Article Text

  1. V. Kafantaris,
  2. E. Saito,
  3. A. Berest,
  4. C. Dombrowski,
  5. J. Hirsch
  1. North Shore-LIJ, Research Institute, Glen Oaks, NY


Background Metabolic syndrome can be a serious complication of treatment with psychotropic medications, particularly the atypical antipsychotics.

Method Adolescents with bipolar I disorder who were taking at least one mood stabilizer (divalproex sodium and/or lithium) and an antipsychotic medication (aripiprazole, olanzapine, risperidone, quetiapine, or ziprasidone) were assessed at baseline and every 12 weeks thereafter. We defined the metabolic syndrome as three or more of the following five criteria: (1) triglyceride level $ 110 mg/dL, (2) high-density lipoprotein (HDL) ≥ 40 mg/dL, (3) body mass index (BMI) $ 95th percentile, (4) fasting glucose level $ 100 mg/dL or fasting insulin level $ 17 μU/mL, and (5) blood pressure $ 90th percentile. We present the prevalence of the metabolic syndrome among adolescents with bipolar I disorder treated with psychotropic medications and compared subjects with metabolic syndrome to those without it on certain variables using t-tests.

Results Thirty-seven adolescents (20 M, 17 F, mean age = 14.90 years, SD = 1.83) with mean follow-up of 36.3 weeks (SD = 18.9) had at least two fasting laboratory evaluations 12 weeks apart. Twelve of the 37 adolescents (32.4 %) met criteria for metabolic syndrome at one or more time points. As expected, BMI at week 24 was significantly higher in the group with metabolic syndrome (mean BMI = 32.8 kg/m2) than without (mean BMI = 25.0 kg/m2, p < .0001). We compared the 12 subjects who “ever met” criteria with those who “never met” criteria on age, gender, race, BMI, fasting glucose level, insulin, lipid profiles. The baseline BMI (p < .0185), weight (p < .0094), glucose (p < .0678) and insulin levels (p < .0793), and HOMA (p < .0432) were significantly higher in the ever-met group compared to never-met group.

Conclusions About one-third of our study sample developed the metabolic syndrome during treatment with a combination of a mood stabilizer and an atypical antipsychotic medication. Those subjects had significantly higher baseline weight, BMI, fasting glucose and insulin levels, and HOMA.

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