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CME Table of Contents   
Year : 2008  |  Volume : 50  |  Issue : 2  |  Page : 135-137
Post-graduate CME


Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India

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How to cite this article:
Andrade C. Post-graduate CME. Indian J Psychiatry 2008;50:135-7

How to cite this URL:
Andrade C. Post-graduate CME. Indian J Psychiatry [serial online] 2008 [cited 2020 May 27];50:135-7. Available from: http://www.indianjpsychiatry.org/text.asp?2008/50/2/135/42403



   CME Questions Top


(A) Weight gain is a vexing problem with many psychotropic drugs, especially atypical antipsychotics such as clozapine and olanzapine. With this background, mark True or False against each of the following statements:

  1. Reboxetine attenuates weight gain in patients who begin treatment with olanzapine.
  2. Metformin prevents weight gain in patients who begin treatment with olanzapine.
  3. Metformin promotes weight loss in patients who gain weight with olanzapine.
  4. Rimonabant promotes weight loss in patients who gain weight with olanzapine.


(B) There are several reasons why psychiatrists often see diabetic patients: diabetes is associated with an increased risk of depression; psychiatric disorders may be associated with hypercortisolemia and other neurohormonal changes that can worsen diabetes; and many medications used in psychiatry may precipitate or worsen diabetes.

The glycated hemoglobin level is a useful measure of blood sugar control during the past 1–3 months; normal levels lie in the 4–6% range. Intensive diabetic control seeks to keep the glycated hemoglobin level within the normal range or, at any rate, below 6.5%. With this background, mark True or False against each of the following statements:

  1. Intensive diabetic control is associated with a lower risk of ischemic cardiovascular or cerebrovascular events.
  2. Intensive diabetic control is associated with a lower risk of mortality.
  3. Intensive diabetic control is associated with a lower risk of nephropathy.
  4. Intensive diabetic control is associated with a higher risk of hypoglycemic events.


(C) In 2005, the Food and Drug Administration (FDA) in the United States issued an alert that, among elderly patients with dementia, the treatment of behavioral disorders with atypical antipsychotic drugs is associated with a higher mortality rate. With this background, mark True or False against each of the following statements:

  1. Recent epidemiological studies suggest that the FDA alert was unjustified.
  2. Atypical antipsychotic drugs increase the mortality risk in elderly subjects with dementia.
  3. Elderly subjects with dementia who require antipsychotic drugs have a form of illness that is associated with a worse prognosis, including a higher mortality risk.
  4. Relative to the atypical drugs, typical antipsychotics carries a lower mortality risk in elderly subjects with dementia.




Click here to view answer. View Answer


 
   References Top

1.Poyurovsky M, Isaacs I, Fuchs C, Schneidman M, Faragian S, Weizman R, et al . Attenuation of olanzapine-induced weight gain with reboxetine in patients with schizophrenia: A double-blind, placebo-controlled study. Am J Psychiatry 2003;160:297-302.  Back to cited text no. 1    
2.Poyurovsky M, Fuchs C, Pashinian A, Levi A, Faragian S, Maayan R, et al . Attenuating effect of reboxetine on appetite and weight gain in olanzapine-treated schizophrenia patients: A double-blind placebo-controlled study. Psychopharmacology (Berl) 2007;192:441-8.  Back to cited text no. 2    
3.Poyurovsky M, Pashinian A, Gil-Ad I, Maayan R, Schneidman M, Fuchs C, et al . Olanzapine-induced weight gain in patients with first-episode schizophrenia: A double-blind, placebo-controlled study of fluoxetine addition. Am J Psychiatry 2002;159:1058-60.  Back to cited text no. 3    
4.Henderson DC, Copeland PM, Daley TB, Borba CP, Cather C, Nguyen DD, et al . A double-blind, placebo-controlled trial of sibutramine for olanzapine-associated weight gain. Am J Psychiatry 2005;162:954-62.   Back to cited text no. 4    
5.Nickel MK, Nickel C, Muehlbacher M, Leiberich PK, Kaplan P, Lahmann C, et al . Influence of topiramate on olanzapine-related adiposity in women: A random, double-blind, placebo-controlled study. J Clin Psychopharmacol 2005;25:211-7.  Back to cited text no. 5    
6.Graham KA, Gu H, Lieberman JA, Harp JB, Perkins DO. Double-blind, placebo-controlled investigation of amantadine for weight loss in subjects who gained weight with olanzapine. Am J Psychiatry 2005;162:1744-6.  Back to cited text no. 6    
7.Morrison JA, Cottingham EM, Barton BA. Metformin for weight loss in pediatric patients taking psychotropic drugs. Am J Psychiatry 2002;159:655-7.  Back to cited text no. 7    
8.Klein DJ, Cottingham EM, Sorter M, Barton BA, Morrison JA. A randomized, double-blind, placebo-controlled trial of metformin treatment of weight gain associated with initiation of atypical antipsychotic therapy in children and adolescents. Am J Psychiatry 2006;163:2072-9.  Back to cited text no. 8    
9.Baptista T, Rangel N, Fernandez V, Carrizo E, El Fakih Y, Uzcategui E, et al . Metformin as an adjunctive treatment to control body weight and metabolic dysfunction during olanzapine administration: A multicentric, double-blind, placebo-controlled trial. Schizophr Res 2007;93:99-108.  Back to cited text no. 9    
10.Chen CH, Chiu CC, Huang MC, Wu TH, Liu HC, Lu ML. Metformin for metabolic dysregulation in schizophrenic patients treated with olanzapine. Prog Neuropsychopharmacol Biol Psychiatry 2008;32:925-31.  Back to cited text no. 10    
11.Wu RR, Zhao JP, Guo XF, He YQ, Fang MS, Guo WB, et al . Metformin addition attenuates olanzapine-induced weight gain in drug-naive first-episode schizophrenia patients: A double-blind, placebo-controlled study. Am J Psychiatry 2008;165:352-8.  Back to cited text no. 11    
12.Baptista T, Martinez J, Lacruz A, Rangel N, Beaulieu S, Serrano A, et al . Metformin for prevention of weight gain and insulin resistance with olanzapine: A double-blind placebo-controlled trial. Can J Psychiatry 2006;51:192-6.  Back to cited text no. 12    
13.Towbin KE. Gaining: Pediatric patients and use of atypical antipsychotics. Am J Psychiatry 2006;163:2034-6.  Back to cited text no. 13    
14.Cefalu WT. Glycemic targets and cardiovascular disease. N Engl J Med 2008;358:2633-5.  Back to cited text no. 14    
15.Dluhy RG, McMahon GT. Intensive glycemic control in the ACCORD and ADVANCE trials. N Engl J Med 2008;358:2630-3.  Back to cited text no. 15    
16.Kales HC, Valenstein M, Kim HM, McCarthy JF, Ganoczy D, Cunningham F, et al . Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. Am J Psychiatry 2007;164:1568-76.  Back to cited text no. 16    
17.Rochon PA, Normand SL, Gomes T, Gill SS, Anderson GM, Melo M, et al . Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med 2008;168:1090-6.  Back to cited text no. 17    
18.Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials. JAMA 2005;294:1934-43.  Back to cited text no. 18    

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Correspondence Address:
Chittaranjan Andrade
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.42403

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