Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library.

October 2020

The post Blood disorders appeared first on NeuRA Library.

Bone density disorders can cause severe disability among those affected. The exact causes of bone density abnormalities are currently unknown. This topic investigates whether they could be a side effect of antipsychotic medications.

What is the evidence for bone density abnormalities?

October 2020

The post Bone density appeared first on NeuRA Library.

Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library.

October 2020

The post Cancer appeared first on NeuRA Library.

Patient populations that are prescribed antipsychotic agents may experience cardio and metabolic side effects.

What are the cardiometabolic side effects?

Medicated patients versus population or healthy controls

Moderate quality evidence suggests small to medium-sized increased risks of hypertension, low HDL cholesterol, hypertriglyceridemia, diabetes, metabolic syndrome, abdominal obesity and reduced heart rate variability in people with schizophrenia. People with first-episode psychosis and antipsychotic-naïve patients also show increased hypertension and reduced heart rate variability, but not other cardiometabolic indices.

Medicated patients versus unmedicated patients

Moderate to low quality evidence shows that after treatment with antipsychotic medications, there is weight gain in the short and long-term, and increased insulin levels, insulin resistance, cholesterol, triglyceride, leptin, and blood pressure levels in the long-term. There are increased rates of diabetes, myocardial infarction, metabolic syndrome, high triglycerides, low HDL, and hyperglycaemia in medicated patients, and reduced heart rate variability in medicated patients on clozapine.

Any antipsychotic versus placebo

High quality evidence shows small effects of increased QTc prolongation with haloperidol, quetiapine, olanzapine, risperidone, and iloperidone; medium-sized effects of increased QTc prolongation with ziprasidone and amisulpride; and a large effect with sertindole. No differences in QTc prolongation were reported between placebo and lurasidone, aripiprazole, paliperidone, or asenapine. There are small effects of more weight gain with aripiprazole, amisulpride, asenapine, paliperidone, brexpiprazole, and lurasidone; and medium-sized effects of more weight gain with risperidone, quetiapine, sertindole, chlopromazine, iloperidone, clozapine, zotepine, and olanzapine. Clozapine resulted in the most weight, cholesterol, triglycerides, and glucose increases. Olanzapine resulted in the most BMI increases, and also increases in weight, cholesterol, and triglycerides. Quetiapine increased weight, cholesterol, and triglycerides. Zotepine increased weight, triglycerides, and glucose.

First generation versus second generation antipsychotics

Moderate or moderate to low quality evidence suggests second generation clozapine, olanzapine, risperidone, and quetiapine are associated with a small increased risk of diabetes mellitus when compared to any first generation antipsychotic. There is more total cholesterol increase with second generation olanzapine than first generation haloperidol, and more triglyceride increase with second generation amisulpride than haloperidol. Second generation amisulpride, clozapine, olanzapine, quetiapine, risperidone, sertindole, and zotepine are associated with more weight gain than first generation haloperidol, with no differences when compared to low-potency first generation antipsychotics.

Second generation versus second generation antipsychotics

Moderate or moderate to low quality evidence suggests shorter Bazett’s corrected QT interval with aripiprazole compared to risperidone, and with risperidone compared to sertindole. Olanzapine was associated with more weight gain and glucose increase than amisulpride, aripiprazole, quetiapine, risperidone, lurasidone, and ziprasidone. Clozapine was associated with more weight gain than risperidone, risperidone was associated with more weight gain than amisulpride, and sertindole was associated with more weight gain than risperidone. Olanzapine was associated with more cholesterol increase than aripiprazole, risperidone and ziprasidone. Quetiapine was associated with more cholesterol increase than risperidone and ziprasidone.

Schizophrenia versus affective disorders

Moderate to low quality evidence suggests olanzapine was associated with more weight gain in people with schizophrenia than people with bipolar disorder, with no differences in cholesterol or blood glucose levels. People with schizophrenia treated with quetiapine show more cholesterol increase than patients with affective disorder treated with quetiapine, with no differences in blood glucose, triglyceride levels or weight gain.

Also see the treatments for weight gain topics (pharmaceutical and psychosocial).

October 2020

The post Cardiometabolic changes and weight gain appeared first on NeuRA Library.

Some antipsychotics cause constipation. Moreover, people with schizophrenia often have pre-existing factors that increase this risk, including sedentary lifestyle, obesity, reduced fibre intake, and dehydration. Constipation can lead to gastrointestinal problems and even death. This topic assesses the risk of constipation as a side effect of antipsychotic use.

What is the evidence for constipation in people with schizophrenia?

Moderate to low quality evidence suggests the overall prevalence of constipation with clozapine use is around 30%, and around 40% in inpatient settings. Moderate to high quality evidence suggests a medium-sized effect of clozapine causing higher rates of constipation than most other antipsychotics, in particular olanzapine.

October 2020

The post Constipation appeared first on NeuRA Library.

Dysphagia refers to swallowing impairment, and can lead to severe outcomes including malnutrition, asphyxiation (suffocating), which can be fatal. It is sometimes reported in people with schizophrenia and other mental illnesses, and may be a side effect of a number of neuroleptic medications including antipsychotics, but may also be due to behavioural disturbance or other neurological disorders.

What is the evidence for dysphagia?

Low quality evidence is unclear as to risk of dysphagia following any specific neuroleptic medication.

October 2020

The post Dysphagia appeared first on NeuRA Library.

Extrapyramidal side effects include dyskinesias; repetitive, involuntary, and purposeless body or facial movements. Parkinsonism may occur, involving cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements. Akathisia involves motor restlessness, especially in the legs, and dystonias are muscle contractions causing unusual twisting of parts of the body, most often in the neck. These side effects are caused by the dopamine receptor antagonist action of antipsychotics, but can also be found in people with schizophrenia who have never taken antipsychotics and in their relatives.

What is the evidence for extrapyramidal side effects?

Overall prevalence rate

Moderate quality evidence finds the overall prevalence of extrapyramidal symptoms in people taking antipsychotics is around 37%. Parkinsonism prevalence is 20%, akathisia prevalence is 11%, and tardive dyskinesia prevalence is 7-25%. The rates of tardive dyskinesia is highest with first generation antipsychotic use and with longer duration of illness. Rates were lowest in Asian countries.

All antipsychotics versus placebo

Moderate quality evidence shows a small effect of fewer extrapyramidal side effects with clozapine than with placebo. Small effects of increased extrapyramidal side effects were reported with ziprasidone, paliperidone, and risperidone, and medium-sized effects were reported with lurasidone, chlorpromazine, zotepine, and haloperidol. No differences in extrapyramidal side effects were reported for sertindole, olanzapine, quetiapine, aripiprazole, iloperidone, amisulpride and asenapine when compared to placebo.

First versus second generation antipsychotics

Moderate to high quality evidence suggests fewer extrapyramidal side effects with second generation antipsychotics, in particular olanzapine and risperidone, when compared to first generation antipsychotic haloperidol. Fewer extrapyramidal side effects were reported with second generation antipsychotic clozapine when compared to first generation antipsychotic chlorpromazine. Moderate quality evidence suggests clozapine, olanzapine, and risperidone produce fewer extrapyramidal side effects than low-potency first generation antipsychotics.

Second generation antipsychotics

Moderate to high quality evidence suggests risperidone may be associated with more use of antiparkinson medication than clozapine (medium-sized effect), olanzapine, quetiapine, and ziprasidone (small effects). Ziprasidone may be associated with more use of antiparkinson medication than olanzapine (small effect) and quetiapine (medium-sized effect). Olanzapine may be associated with more use of antiparkinson medication than quetiapine (medium-sized effect), and aripiprazole may be associated with more use of antiparkinson medication than olanzapine (small effect). No differences were found between amisulpride and olanzapine, risperidone, or ziprasidone. No differences were found between aripiprazole and risperidone, or between clozapine and olanzapine or ziprasidone. Low quality evidence is unable to determine if there are differences between zotepine and clozapine.

Schizophrenia versus affective disorders

Moderate quality evidence suggests people with affective disorders treated with aripiprazole may show more akathisia than people with schizophrenia treated with aripiprazole. People with schizophrenia treated with olanzapine may show more parkinsonism than people with bipolar disorder treated with olanzapine.

Ethnic differences

Moderate to low quality evidence suggests people from China, Japan and Korea who are treated with antipsychotics may show a small increase in extrapyramidal side effects compared to people from other countries treated with antipsychotics. No differences were reported between Black and White populations.

Please also see the treatment topic for movement disorders.

February 2022

Image: ©shidlovski – stock.adobe.com

The post Extrapyramidal appeared first on NeuRA Library.

One potential side effect of antipsychotic use hyperprolactinemia, which can disrupt sex hormones and the production and flow of breast milk, and can cause infertility and erectile dysfunction in men. Hyperprolactinemia is caused by blocking of the D2 dopamine receptor at the anterior lobe of the pituitary gland, resulting in high prolactin levels. As different antipsychotics have different actions, they also differ in the degree to which they affect prolactin levels.

What is the evidence for hyperprolactinaemia?

High quality evidence shows large increases in prolactin levels with risperidone and paliperidone when compared to placebo. Medium-sized increases were found with sertindole and haloperidol, and small increases were found with ziprasidone and lurasidone. Moderate to low quality evidence suggests increased prolactin  may also be associated with amisulpride. No differences in prolactin levels were found between placebo and aripiprazole, quetiapine, asenapine, chlorpromazine, and iloperidone.

For children and adolescents with schizophrenia, moderate to low quality evidence found a large increase in prolactin levels with risperidone compared to placebo, medium-sized increases with olanzapine and paliperidione and a small increase with quetiapine. There was decreased prolactin with aripiprazole compared to placebo. Indirect comparisons between antipsychotics used by children and adolescents found greater prolactin increases with risperidone than aripiprazole, molindone, quetiapine, olanzapine and paliperidone; greater increases with paliperidone than aripiprazole and quetiapine; and greater increases with olanzapine than aripiprazole.

October 2020

The post Hyperprolactinaemia appeared first on NeuRA Library.

Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library.

November 2019

The post Hypersalivation appeared first on NeuRA Library.

Hyponatraemia is an imbalance of electrolytes in the blood serum, typically involving reduced salt (sodium) levels. This usually occurs through excessive water retention diluting the salt content of the blood in combination with increased sodium excretion in the kidneys. Mild hyponatraemia does not have obvious symptoms, however when sodium levels drop dangerously low they can cause muscle cramps, lethargy, and delirium; eventually leading to convulsions, which can be fatal. Hyponatraemia can occur as a side effect of many medications including antipsychotics.

What is the evidence for hyponatraemia?

Moderate to low quality evidence suggests hyponatraemia occurs more commonly in people taking antipsychotic medications than those not taking antipsychotic medication.

October 2020

The post Hyponatraemia appeared first on NeuRA Library.