Woodward, M. Holt, G. I.R. Peveler, C. R. Hopkins, C. and Smith, M. The 2008 article appeared in the British Journal of psychiatry, volume 192; issue number 1.The article presents results of a meta-analytical research that compares the diabetes risk posed by different antipsychotics used by schizophrenics (Ismail, 2008, p. 406). Background: The higher occurrence of diabetic conditions among patients using antipsychotics for schizophrenic treatment has been mostly attributed to the use of antipsychotics, and more so SGAs. However, there has been no substantial evidence that has undergone a systematic review. As such, the researchers that presented this information sought to find out the diabetic risk posed different antipsychotics (Ismail, 2008, p. 407). Overview: The research found 11 studies that had the criteria for inclusion and enough data for analysis. The relative diabetes risk in individuals undergoing schizophrenia treatment with prescriptions of the SGAs versus FGAs was 1.32 (95% CI 1.15–1.51). There was a variability of 80% (95% CI 66–89) across the studies, which was attributed to heterogeneity. The heterogeneity test was significant with a level of (P Read More