cardiovascular-agents and Schizophrenia

Metabolic syndrome is a constellation of clinical findings that identify individuals at higher than normal risk of developing diabetes mellitus or cardiovascular disease. There are two principal definitions, one emerging from the American National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, and the other from the World Health Organization. Both definitions share the common elements of abdominal obesity, hypertriglyceridaemia, low HDL-cholesterol, hypertension and abnormal glucose regulation. The syndrome is relatively common across continents, and also among those without marked obesity. It is even more common among patients with major mental health disorders such as schizophrenia. Metabolic syndrome can be used to assess risk for cardiovascular disorder and death, and is an alternative to Framingham Risk Calculations. C-reactive protein may play an additional role in risk prediction. Ongoing monitoring for all components of the metabolic syndrome is necessary. Individuals at high risk require multimodal interventions, including lifestyle interventions and targeted medications as appropriate.

Topics: Adult; Antipsychotic Agents; C-Reactive Protein; Cardiovascular Agents; Cardiovascular Diseases; Diet; Exercise; Female; Humans; Life Style; Male; Metabolic Syndrome; Middle Aged; Risk Assessment; Risk Factors; Risk Reduction Behavior; Schizophrenia; Schizophrenic Psychology; Terminology as Topic; Time Factors; Treatment Outcome

Reports of decreased mortality among patients with schizophrenia who use clozapine may be biased if clozapine is prescribed to relatively healthy patients and if intensive monitoring during its use prevents (under-treatment of) somatic disorder. We aimed to assess whether there is a difference in: (1) somatic comorbidity between patients who start with clozapine and those who start with other antipsychotics and (2) prescribed somatic medication, between patients using clozapine and those using olanzapine. Cohort study based on insurance claims (2010-2015). After selecting new users of antipsychotics and those who subsequently switched to clozapine (N = 158), aripiprazole (N = 295), olanzapine (N = 204) or first-generation antipsychotics (N = 295), we compared the clozapine starters to others on cardiovascular or diabetic comorbidity. Those using clozapine and olanzapine were compared on new prescriptions for cardiovascular or antidiabetic drugs. The ORadj of cardiovascular or diabetic comorbidity among other starters compared with clozapine starters was 0.77 [95% confidence interval (CI): 0.43-1.39], that is, a nonsignificantly increased prevalence associated with clozapine was found. Users of clozapine received significantly more new prescriptions for cardiovascular or antidiabetic medication (ORadj: 2.70, 95% CI: 1.43-5.08). Starters with clozapine were not cardiovascular/metabolic healthier than starters with other antipsychotics. During its use, they received more somatic treatment.

Topics: Aged; Antipsychotic Agents; Cardiovascular Agents; Cardiovascular Diseases; Clozapine; Diabetes Mellitus; Drug Administration Schedule; Drug Monitoring; Female; Health Status; Humans; Hypoglycemic Agents; Insurance Claim Review; Male; Middle Aged; Netherlands; Schizophrenia

Cardiovascular (CV) co-morbidity is one of the major modifiable risk factors driving the excess mortality in individuals with schizophrenia or bipolar disorder. Population-based studies in this area are sparse.. We used Danish population registers to calculate incidence rate ratios (IRRs) for CV drug use, and mortality rate ratios comparing subjects with schizophrenia or bipolar disorder with subjects with no prior psychiatric hospitalization.. IRRs for CV prescriptions were significantly decreased in patients with schizophrenia or bipolar disorder compared with the general population. Among persons without previous myocardial infarction (MI) or cerebrovascular disease, persons with schizophrenia or bipolar disorder had an up to 6- and 15-fold increased mortality from all causes or unnatural causes, respectively, compared with the general population, being most pronounced among those without CV treatment (16-fold increase). Among those with previous MI or cerebrovascular disease, excess all-cause and unnatural death was lower (up to 3-fold and 7-fold increased, respectively), but was similar in CV-treated and -untreated persons.. The present study shows an apparent under-prescription of most CV drugs among patients with schizophrenia or bipolar disorder compared with the general population in Denmark. The excess of mortality by unnatural deaths in the untreated group suggests that the association between CV treatment and mortality may be confounded by severity of illness. However, our results also suggest that treatment of CV risk factors is neglected in these patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bipolar Disorder; Cardiovascular Agents; Cardiovascular Diseases; Child; Denmark; Drug Prescriptions; Female; Humans; Male; Middle Aged; Registries; Schizophrenia; Young Adult

A 42-year-old obese man presented with acute pulmonary edema. He had a history of chronic residual schizophrenia for which he had been taking clozapine for 7 years, but had no known prior cardiac disease. Echocardiography demonstrated severe biventricular systolic and diastolic dysfunction with severe left ventricular enlargement. Cardiac catheterization showed no coronary artery disease.. Physical examination, chest radiography, electrocardiography, transthoracic echocardiography, laboratory testing, viral serology, cardiac catheterization, coronary angiography and abdominal and renal ultrasonography.. Clozapine-induced dilated cardiomyopathy.. Intravenous nesiritide, furosemide and morphine followed by oral heart-failure therapy comprising ramipril, metoprolol succinate, spironolactone, and furosemide. Clozapine therapy was withdrawn.

Topics: Administration, Oral; Adult; Antipsychotic Agents; Cardiac Catheterization; Cardiomyopathy, Dilated; Cardiovascular Agents; Clozapine; Coronary Angiography; Echocardiography; Humans; Infusions, Intravenous; Male; Pulmonary Edema; Schizophrenia; Treatment Outcome

Topics: Cardiovascular Agents; Ergot Alkaloids; Lysergic Acid; Oxytocics; Psychopathology; Schizophrenia

Topics: Carbohydrate Metabolism; Carbohydrates; Cardiovascular Agents; Ergot Alkaloids; Oxytocics; Schizophrenia; Succinates; Succinic Acid

Topics: Alkaloids; Cardiovascular Agents; Dihydroergotamine; Ergot Alkaloids; Humans; Schizophrenia; Secale