Metabolic Effects Associated With Atypical Antipsychotic Treatment in the Developmentally Disabled
J Clin Psychiatry 2005;66(9):1161-1168
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Objective: Atypical antipsychotics, especially
clozapine and olanzapine, have been increasingly
associated with weight gain and other adverse
metabolic events (diabetes mellitus, hyperlipidemia) in
non-mentally retarded populations. This report
explores the incidence of this phenomenon in an
institution-dwelling population of individuals with
Method: A retrospective longitudinal analysis
was performed for a sample of 41 adults with
developmental disabilities and comorbid psychiatric and/or
behavioral syndromes for whom treatment was
converted from typical antipsychotics to olanzapine or
risperidone for a minimum period of 2 years. Data were
collected from October 1998 to September 2002.
Among parameters analyzed were chlorpromazine
equivalent dosage of antipsychotic, metabolic parameters,
body mass index (BMI), level of concurrent
medications, and concomitant dietary restrictions.
Results: Thirty-two study subjects (78.0%)
were men. The mean age of the study subjects was
43.6 years (at the end of the study). Thirty-seven
(90.2%) had severe-to-profound mental retardation.
Eight (19.5%) were on a restricted diet. Twenty-three
subjects (56.1%) were switched from a typical
antipsychotic to olanzapine, and 18 subjects (43.9%)
were switched from a typical antipsychotic to
risperidone. Of the subsample of subjects who were switched
from a typical antipsychotic to risperidone, 12
(66.7%) went on to be switched to olanzapine because of
either emergent side effects or lack of efficacy. For
the overall sample (N = 41), there was a 19.3%
increase in chlorpromazine-equivalent antipsychotic
dosage from baseline to the 2-year endpoint along with
a 5.6% decrease in fasting blood glucose from
baseline to the 2-year endpoint. There were no significant
differences between baseline and endpoint values
for BMI, total cholesterol, low-density lipoprotein
cholesterol, or triglycerides.
Conclusion: The findings of this 2-year
evaluation suggest that clinically or statistically significant
BMI increases as well as blood glucose and lipid
elevations are not unavoidably correlated with the use of
the atypical antipsychotic agents olanzapine and
risperidone and may be minimized by careful monitoring,
a regimen of dietary control, and a moderate
activity level in a residential population of individuals
with mental retardation.