Risk factors for mood destabilization with antidepressants in bipolar disorder include the following:
Assessing for these risk factors before antidepressants are used in bipolar patients may help to reduce the risk for adverse consequences.
Ref: - Goldberg, J.F. (2003) When do antidepressants worsen the course of bipolar disorder? Journal of Psychiatric Practice, 9, 181-194.
Concern about type 2 diabetes has lead to baseline screening and ongoing monitoring recommendations for people prescribed second generation antipsychotics. Consensus development conference of American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists and North American Association for the Study of Obesity recommended checking plasma glucose before and three months after initiation of a second-generation antipsychotic, followed by annual checks. A glucose level greater than 300 mg/dl or less than 60 mg/dl as well as symptoms of hyperglycemia or hypoglycemia should lead to an immediate referral. Symptoms of diabetic ketoacidosis, such as rapid onset of polyuria, polydipsia, weight loss, nausea, vomiting, dehydration, rapid respiration, clouding of sensorium, or coma, constitute an acute emergency (Cimpean, et al., 2005).
Ref: -
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes (2004). Diabetes Care, 27, 2, 596-601.
Cimpean, D., Torrey, W.C., Green, A.I. (2005) Schizophrenia and co-occurring general medical illness. Psychiatric Annals, 35, 1, 71-81.
Taking the olanzapine tablet on an empty stomach about an hour bedtime may increase the nighttime sedation and reduce the daytime somnolence (Schatzberg et al., 2003).
Ref:- Schatzberg, A.F., Cole, J.O. & DeBattista, C. (2003) Manual of Clinical Psychopharmacology. Washington, DC: American Psychiatric Press.
Neuroleptic malignant syndrome associated with clozapine may be atypical and tend not to be characterized by rigidity, fevers, and elevation of creatine phosphokinase that are seen with standard antipsychotic drugs. Rather, the presentation in clozapine-treated patients may include delirium, autonomic instability, and milder extrapyramidal symptoms (Hasan and Buckley, 1998; Karagianis et al., 1999).
Ref:-
Hasan, S. & Buckley, P. (1998) Novel antipsychotics and the neuroleptic malignant syndrome: a review and critique. American Journal of Psychiatry, 155, 1113-1116.
Karagianis, J.L., Philips, L.C., Hogan, K.P., et al. (1999) Clozapine-associated neuroleptic syndrome: two new cases and a review of the literature. Annals of Pharmacotherapy, 33, 623-630.
People with schizophrenia are at high risk for heart disease, and a lipid profile should be checked at least once every two years when LDL is normal and every six months when LDL is greater than 130 mg/dl (Marder et al., 2004). A recent consensus conference sponsored by the American Diabetes Association and the American Psychiatric Association recommended that all patients with schizophrenia should have baseline screening for family and personal history of dyslipidemia, undergo a fasting lipid profile, and be referred for treatment if found to be hyperlipidemic. A fasting lipid profile also should be obtained three months after starting an antipsychotic, at five year intervals if normal, and more often if clinically indicated.
Ref: -
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes (2004). Diabetes Care, 27, 2, 596-601.
Marder, S.R., Essock, S.M., Miller, A.L. et al. (2004) Physical health monitoring of patients with schizophrenia. American Journal of Psychiatry, 161, 8, 1334-1349.
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This blog on Clinical Psychopharmacology is maintained by Dr. Shahul Ameen, M.D., Psychiatrist, St. John's Hospital, Kattappana, Idukki, Kerala, India.
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This blog is only for educational purpose of psychiatrists and other physicians. The information published in this blog is not intended for use as a substitute for consultation to a licensed health professional. Patients and consumers who visit Psychopharmacology Tips should carefully review the information gathered from the site with a professional healthcare provider.