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Comprehensive further review of safety of atypical and conventional antipsychotics is needed.
- Mokhtar G E K N Isaac (5 December 2005)
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Mokhtar G E K N Isaac, Specialist Registrar Olad age and Genera;l Adult Psychiatry MRCPsych
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mokhtar.isaac{at}eastsussexcounty.nhs.uk Mokhtar G E K N Isaac
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Editor, I read with grate interest the paper of “Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol” by Zipursky, R. B. et all. It raises once more the issues of safety and tolerability of atypical and conventional antipsychotics. There are many publications that have looked at the issue of safety of atypical antipsychotics. Substantial evidence from a variety of studies showed side effects including diabetes, ketoacidosis, hyperglycaemia, obesity and lipid dysregulation in treated psychiatric patients ( Baptista et al 2002; Bergman&Ader 2005; Gury 2004; Melkersson & Dahl 2004; Lieberman et al 2003; Newcomer 2004 and 2005). There have been more significant side effects for special age groups including risk of increased death in elderly with dementia (Schneider 2005; Layton 2005) and more metabolic risk for children and adolescent treated with some of the atypical antipsychotics (Toren 2004). Despite the limitations mentioned in Zipursky’s paper and the added limitation of the use of specific age group (16-40 years old) and the data being collected more than 4 years ago, however the results are shedding more light on the harmful effects of some of the atypicals. I believe that a comprehensive review evaluating the real benefits and risks of both conventional and atypical antipsychotics is long overdue. Baptista,T.’ Kin, N.M., Beaulieu, S., de Baptista,E.A. (2002) Obesity and related metabolic abnormalities during antipsychotic drug administration: mechanisms, management and research perspectives. Pharmacopsychiatry. 2002 Nov;35(6):205-19. Bergman,R.N., Ader, M. (2005) Atypical antipsychotics and glucose homeostasis. J Clin Psychiatry. 2005 Apr;66(4):504-14. Gury, C. (2004) Schizophrenia, diabetes mellitus and antipsychotics. Encephale. 2004 Jul-Aug;30(4):382-91. Lindenmayer, J. P., Czobor, P., Volavka, J., et al (2003) Changes Changesin in glucose and cholesterol levels in patients with schizophrenia treated with typical or atypical antipsychotics. American Journal of Psychiatry, 160, 290 –296 Layton, D., Harris, S., Wilton, L.V., Shakir, S.A. Comparison of incidence rates of cerebrovascular accidents and transient ischaemic attacks in observational cohort studies of patients prescribed risperidone, quetiapine or olanzapine in general practice in England including patients with dementia. J Psychopharmacol. 2005 Sep;19(5):473- 82. Melkersson,K., Dahl, M.L. (2004) Adverse metabolic effects associated with atypical antipsychotics: literature review and clinical implications. Drugs. 2004;64(7):701-23. Newcomer, J.W.(2004) Metabolic risk during antipsychotic treatment. Clin Ther. 2004 Dec;26(12):1936-46. Newcomer, J.W. (2005) Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005;19 Suppl 1:1-93. Schneider, L.S., Dagerman, K.S., Insel, P., (2005) Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005 Oct 19;294(15):1934-43. Toren, P., Ratner, S., Laor, N., Weizman, A. (2004) Benefit-risk assessment of atypical antipsychotics in the treatment of schizophrenia and comorbid disorders in children and adolescents. Drug Saf. 2004;27(14):1135-56. Zipursky,R.b., Hongbin, G.u., Green, A. I., Perkins, D. O., et al. (2005) course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperido Br J Psychiatry 2005; 187: 537-543 |
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