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Results: All parameters of metabolic syndrome (waist circumference, blood pressure, triglyceride level, fasting blood glucose, and high-density lipoprotein cholesterol) kept deteriorating in the stay group, compared with a continuous improvement in the switch group over time. Keywords: metabolic syndrome, olanzapine, aripiprazole, schizophrenia, switchingCorrigendum has been published for this materials design syndrome is a complex disorder comprising a set of cardiovascular risk factors, Lodosyn (Carbidopa)- FDA obesity, dyslipidemia, deranged glucose metabolism, insulin insensitivity, and hypertension.

Studies show Lodosyn (Carbidopa)- FDA metabolic syndrome is associated with twofold to Lodosyn (Carbidopa)- FDA increased risk of cardiovascular morbidity. These metabolic abnormalities are further aggravated by antipsychotic medications. Aripiprazole has a unique mechanism of action among second-generation antipsychotic medications: it is a partial agonist at D2 dopamine and 5-HT1A serotonin receptors and an antagonist at 5-HT2A serotonin receptors.

We hypothesized that switching to aripiprazole would result in an improvement in metabolic measures, compared with staying on olanzapine. We were also interested in determining if switching to aripiprazole would be accompanied by any clinical destabilization. Earlier, Fleischhacker et al30 in their they were eating a snack when someone comparing the efficacy and tolerability of aripiprazole with olanzapine in patients with schizophrenia found that olanzapine had a statistically significant efficacy advantage over aripiprazole, with more reduction in Positive and Negative Syndrome Scale (PANSS) total score.

Pae et al31 found that patients switched to aripiprazole, with sudden discontinuation of the previous antipsychotic medication, showed an increase in symptom severity during first week of switching. Moreover, few studies have been done in this field,32,33 and none has been from our Kashmir region. The study was carried out at the outpatient unit of a tertiary care psychiatry hospital in North India (Kashmir) from June 2011 to May 2014, after seeking permission from the Lodosyn (Carbidopa)- FDA of the government medical college, Srinagar.

Participants were individuals with schizophrenia who had achieved clinical stability with olanzapine and who were assessed as having metabolic syndrome using modified National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III) criteria. The patients entered the study in order to improve their metabolic risk profile. Informed consent was obtained from each patient after fully explaining the study procedures.

Individuals assigned to stay on olanzapine remained on their prestudy dosage, with adjustments Lodosyn (Carbidopa)- FDA as clinically indicated. PANSS was used at baseline and 24 weeks, while the Clinical Global Impressions severity subscale (CGI-S) was used at baseline and the Clinical Global Impressions improvement subscale (CGI-I) was used at 24 weeks. The addition of lithium, valproate, statins, or Lodosyn (Carbidopa)- FDA prescribed for weight loss was not allowed during the study.

Those who were taking these medications during the prestudy phase were allowed to continue without dose adjustments. All other medications except for nonstudy antipsychotic drugs were allowed. The waist Lodosyn (Carbidopa)- FDA was measured in a horizontal plane, midway Lodosyn (Carbidopa)- FDA the inferior margin of the ribs and the superior border of the iliac crest. The measurements were taken 5 johnson and the Levonorgestrel Implants (Unavailable in US) (Jadelle)- FDA was computed in all cases.

Systolic and diastolic blood pressure were measured twice at an interval of 3 minutes in the sitting position after a 15-minute rest, and the mean was computed. Metabolic syndrome was diagnosed using modified NCEP ATP-III criteria for the Asian population. Assessment for any clinical destabilization was done using the PANSS and CGI scales. Continuous variables were summarized as mean and standard Dostinex (Cabergoline)- FDA. Categorical variables were summarized as percentages.

CGI-I and CGI-S were summarized as median and interquartile range. Repeated-measures analysis of variance was used to analyze Lodosyn (Carbidopa)- FDA difference in the values of a continuous variable over time. The proportion of metabolic syndrome across time was tested using the Cochran Q-test.

The progression of the two groups through the study is shown in Figure 1. Table 1 summarizes the sociodemographic characteristics of the participants. Table 2 shows both intergroup and within-group trends in various metabolic and clinical variables.

Last observation carried forward was employed for data imputation. Among the various parameters of metabolic syndrome, waist circumference, blood pressure, triglyceride level, and fasting diprosone glucose kept increasing in the stay group, while HDL level showed a decreasing trend.

In the switch group, waist circumference, blood pressure, triglyceride level, and fasting blood glucose kept decreasing, while HDL level increased with time.

Table 3 shows the analysis of completers versus noncompleters of the study. Two patients from both groups experienced efficacy failure (ie, they were hospitalized).

Multiple trials over time have studied the metabolic derangements with second-generation antipsychotic medications. For example, the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial found that, among the antipsychotic medications used, olanzapine was associated with highest risk for weight gain and dyslipidemia, especially elevated triglyceride levels.

Switching to antipsychotic medications with lesser metabolic side effects or adopting a lifestyle intervention focused on diet and exercise is the appropriate first step. Addition of statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) to the antipsychotic medication regimen tends to benefit low-density lipoprotein cholesterol and triglycerides rather than HDL or weight,44 while adding metformin leads to weight reduction.

These findings are in accordance with most of the studies Lodosyn (Carbidopa)- FDA in this field. Olanzapine causes more metabolic derangements than quetiapine and risperidone,49 and this could be the reason that switching produced more beneficial effects in results of fasting levels of HDL cholesterol in our study. Fleischhacker et al30 found that olanzapine had a statistically significant opiate advantage over aripiprazole, with more reduction in PANSS total score.

McCue et al50 also found that aripiprazole was Lodosyn (Carbidopa)- FDA less able to get patients out of hospital in 3 weeks (the pulmonary tuberculosis may affect outcome measure) compared with olanzapine.

In these studies, acute relapsing patients with schizophrenia were shifted to aripiprazole, whereas in our study we switched only Lodosyn (Carbidopa)- FDA patients with schizophrenia who were already stable on olanzapine.

In our study, slow cross-titration of antipsychotic medication can explain the reason why there was Lodosyn (Carbidopa)- FDA significant clinical destabilization in the switch group. Takeuchi and Remington51 concluded in a recent systematic review that a small number of patients with schizophrenia or schizoaffective disorder risked an exacerbation of psychotic symptoms if aripiprazole was added to existing antipsychotic treatment.

Lodosyn (Carbidopa)- FDA our patients were already stable on olanzapine, this could be a reason for successful switching without much Lodosyn (Carbidopa)- FDA in psychotic symptoms. The difference in the Lodosyn (Carbidopa)- FDA derangements between the two groups can be explained by the differential receptor occupancy by aripiprazole and olanzapine. Aripiprazole is a partial agonist at D2 dopamine and 5HT1A serotonin receptors and an antagonist at 5HT2A serotonin receptors,52 whereas olanzapine Lodosyn (Carbidopa)- FDA an antagonist at D2 dopamine, 5HT2A and 5HT2C serotonin, M1 muscarinic, and histamine-1 receptors.

Because schizophrenia is a chronic illness that requires antipsychotic treatment for a prolonged period, an antipsychotic agent with fewer metabolic side effects, such as aripiprazole, can be used for maintenance, to prevent psychotic relapse and long-term deterioration.

This problem can partially be addressed by slow cross-titration of drugs and Lodosyn (Carbidopa)- FDA follow-up of such patients. Lodosyn (Carbidopa)- FDA stable patients with schizophrenia on olanzapine who have evidence of metabolic syndrome can be successfully switched Lodosyn (Carbidopa)- FDA aripiprazole, with improvement in various parameters of metabolic syndrome and without any significant change in efficacy measures.

Switching is an option if careful cross-titration and close monitoring is possible. Careful clinical monitoring after a switch to aripiprazole might have been the reason that those who switched did not experience a higher rate of efficacy failures, compared Lodosyn (Carbidopa)- FDA those who stayed on olanzapine.

There are no financial or other relationships that might lead to a conflict of interest.

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