Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India.
Neuropsychiatr Dis Treat. 2015 Mar 13;11:685-93. doi: 10.2147/NDT.S80925. eCollection 2015.
Patients with schizophrenia suffer high rates of metabolic derangements on some antipsychotic medications that predispose them to cardiovascular diseases. Keeping this fact in mind, we planned this open-label study to see the effect on various metabolic parameters after switching stable schizophrenia subjects, who had developed metabolic syndrome on olanzapine, to aripiprazole.
Sixty-two patients with schizophrenia who were stable on olanzapine and were fulfilling modified National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III) criteria for the presence of metabolic syndrome were enrolled on the study. Patients were randomly assigned either to switch to aripiprazole or to stay on olanzapine, on a 1:1 basis. Cross-tapering over a period of 1 month was done while switching patients to aripiprazole. Laboratory assessment for metabolic parameters was done at baseline, 8 weeks, and 24 weeks after enrollment; efficacy assessment was done using the Positive and Negative Syndrome Scale (PANSS) at baseline and 24 weeks, the Clinical Global Impressions severity subscale (CGI-S) at baseline, and the Clinical Global Impressions improvement subscale (CGI-I) at 24 weeks.
All parameters of metabolic syndrome (waist circumference, blood pressure, triglyceride level, fasting blood glucose, and high-density lipoprotein cholesterol) kept deteriorating in the stay group, compared with a continuous improvement in the switch group over time. At the end of the study, 26 patients (100%) from the stay group and 15 patients (42.8%) from switch group met the modified NCEP ATP-III criteria for presence of metabolic syndrome (P<0.001). There were no statistically significant differences between groups in psychopathology changes as measured by the PANSS total score and CGI-I scores.
Clinically stable patients with schizophrenia who are taking olanzapine and who have evidence of metabolic syndrome can be successfully switched to aripiprazole, with improvement in various parameters of metabolic syndrome and without any significant change in efficacy measures.
一些抗精神病药物会导致精神分裂症患者出现代谢紊乱，使他们易患心血管疾病。鉴于这一事实，我们计划进行这项开放性研究，以观察在改用阿立哌唑后，稳定期精神分裂症患者的各种代谢参数的变化。这些患者在使用奥氮平治疗期间出现了代谢综合征。
本研究纳入了 62 名稳定期精神分裂症患者，他们正在使用奥氮平，并且符合改良的美国国家胆固醇教育计划（NCEP）成人治疗专家组 III 期（ATP-III）代谢综合征的标准。将这些患者随机分为两组，一组换用阿立哌唑，一组继续使用奥氮平，两组比例为 1:1。在换用阿立哌唑的过程中，进行为期 1 个月的交叉减量。在基线、8 周和 24 周时检测代谢参数；在基线和 24 周时使用阳性和阴性综合征量表（PANSS）评估疗效，在基线时使用临床总体印象严重程度量表（CGI-S）和 24 周时使用临床总体印象改善量表（CGI-I）评估疗效。
与换用阿立哌唑组的代谢综合征各项参数持续改善相比，继续使用奥氮平组的代谢综合征各项参数（腰围、血压、甘油三酯水平、空腹血糖和高密度脂蛋白胆固醇）持续恶化。研究结束时，继续使用奥氮平组的 26 名患者（100%）和换用阿立哌唑组的 15 名患者（42.8%）符合改良的 NCEP ATP-III 代谢综合征标准（P<0.001）。PANSS 总分和 CGI-I 评分显示，两组之间的精神病理学变化无统计学差异。
可以成功地将服用奥氮平且有代谢综合征证据的稳定期精神分裂症患者换用阿立哌唑，可改善代谢综合征的各项参数，且疗效无明显变化。
