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The Weight of Evidence: The Role of Metformin in Cardiometabolic Protection in Early Psychosis.

The Weight of Evidence: The Role of Metformin in Cardiometabolic Protection in Early Psychosis.

The relationship between weight gain and the treatment of first episode psychosis (FEP) with psychotropic medication is well established, with weight gain and increased cardiovascular risk as common sequelae. Such metabolic abnormalities create further disease burden and shorten the life expectancy of a population already dealing with mental illness. Antipsychotic-induced weight gain has been shown to commence within the first months of initiating treatment in drug-naïve youth, thus early intervention is necessary in order to attenuate the progression of metabolic abnormalities. Initial studies using metformin in this population have shown promising results.

This study aimed to examine the efficacy of initiating metformin in FEP youth (aged 15-25) who were engaged in treatment with the Early Psychosis Program (EPP) in Sydney, Australia, following clinically significant weight gain. Baseline anthropometric and fasting pathology measures (weight, BMI, waist circumference, BP and plasma glucose and lipids) were obtained in all EPP clients. Metformin was recommended to those who gained ≥ 7% of baseline weight. Findings were compared to data from those who were not prescribed metformin matched for age, sex and use of clozapine.

There was evidence that metformin either halted the deterioration of anthropometric measures and lowered blood pressure. There was no evidence that metformin decreased fasting blood sugars, which were at pre-diabetes threshold at the time of metformin initiation. Not all of the changes observed could be ascribed to metformin per se, as this was a naturalistic study in which patients were prescribed a range of antipsychotic medications. Conclusions: These findings suggest that large-scale clinical efficacy studies are warranted to augment the evidence-base provided by randomised controlled trials.

Speakers: Philip Ward
Conference: MAPrc
Areas of Interest / Categories: MAPrc 2014

MAPrc 2014

The effect of symptomatic improvement on gamma synchrony in psychosis: a pilot study.

Impaired functional connectivity, as measured by synchronous gamma activity, has been observed in both the early and chronic stages of schizophrenia, as well as in unaffected first-degree relatives. This suggests gamma synchrony may be a trait-like marker of psychosis susceptibility, and not just a state-dependant characteristic. To conduct a pilot study into the short-term temporal stability of gamma synchrony and its relationship to symptomatic improvement in young patients who have been treated for recent onset psychosis. 20 medicated subjects underwent both clinical (PANSS) and electrophysiological (auditory oddball task during EEG) evaluation at both baseline and 8 weeks follow-up.

The effect of symptomatic improvement on gamma synchrony in psychosis: a pilot study.

Impaired functional connectivity, as measured by synchronous gamma activity, has been observed in both the early and chronic stages of schizophrenia, as well as in unaffected first-degree relatives. This suggests gamma synchrony may be a trait-like marker of psychosis susceptibility, and not just a state-dependant characteristic. To conduct a pilot study into the short-term temporal stability of gamma synchrony and its relationship to symptomatic improvement in young patients who have been treated for recent onset psychosis. 20 medicated subjects underwent both clinical (PANSS) and electrophysiological (auditory oddball task during EEG) evaluation at both baseline and 8 weeks follow-up.

Cerebral cortical grey matter deficits in schizophrenia and their associations with ageing, psychopathology, cognition and treatment response.

The diagnosis of schizophrenia lacks a broadly accepted biological basis and its heterogeneity may well represent a group of disorders with different aetiologies. Even so, brain imaging can map and quantify structural brain abnormalities in vivo as an intermediate (or endo-) phenotype of the disorder. To identify the degree of regional grey matter deficits in relation to age, the severity of psychopathology and cognitive/ neurological impairment, and treatment response in schizophrenia. Eighteen schizophrenia patients (32.2 years [SD 14.3], meeting DSM-IV criteria were examined. Eighteen pair-wise age (±2 years) and gender-matched healthy volunteers (31.9 years [SD 14.3]) served as control group.

The effect of Ketamine on striatal functional connectivity as a model for risk for psychosis.

Ketamine is a potent antagonist of the N-methyld-aspartate receptor that induces positive psychotic symptoms in healthy individuals reminiscent of those seen in people with schizophrenia. Ketamine is believed to act by imposing a broad modulatory effect on brain networks, particularly cortico-striatothalamic circuitry. To investigate the effect of a sub-anaesthetic dose of ketamine on the resting-state functional connectivity of dorsal and ventral corticostriatal circuits, structures that have strongly been implicated in the emergence of psychotic symptoms, and to characterize the symptom correlates of putative changes in cortico-striato-thalamic functional connectivity induced by ketamine infusion.

Determinants of high smoking rates among people with psychosis living in a socially disadvantaged region in South Australia.

People suffering from psychiatric illness have alarmingly higher smoking rates than the general population, up to 80% in some cases. This has previously been attributed to measures of social disadvantage and poor economic well-being. This study aimed to identify factors associated with the high rates of tobacco smoking amongst people with psychosis living in a disadvantaged region in Adelaide, South Australia. We hypothesised that whilst tobacco use by people with psychosis living in this region was primarily associated with mental illness, smoking prevalence would be further increased by the disadvantaged conditions existing within this context. Data were collected from 402 people with psychosis aged 18-64 who resided in the Northern suburbs of Adelaide. Demographic data and lifestyle variables were assessed that may be accountable for smoking prevalence. 74% of men and 71% of women with psychosis were current smokers. Factors including unemployment, lower education, and receiving government welfare known to be associated with smoking in the general population, were more prevalent in the Northern region.

A healthy lifestyle intervention among people with psychotic disorders: Results from a RCT.

People with psychotic disorders have higher rates of CVD risk factors compared to the general community. To our knowledge, this is the first RCT of its kind. To determine the efficacy of a multi-component intervention (smoking, diet and activity) delivered face to face compared to a largely telephone delivered intervention (smoking) among smokers with psychotic disorders. Participants with psychotic disorders residing in the community and smoking =15 cigarettes/day (CPD) were randomly assigned to either condition.

Schizophrenia and neurodevelopment – Where do we stand today?

The schizophrenia brain is differentiated from the normal brain by subtle changes, with significant overlap in measures between normal and disease states. For the past 25 years, schizophrenia has increasingly been considered a neurodevelopmental disorder. This frame of reference challenges biological researchers to consider how pathological changes identified in adult brain tissue can be accounted for by aberrant developmental processes occurring during fetal, childhood or adolescent periods. The objective is to place schizophrenia neuropathology in a neurodevelopmental context. This requires solid, scrutinized evidence of changes occurring during normal development of the cerebral cortex. We review literature on the development of the prefrontal cortex and chart major molecular and cellular events on a similar time line. Whilst neurogenesis, neuronal migration and myelination undergo most dramatic changes prenatally, these processes also extend into adolescence.