Jul-Sep, 2012 - Indian Journal of Pharmacy Practice

More documents

Recommendations

Info

Linu Mohan - Prevalence of Metabolic Syndrome in Psychiatric Outpatients in a Tertiary Care Hospital, Kerala.HDL-c levels decreased by a value of -8.08% and themean difference obtained are 4.920 with a p-value of 0.001.Therefore HDL-c is significantly causing MS.Triglyceride level was found increased by a value of3.18% .The mean difference is -4.320 and p-value is0.001. Hyperlipidemia is one of the main features ofmetabolic syndromeDISCUSSIONRecently there has been increased concern over the sideeffects of the atypical antipsychotic drugs, including diabetes,hyperlipidemia and obesity. The relationship between thesefactors and antipsychotic drugs requires a careful analysis.Metabolic syndrome (MS) is comprised of numerous factorswhich predict the risk of CVD and diabetes, which may occurdue to number of etiological factors but particularly withantipsychotic usage.In this study among seriously mentally ill patients, 38.5% metcriteria for the metabolic syndrome as defined by IDF. Thisrate is elevated, compared with the rate of 21.4% found in6studies in United States' general population. However it iscompatible with 38% prevalence rate in a study on in patientswith severe psychotic and mood disorders. A generalpopulation study from south India using IDF criteria put the7prevalence of MS at 25.8 percent.Metabolic syndrome in this study is higher in females andmore common in middle aged (30-50 yrs) group. This is inaccordance with general knowledge that females are moreprone to metabolic disorder as compared to males. Higher agein general make people more predisposed to metabolicsyndrome. The results were similar to those of others showing8preponderance of females among those with the MS.Interestingly, there were no associations between metabolicsyndrome and various lifestyle risk factors, such as smoking,alcohol consumption etc. Family history of diabetes andhypertension is not associated with risk of developingmetabolic syndrome; this indicates that other environmentalor acquired factors relating to the mood or psychotic illnesshave more influence in the development of metabolicsyndrome than genetic factors.In this study, prevalence of metabolic syndrome is higher inbipolar patients (44%) followed by OCD (20%).As theprevalence of metabolic problems is significantly higher inbipolar patients than others, pharmacologic treatment shouldbe implemented only after consideration of metabolic riskfactors. In particular, bipolar patients beginningpharmacological treatment for acute mood episodes may bemore vulnerable to metabolic derangements, becausesignificant weight gain has been shown to occur during acutetreatment with atypical antipsychotics in combination withmood stabilizers.The other important finding in this study is that the utilizationof atypical antipsychotics (eg. resperidone, clozapine,olanzapine, quietiapine) was not significantly associated withthe occurrence of metabolic syndrome. Abdul Hamid AbdulRahman et al conducted a study and found that the metabolicsyndrome is not associated with the anti psychotic therapy9(p=0.41). Some atypical agents cause substantial metabolicadverse effects. This is of concern because of the wellestablished excess of cardiovascular morbidity and mortalityin patients with schizophrenia that predates the widespreadintroduction of atypical agents. Individual drugs havediffering propensities to cause metabolic adverse effects.Results of this study shows that metabolic syndrome washigher in patients taking resperidone 17 (68%) followed byquietiapine 10 (40%).There are several reasons why severe mood and psychoticdisorders might be associated with higher rates of themetabolic syndrome. Certain lifestyles, such as sedentaryhabits and high fat and carbohydrate diets, are common inpeople with severe mental illness and are associated with the6,9metabolic syndrome. Finally, severe mood disorders andpsychotic disorders may predispose individuals tophysiological changes that increase the rate of the metabolicsyndrome.Abnormalities of glucose regulation, with a pattern of insulinresistance, have been described in schizophrenic patientseven before the development of illness and the use of10antipsychotic agents. Genetic risk factors, increased cortisollevels, unhealthy diet, lack of exercise, propensity for thedevelopment of abdominal obesity, and antipsychotictreatment might all be common factors in the etiology ofmetabolic syndrome in people with schizophrenia and11affective disorders. In two recent studies, Thakore et al.found increased central obesity in untreated first-episode12patients diagnosed with schizophrenia or major depression.Both depression and schizophrenia have been associated withdysregulation of the hypothalamic–pituitary–adrenal (HPA)axis, which has been implicated in the development of the13metabolic syndrome.Table 1: MS -baseline And Review Comparison.Metabolic Metabolic Syndrome (review)syndrome(baseline) Yes No Total df p-valueYes 16 0 16 1 0.001(100.0%) 0% (100.0%)No 9 1 40 498.4% 81.6% 00.0%Total 25 40 6538.5% 61.5% 100.0%Indian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 59
Linu Mohan - Prevalence of Metabolic Syndrome in Psychiatric Outpatients in a Tertiary Care Hospital, Kerala.Table 2: Family History of Risk FactorsFamily History Metabolic Total df p-valueSyndromeHypertension 9(36.0%) 25(100.0%) 1 0.362Diabetes 8(32.0%) 25(100.0%) 1 0 .865Table 3: Social HabitsSocial Habits Metabolic Total df p-valueSyndromeSmoking 2(8%) 25(100.0%) 1 0.403Alcoholic 3 (12.0%) 25(100.0%) 1 0.800Table 4: MedicationsMedications Metabolic Syndrome df p-valueResperidone 17 (68.0%) 1 0.217Olanzapine 6 (24.0%) 1 0.755Clozapine 0 1 0.066Quietiapine 10 (40.0%) 1 0.684Atypical + valproate 13 (52.0%) 1 0.176Total 25Fig. 2: Age Wise Distribution of the PatientsFig. 3: diagnosis and metabolic syndromeFig.1: Gender Wise distribution of the Study Population.CONCLUSIONIn conclusion, this study shows that in routine practice thenatural course of metabolic syndrome in patients withpsychotic disorders is dynamic. In one year follow-up aconsiderable number (25) of patients developed metabolicsyndrome. The clinical relevance of this study's findings ishigh–a positive detection of metabolic syndrome provides abaseline from which to monitor and treat any emerging (andpotentially life-threatening) cardiovascular problems.It have also been demonstrated that measuring the criteria formetabolic syndrome is quick, simple and inexpensive.Therefore, it is proposed that the measurement of themetabolic syndrome parameters (including the recording ofwaist circumference) become routine for psychiatric patients.BPAD –Bipolar affecting disorder, SAD –Seasonal Affective DisorderOCD –Obsessive Compulsive DisorderAbnormalities in either BP or waist circumference warrantscreening for the other components of the syndrome, morefrequent monitoring of fasting glucose and lipids, and furtherinterventions such as diet and exercise-counseling to reversethe changes. All patients taking atypical antipsychotics14require monitoring of weight, fasting glucose, and lipids.Failure to monitor metabolic parameters and intervene earlymay result in continued high rates of morbidity in severelymentally ill patients secondary to complications of CVD anddiabetes. Whether as a part of the illness or its consequence(change in lifestyle) or medication, patients with severemental illnesses have a high prevalence of metabolic1syndrome. With the Indian population already susceptible todevelop metabolic syndrome, screening of larger samples ofpatient with mental disorders and those who are receivingneuroleptic medication becomes essential. With a largeproportion of the country still having limited access toprimary care and with limited availability of laboratoryinvestigations, it becomes essential to at least performphysical measures in patients on antipsychotic medication.Regular screen for metabolic disturbances where facilities areavailable should be ensured. A prudent approach to caring forpersons with major mental illnesses involves monitoringcardio metabolic risk, including measurement of baseline andIndian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 60
Page 7:
Chang J - India's Progress towards
Page 10 and 11:
Ingle P.V - Sociocultural, Healthy
Page 12 and 13: Ingle P.V - Sociocultural, Healthy
Page 14 and 15: Ingle P.V - Sociocultural, Healthy
Page 16 and 17: Indian Journal of Pharmacy Practice
Page 18 and 19: Mahendra Kumar BJ - Drug Induced Sy
Page 20 and 21: Mahendra Kumar BJ - Drug Induced Sy
Page 25 and 26: Ramesh A - Prospective Monitoring a
Page 27 and 28: Ramesh A - Prospective Monitoring a
Page 29 and 30: Stejin J - Pharmacoeconomic Analysi
Page 31 and 32: Stejin J - Pharmacoeconomic Analysi
Page 35 and 36: Smitha F - A Retrospective Evaluati
Page 37 and 38: Smitha F - A Retrospective Evaluati
Page 41 and 42: Thomas D - Comparison of days lost
Page 45 and 46: Mohammed S.S - The Prevalence of Po
Page 47 and 48: Mohammed S.S - The Prevalence of Po
Page 49 and 50: Munsab Ali - Associated socioeconom
Page 51 and 52: Munsab Ali - Associated socioeconom
Page 53 and 54: Dilip .C - Prescription Monitoring
Page 55 and 56: Dilip .C - Prescription Monitoring
Page 57 and 58: Vijayakumar S - A Hospital Based Cr
Page 59 and 60: Vijayakumar S - A Hospital Based Cr
Page 61: Linu Mohan - Prevalence of Metaboli
Page 67 and 68: Mohammed Saleem TK - Assessment of
Page 73 and 74: Rao JR - Development and Validation
Page 79 and 80: Aishwaryalakshmi K - Assessment of
Page 81 and 82: Aishwaryalakshmi K - Assessment of
Page 83 and 84: Pawar V - A Possible Case of Filgra
Page 85 and 86: Instructions to AuthorsIntroduction
Page 87: Instructions to AuthorsElectronic j
show all

Jul-Sep, 2012 - Indian Journal of Pharmacy Practice

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?