항정신병약물 복용 환자들의 Hyperlipidemia와 Hyperglycemia 이환율에 관한 예비연구

Prevalence of Hyperlipidemia & Hyperglycemia Associated with Antipsychotics Preliminary Study

Objective: Weight gain and DM can be serious side effects in the use of atypical ahtipsychotics (AAP), although conventional antipsychotics (CAP) have also been implicated. Also weight gain & DM are the adverse effects that are often associated with noncompliance and medical problems. The relationship between weight gain, dyslipidemia and DM is well established. Patients with schizophrenia are not only at risk of DM, but a1so taking antipsychotic medication further increases the chance of developing non-insulin-dependent hyperglycemia. Thus, this pilot study was conducted to investigate the risk of hyperlipidemia & DM in Korean patients taking antipsychotic medications. Methods: After receiving informed consent, demographic data and history of medication were collected from medical records of 174 inpatients (92 male, 82 female). For the laboratory tests blood sampling was done at 7 A.M. before the meal and medication. Results: For all subjects, the mean age was 41.10±9.56 years (range 1465 years): 88% were diagnosed with schizophrenia. Of these, 55% were treated with antipsychotics alone (Monothcrapy) and 45% were treated with combination therapy (such as antipsychotics plus a mood stabilizer). The mean age of onset of illness was 24.8±47.25 years old and mean duration of admission was 45.44±133.84 months. In the monotherapy group, the duration & dosage of each medications were 42.1±60.5 weeks and 12.2±8.22 rng/day of haloperidol (N=35), 6.95±9.52 weeks & 5.03±1.88 mg/day of rispcridone (N=19), 9.1±11.1 weeks & 13.9±6.5 mg/day of olanzapine (N=8), 10.2±6.3 weeks and 287.6±62.9 mg/day of lodopinc (N=4), 15.7±9.54 weeks and 335±172.8 mg/day of clozapine (N=5), 20±22.23 & 620±265.9 mg/day of chlorpromazine (CPZ; N=5). Mean weight gains. of CAP group and AAP group, which was divided by the main therapeutic drug, were, 0.18±5.99 and 2.18±6.38 kg in total subjects, however. there was no statistical significance between the groups. Moreover there was no statistically significant difference in weight gain between groups when comparing each individual monotherapy (haloperidol, risperidone, olanzapine, lodopine, clozapine, CPZ: ANOVA; df=5, f=l.l2. p=0.35). In the laboratory test results of total subjects abnormali1y of total cholesterol was 23.6%. triglyceridc was 50.6%. fasting blood sugar (FBS) 1.7%, hemoglobin A1c (HbA1c) 27.6%, insulin 3.4%. There were statistical significances of correlations between HbA1c & FBS (r=O.489, p<0.01), total cholesterol (r=0.286, p<0.01), low density lipid (LDL; r=0.299. p<0.01) and triglyceride (TG; r=0.277, p<0.05), high density lipid (HDL; r=-0.192, p<0.05), original weight (r=0.154, p<0.05). With ANQVA for the evaluations of drug effect in mono therapy groups, the level of ALT (SGPT; p=O.04) Was higher in olanzapine group,, TG was higher in clozapine & en CPZ group (p=0.03). HDL was lower in lodopine, clozapine & CPZ group (p=0.01). LDL was highr in olanzapine & lodopine group (p=0.01), Abnormalities of ALT in olanzapine & clozapine group were 37.5% & 40%, those were statistically significant (p=0.02). Although there was no statislica1 significance (p=0.05), clozapine (60%), CPZ (60%) & olanzapine (37.5%) groups revealed more abundant ahormalities than haloperidol (11.4%) & risperidone (21 %) groups' in total cholesterol. CPZ (100%), clozapine (80%), lodopine (75%), olanzapine (75%) groups revealed more abundant abnormalities than haloperidol (48.6%) & risperidone (57.9%) groups in TG. however, there was no statistical significance. And the abnormality of HbA1c was 62.5% in olanzapine group and 40% in CPZ group, those were more abundant than other groups (20-25.1 %), even though no statistical significance. Conclusion: In the cases of Korean patients taking antipsychotic medication, the tentative risk me of hyperlipidemia