The time course of second generation antipsychotic metabolic side effects: results from a one-year prospective evaluation in a community mental health service

Object: Although many data have been accumulated on the metabolic side effects of SGAs (Second Generation Antipsychotics) during the last few years, some important questions remain unanswered. Most published studies have a retrospective design and derive from pre-existing data bases lacking importart clinical information and it is not clearly defined when and how the metabolic side effects arise. Moreover most of these studies are sponsored by pharmacological industries and may reflect a conflict of interests. Our study is a one of the few prospective studies carried out in the real practice world. It is aimed to evaluate the time course of metabolic disorders during the first 12 months of treatment. Method: This study is a one-year prospective non-controlled evaluation in a community mental health service. All patients starting a new SGA treatment (clozapine, olanzapine, risperidone or quetiapine) were enrolled. Planned assessments included fasting glucose, cholesterol, triglycerides and BMI (baseline and 4th, 24th, 48th week). Results: Thirty-nine outpatients provided complete blood samples. At the 24th week we observed an increase in mean BMI and a tendency for cholesterol to increase; at the 48th week we observed only an increase in mean BMI. No further metabolic worsening was observed after the first 6 months of treatment. All new cases of metabolic disorders occurred during the first 6 months of treatment. Conclusions: Our study highlights that weight gain and metabolic disorders begin to appear right from the first month of treatment and reach a peak at 6 months. Our results suggest that clinical attention right from the first month of SGA treatment could be possible an early detection of metabolic side effects and thus early monitoring could prevent the clinical consequence of metabolic disorders. Therefore, weight, glycaemia and lipaemia should be monitored routinely in clinical practice right from the first months of antipsychotic treatment.