Association of weight gain and metabolic syndrome in patients taking clozapine: an 8-year cohort study.

INTRODUCTION: Metabolic syndrome is an important side effect associated with clozapine. It has been hypothesized that weight gain contributes to the development of metabolic syndrome, but a direct diabetogenic effect has also been suggested. We conducted an 8-year cohort study to determine the association between weight gain and metabolic parameters among schizophrenic patients taking clozapine. METHOD: This study is a retrospective cohort study combining a cross-sectional survey of metabolic syndrome and retrospective chart review. The subjects were hospitalized schizophrenic patients (DSM-IV) who began to receive clozapine at least 3 months before the survey (March to September 2005) and subsequently had monthly body weight monitoring. Anthropometric and biochemical measurements were performed to determine the presence of metabolic syndrome. The chart reviews were conducted to obtain gender, age at initiation of clozapine treatment, baseline body mass index (BMI), BMI changes after the initiation of clozapine treatment, treatment duration with clozapine, and concomitant psychotropic medications. RESULTS: One hundred eighty-nine patients were maintained on clozapine for a mean ± SD treatment duration of 57.6 ± 27.3 months (range, 5-96). The prevalence of metabolic syndrome was 28.4%. The cohort regression models showed that baseline BMI (P < .01) and BMI change after clozapine treatment (P < .01) were significant factors for metabolic syndrome and 4 metabolic parameters except hyperglycemia, which was related to treatment duration (P < .05). CONCLUSIONS: For patients treated with clozapine, metabolic syndrome and most metabolic parameters were related to weight gain; however, glucose dysregulation was associated with treatment duration independent of weight gain. The results confirm that monitoring body weight is important, but periodic monitoring of blood sugar may also be required for clozapine patients who do not have significant weight gain.

Adiponectin as a potential biomarker for the metabolic syndrome in Chinese patients taking clozapine for schizophrenia.

OBJECTIVE: As the metabolic syndrome is an important side effect of some antipsychotics, use of a biomarker will enable clinicians to identify metabolic changes more effectively than anthropometry and biochemistry. Adiponectin, an adipocyte-derived hormone, serves as a central regulatory protein in many of the physiologic pathways controlling lipid and carbohydrate metabolism. The aim of this study is to determine the possible relationship between adiponectin and the metabolic syndrome among Chinese patients taking clozapine for schizophrenia. METHOD: The study sample consisted of 188 hospitalized Chinese patients with schizophrenia (DSM-IV criteria) who had been receiving clozapine for at least 3 months. Cross-sectional anthropometric measurements, biochemical analysis, and serum adiponectin levels were assessed to determine the prevalence of metabolic syndrome. Retrospective chart reviews were conducted to obtain demographic data, age at which clozapine treatment was initiated, and weight change after the initiation of clozapine treatment. The study was conducted from March to September of 2005. RESULTS: The prevalence of the metabolic syndrome was 28.4%. Adiponectin levels were negatively associated with weight change after the initiation of clozapine treatment, systolic blood pressure, diastolic blood pressure, body weight, body mass index (BMI), waist circumference, serum triglycerides, and insulin and were positively associated with high-density lipoprotein cholesterol. Multiple logistic regression analysis showed that age (OR = 1.083, p = .009), BMI (OR = 1.423, p < .001), and serum adiponectin (OR = 0.847, p = .01) each correlated significantly with the presence of the metabolic syndrome. CONCLUSION: Independent of age and BMI, hypoadiponectinemia is a potential biomarker of the metabolic syndrome in patients taking clozapine for schizophrenia.

The cost of schizophrenia treatment in Taiwan.

The costs associated with mental illness in Taiwan have been the subject of discussion and concern in Taiwan's Bureau of National Health Insurance. The authors report the first estimates of these costs on the basis of national data for 52,432 patients treated in 1999. Total schizophrenia-related health care expenditure was estimated at 112.4 million dollars, which constituted 1.2 percent of national health care expenditures that year. The cost per outpatient visit was 57 dollars, the cost per admission was 1,123 dollars, and the annual average direct cost of treating a person with schizophrenia was 2,144 dollars.