Ethnic heterogeneity in glucoregulatory function during treatment with atypical antipsychotics in patients with schizophrenia

Marilyn Ader, W. Timothy Garvey, Lawrence S. Phillips, Charles B. Nemeroff, Georges Gharabawi, Ramy Mahmoud, Andrew Greenspan, Sally A. Berry, Dominique L. Musselman, Jacqueline Morein, Young Zhu, Lian Mao, Richard N. Bergman

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Objective: Atypical antipsychotics induce weight gain and are linked to increased diabetes risk, but their relative impact on factors that elevate disease risk are unknown. Methods: We performed a 6-month, randomized, double-blind study to evaluate the effects of risperidone and olanzapine in patients with schizophrenia. At baseline and weeks 6 and 24, we quantified: (1) total adiposity by DEXA, (2) visceral adiposity by abdominal CT, and (3) insulin sensitivity (SI) and (4) pancreatic function ("disposition index", DI) by intravenous glucose tolerance test. Results: At baseline, groups (risperidone: n = 28; olanzapine: n = 31) were overweight or obese by body mass index (risperidone: 28.4 ± 5.4, olanzapine: 30.6 ± 7.0 kg/m2). Both drugs induced weight gain (p < 0.004). Total adiposity was increased by olanzapine at 6 weeks (p = 0.0006) and by both treatments at 24 weeks (p < 0.003). Visceral adiposity was increased by olanzapine and risperidone by 24 weeks (p < 0.003). SI did not deteriorate appreciably, although a downward trend was observed with risperidone. Given known ethnic differences in adiposity and SI, we performed secondary analysis in African American and Hispanic subjects. In this subset, olanzapine expanded both total and visceral adiposity (p < 0.02); no increase was observed with risperidone. There were modest downward trends for SI with both treatments. By week 24, olanzapine-treated subjects exhibited diminished DI (p = 0.033), indicating inadequate pancreatic compensation for insulin resistance. Conclusions: This is the first prospective study in psychiatric patients that quantified antipsychotic effects on the multiple metabolic processes that increase diabetes risk. Results indicate that ethnic minorities may have greater susceptibility to antipsychotic-induced glucoregulatory complications.

Original languageEnglish (US)
Pages (from-to)1076-1085
Number of pages10
JournalJournal of Psychiatric Research
Volume42
Issue number13
DOIs
StatePublished - Oct 2008

Keywords

  • Diabetes
  • Minorities
  • Olanzapine
  • Risperidone
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Psychology(all)

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    Ader, M., Garvey, W. T., Phillips, L. S., Nemeroff, C. B., Gharabawi, G., Mahmoud, R., Greenspan, A., Berry, S. A., Musselman, D. L., Morein, J., Zhu, Y., Mao, L., & Bergman, R. N. (2008). Ethnic heterogeneity in glucoregulatory function during treatment with atypical antipsychotics in patients with schizophrenia. Journal of Psychiatric Research, 42(13), 1076-1085. https://doi.org/10.1016/j.jpsychires.2008.01.004