A Study Of Abnormal Glucose And Lipid Metabolism In Patients With Schizophrenia

Objective:Abnormal glucose and lipid metabolism in schizophrenia with antipsychotic treatment have become more apparent and impact seriously on the efficacy of mental illness. It has become a thorny issue in the clinical treatment of antipsychotic. It has been suggested that these could be secondary to the use of antipsychotics. However, some researches indicate that abnormal glucose metabolism may be potentially involved in the pathogenesis of schizophrenia. There is no direct evidence that there are common genetic disease in schizophrenia and metabolic disorders. And we do not sure that how antipsychotics affect the regulation of glucose and lipid metabolism. This study mainly focus on the abnormal glucose and lipid metabolism in the process of treatment with antipsychotics, who are the first onset and not used antipsychotic drugs in patients. In our study, we also research glucose and lipid metabolism in the pathogenesis of schizophrenia. We want to provide the relationship between the clinical evidence of abnormal metabolism in patients with schizophrenia and the treatment period with antipsychotics. In the further, it may provide a theoretical basis and provide reference for clinical standardized management of patients with schizophrenia.Methods:The study constitute of animal experiments and clinical trials, be divided into three parts.The first part of the experiment is to explore the impact of antipsychotics on glcose and lipid metabolism in normal population. In this part, normal SD rats were given six weeks of antipsychotics (haloperidol, aripiprazole, olanzapine). During the observation, water weight, GH, COR, Leptin, INS, IGF-1、IGFBP-1、IGFBP-3were measured and made side-by-side comparison between them.The second part of the experiment is to explore whether the schizophrenia who is first onset and not used antipsychotic drugs have abnormal glucous lipid metabolism. We also research the relationship between the treatment efficacy and the medication cycle. This Part collect of61patients with first-episode schizophrenia. The observed incidence for the first time, never used antipsychotic drugs in patients with schizophrenia. Body mass index, waist circumference, plasma glucose, CHOL, TGL, HDL, VLDL, glucose and lipid metabolism associated factor levels were tested in1,4,8,12th week after antipsychotics olanzapine treatment. PANSS rating scale before and after treatment of psychiatric symptoms at the same time. The third part of the study is to investigate the glucose and lipid metabolism in the normal first-degree relatives of schizophrenia. This section collects60the normal first-degree relatives of schizophrenia and60cases of normal control. The body mass index, waist circumference, plasma glucose, plasma GH, COR, Leptin, INS, IGF-1, IGFBP-1, IGFBP-2, IGFBP-3were tested and made comparison each orther.Results:The first part of the experiment show that the groups administered antipsychotic show the increase of the consumed amount of water and food, following with lower lever in plasma GH, COR, Leptin INS after6weeks. However, the plasma IGF-1level in the group given olanzapine rat was significantly lower than aripiprazole, haloperidol and saline groups and the difference was statistically significant (P<0.05). But the difference between aripiprazole, haloperidol and saline was not statistically significant (P>0.05).The second part of the experiment show that PANSS total score have significant decrease compared with the before after12weeks of treatment given olanzapine and the difference was statistically significant (P<0.05); The plasma glucose, CHOLTGL and VLDL levels were higher than pre-treatment in the1week after treatment,4weeks,8and weeks and12weeks and the difference was statistically significant (P <0.05). The result also show that the difference become more obvious with the extension of the treatment cycle.The third part show that the body mass index, waist circumference, plasma glucose, plasma GH, COR, Leptin, INS, IGF-1, IGFBP-1, IGFBP-2, IGFBP-3in the normal first-degree relatives have a higher level compared with the normal, and there are significant differences (P<0.05).Conclusion:In this study, by binging animal experiments with clinical trials, we investigate glucose and lipid metabolism in the schizophrenia treatment with antipsychotic. The main conclusions are as follows:(1) The level of glucose and lipid metabolism of normal individuals may be affected by antipsychotic drugs, and atypical antipsychotics is most manifest on glucose and lipid metabolism.(2) Olanzapine significantly improved psychotic symptoms. PANSS scale score was significantly reduced in a12-week olanzapine treatment, suggesting that olanzapine treatment of patients with first-episode schizophrenia drug of choice, the curative effect is obvious; but in Austria olanzapine treatment after4weeks, lipid metabolism parameters were significantly increased. (3) The plasma insulin levels in normal first-degree relatives of patients were significantly higher than that in the control group and IGF-1was significantly lower than the control group, suggesting that first-degree relatives of schizophrenia there is a high risk of abnormal glucose and lipid metabolism.In conclusion, through animal experiments and clinical observations, this study firstly fouce on the impact of antipsychotic drugs on normal glucose and lipid metabolism. Simultaneously, in clinical trials, using single agent (olanzapine), we detect plasma glucose and lipid metabolism in the different treatment period. Glucose and lipid metabolism associated with the treatment of patients with schizophrenia can be more accurate and comprehensive evaluation. This study provide a theoretical basis for clinical treatment and prevention of metabolic disorders associated with the treatment of schizophrenia.