Psychiatrists are doing a “modest” job of monitoring for weight gain, diabetes and other metabolic problems that may result from use of the newer antipsychotics for schizophrenia, researchers say.
Nearly all of the 258 members of the American Psychiatric Association in Georgia, Ohio and Iowa responding to a survey said they considered metabolic side effects serious or very serious, say researchers from the Medical College of Georgia, University of Iowa and Northcoast Behavioral Healthcare in Ohio.
However monitoring for these problems – including getting baseline data on personal and family health history as well as baseline and regular checks of height and body weight, waist circumference, blood pressure, fasting blood glucose and lipid levels – largely goes undone, researchers say of findings being presented during the 10th International Congress on Schizophrenia Research April 2-6 in Savannah, Ga.
“What we have found is that metabolic problems often associated with these drugs are a substantial concern and that clinicians are slowly beginning to change their practice to reflect that concern,” said Dr. Peter F. Buckley, lead investigator on the study and chair of the MCG Department of Psychiatry and Health Behavior.
Antipsychotics, such as clozapine and risperidone, which have come on the market in the last 10-15 years are touted for an improved ability to treat the delusions and hallucinations of schizophrenia without damaging muscle control, Dr. Buckley says. Parkinson-like tremors have been associated with older antipsychotics.
“These newer drugs are definitely more effective, they are just not without their own side effects,” Dr. Buckley says. “Some of those side effects fit unfortunately well with what’s happening in the world and America with rampant problems with obesity and type 2 diabetes.”
Groups such as the American Diabetes Association, the American Psychiatric Association and the American Association for Clinical Endocrinologists, have weighed in, making recommendations for evaluating and monitoring adverse metabolic effects. However, much like the current study, a 2004 phone survey of 300 psychiatrists commissioned by a pharmaceutical company showed while most were aware of metabolic consequences many had not incorporated recommendations for dealing with them into their practice.
“We still have a way to go,” says Dr. Buckley, who had just met with a young woman with schizophrenia already struggling with her weight. “I was telling her she needs a drug for her illness and that, unfortunately, there is also a risk that this drug will make her gain weight. She said she didn’t want to take it. I said you really don’t have a choice to take nothing. It’s awful having to present people with such difficult choices, especially when they’re already stressed dealing with mental problems,” he says.
Noncompliance has long been a problem for schizophrenics, because of movement problems associated with older drugs, and because many patients don’t realize they are ill, he says. The newer class of drugs work effectively to silence the over-communication in the brain that causes hallucinations, the hallmark of schizophrenia, by dampening the action of the neurotransmitter dopamine. Somehow in that process of altering brain chemistry, they also make people hungrier and likely alter metabolism, Dr. Buckley says.