Older Diabetics Should Avoid Dementia Meds

02 aug 2009-- Older diabetics who take antipsychotic medications have an increased risk of ending up in the hospital with elevated blood glucose levels, or hyperglycemia, researchers say.

More and more seniors are being prescribed these medications for dementia and other conditions, the study authors noted in their report in the July 27 issue of Archives of Internal Medicine.

In the study, Dr. Lorraine L. Lipscombe of the Institute for Clinical Evaluative Sciences at the University of Toronto and Women's College Research Institute at Women's College Hospital in Ontario, Canada, and colleagues looked at 13,817 diabetic patients who were 66 and older. These patients started taking antipsychotics between April 2002 and March 2006.

The researchers compared these patients' hospitalization rates for hyperglycemia with the rates of patients who had stopped taking antipsychotic medications for more than 180 days.

"Our study indicates that the initiation of antipsychotic therapy represents a critical period during which seniors with diabetes are particularly vulnerable to metabolic decompensation [the failure of the metabolic system to function adequately]," the authors wrote in a news release. "The new use of both atypical [newer] and typical antipsychotic drugs was associated with a significant increase in hospitalizations for hyperglycemia, which appeared independent of baseline diabetes treatment and was strikingly high during the initial period of antipsychotic therapy."

Other studies suggest that the neurotransmitter dopamine has a role in keeping blood glucose levels under control. The researchers noted that first-time antipsychotic users may get a disruption in this system and hyperglycemia episodes may result.

Until experts do more studies, "other options to manage behavioral symptoms of dementia should be considered among older persons with diabetes," the authors concluded. "Patients and their families should be alerted to observe for signs of glycemic decompensation when treatment with an antipsychotic agent is initiated, and enhanced glucose monitoring is recommended for all patients for whom an antipsychotic drug is prescribed, particularly after treatment initiation

Combating weight gain caused by antipsychotic treatments

Philadelphia, PA, 27 mar 2009– Antipsychotic drugs, such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), are commonly used to treat psychotic disorders like schizophrenia, but also bipolar disorder and even behavioral problems related to dementia. Unfortunately, the weight gain commonly experienced with antipsychotic treatment is an important side effect for many patients, and causes many patients to discontinue their use leading to even further problems. Biological Psychiatry, in its April 1st issue, is now publishing a new study that has evaluated an add-on treatment to potentially reduce treatment-associated weight gain.

In a randomized, double-blind, placebo-controlled trial, Dr. James Roerig and colleagues evaluated the effect of modafinil on olanzapine-associated weight gain in normal volunteer subjects. Modafinil is a drug currently used to increase wakefulness in individuals with sleep disorders, such as narcolepsy. All of the subjects received olanzapine, and half also received modafinil treatment while the other half instead received placebo. After three weeks, although the body mass index was increased in both groups, those receiving olanzapine/placebo showed significantly greater weight increase than those receiving olanzapine/modafinil.

Dr. Roerig notes that now that this short-term study in healthy individuals has shown promise, modafinil can now be evaluated as a "viable candidate for a larger, more complex clinical trial to determine efficacy in a patient population."

Dr. John Krystal, Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, agrees that further research is warranted. "Psychiatrists are now working more closely with patients to manage the side effects of antipsychotic treatment. The finding that modafinil reduces weight gain may encourage more research to see whether there are other benefits associated with modafinil prescription with regards to symptoms or cognitive impairments associated with schizophrenia."