Metabolic alterations associated with first and second generation antipsychotics: an twenty-years open study

The initial enthusiasm for atypical antipsychotics, with a lower incidence of extra pyramidal symptoms, was tempered by the association with metabolic disorders. The presence of metabolic alterations significantly influences morbidity and patients' quality life. We performed this open-study to determine the relationship between antipsychotic efficacy and side effects, especially the impact of various antipsychotics on metabolic parameters after 20-year treatment with atypical (SGA) and typical antipsychotics (FGA).

62 psychiatric schizophrenic inpatients treated with typical (haloperidol) and atypical (clozapine, risperidone, olanzapine, quetiapine, aripiprazole) antipsychotics were studied over 20 years. Some biological parameters such as blood arterial pressure, lipidic and glucidic profile, liver enzymes, complete blood count, electrocardiogram and body weight (and body mass index) were collected.

The results have demonstrated a not homogeneous statistically significant variation of the lipidic and glicidic profile but we have also found a reduction of the recorded values at endpoint vs baseline in aripiprazole and haloperidol groups vs clozapine, olanzapine, and quetiapine groups.

We want to point out that to endpoint of the period of observation (20 years) the patients with typical antipsychotics haloperidol reported satisfactory and a better glycemic and lipidic profiles than previous pharmacological treatments with antipsychotics of second generation. Optimal monitoring should include assessments of fasting glucose, lipids, cholesterol, and blood pressure.