Case Report

Austin J Psychiatry Behav Sci. 2014;1(1): 1001.

# Incidence of Weight Gain and Hyper Lipidemia with a Typical Antipsychotic Treatment: A Prospective Community Based Clinical Study

Antony S Amaladoss^{1}*, Christopher Balram^{2} and Wang A^{3}

^{1}Department of psychiatry and behavioral science,McMaster University, Canada

^{2}Department of Health & Wellness, University of Prince Edward Island, Canada

^{3}Department of Health Fredericton, University of New Brunswick, Canada

***Corresponding author: ** Antony S Amaladoss, Joseph Brant Memorial Hospital, Burlington, Ontario, Canada

**Received: **January 20, 2014; **Accepted: **February 24, 2014; **Published: **March 05, 2014

## Abstract

Atypical Antipsychotic (AAPS) have been found to be effective in various psychiatric conditions however evidence of treatment, emergent weight gain and hyperlipidemia limit their clinical benefits.

**Objective:** To determine the incidence of treatment emergent weight gain and hyperlipidemia with atypical antipsychotics.

**Method:** Patients with schizophrenic and non-schizophrenic conditions were randomly started on AAPS .Weight, BMI, triglycerides were measured every 3 months from the base line for one year.

121 enrolled, 119 completed the one year follow up study.

**Male :** 69; **Female:** 50; Olanzapine: 51; Risperidone: 59; Quetiapine: 8; Clozapine: 1.

**Data Analysis:** Descriptive and inferential analysis was carried out except Clozapine to examine the effects on weight, BMI and triglycerides.

**Limitataions:** Polypharmacy and ethnicity were not considered.

**Results:**

**Mean Weight Gain:**

**Males:** Risperidone 7.5 kg > Olanzapine 5.353 kg > Quetiapine 4.43 KG.

**Females:** Olanzapine 4.71 grams >Quetiapine 3.81 grams >Risperidone 3.14 kg.

**Percentage of weight gain – more than 7%:**

**Males:** Risperidone 46% > Quetiapine 33%>Olanzapine 16%

**Females:** Quetiapine 40% >Olanzapine 35% >Risperidone 9%

**BMI**

**Overweight:**

**Males:** Quetiapine 100%> Olanzapine 58.06%> Risperidone 51.35%

**Females:** Quetiapine 80%> Risperidone 50% >Olanzapine 45%

**Obesity**

>Males: Quetiapine 33.33% >Olanzapine 32.26%> Risperidone 16.22%

**Females:** Risperidone 50%> Quetiapine 20% >Olanzapine 20%

**Mean Triglycerides**

**Males:** Risperidone 1.92> Olanzapine 1.7

**Females:** Olanzapine 1.97 > Risperidone 1.78

**Percentage of Hyperlipidemia**

**Males:** Olanzapine 54.84% >Risperidone 43.24%>Quetiapine 33.33%

**Females:** Quetiapine 80% > Olanzapine 65% > Risperidone 45.45%

**Hyper Lipidemia Related to Age and Disease**

Risperidone – Mostly seen in the 20 to 40 years age group

Olanzapine – Mostly seen in 61 years plus.

Olanzapine seems to be having more propensity to induce hyper–lipidemia in Schizophrenia and Bi–polar disorder.

**Odd ratio**

Olanzapine Vs Risperidone – 1.81% (S.e.(O) 0.70034827).

**Conclusion:** The results show that atypical antipsychotic do affect weight, BMI and Triglycerides in varying degree and in relation to age, gender and disease which has significant clinical implications that warrant close monitoring with ongoing education on life style, diet and exercise in a heuristic manner.

## Introduction & Background

Patients with chronic psychiatric disorders are at increased risk for morbidity and mortality resulting from various medical diseases including respiratory diseases, infectious diseases, obesity, diabetes mellitus and cardiovascular disease [1].

In patients with schizophrenia and affective disorder the prevalence of risk factor for cardiovascular disease is approximately 1.5 to 2 times higher than the rate in the general population [2].

Mood disorders associated with obesity and it has been postulated gluco–corticoids play a central role in that role in the patho genesis ofmetabolic syndrome [3,4].

It has been evidenced all atypical antipsychotics induce weight gain and hyperlipidemia [5–7]. However, nearly all psychotropic medications induce weight gain [8–10].

The use of the atypical anti–psychotics is not confined to the treatment of schizophrenia but used to treat a broad array of other psychiatric disorders for which it has been found effective [11].

Recently there is a general consensus of varying adverse effects on weight and triglycerides with atypical antipsychotic have been proposed [12–18].

Hence this one year prospective study has been undertaken to quantify the incidence of weight gain and hyperlipidemia due to atypical anti–psychotics, which may enhance physicians in their clinical decision making.

## Objective

To determine treatment effects of atypical antipsychotics on weight and triglycerides in both schizophrenic and non–schizophrenic conditions in a community setting.

## Methods

Patients with schizophrenic and non —schizophrenic conditions were started randomly on atypical antipsychotics. Weight, BMI and triglycerides were measured every 3 months from the baseline for one year. There were 121 patients were enrolled in the study and 119 of them completed the one year follow up. There were 69 males and 50 females.

Treatment breakdown was as follows:

Olanzapine 51: risperidone 59: quetiapine 8: and Clozapine 1

The variables included in the analysis were

BMI– overweight is more than 25 to 29.9, Obesity is above 30

Hyperlipidemia is more than 1.7mmol⁄l.

## Analysis and Interpretation

Descriptive and inferential analyses were carried out to examine the treatment effects on weight, BMI and triglycerides and in relationships to age, gender and disease. Clozapine was omitted from the analysis as there was only one patient.

The number of patients treated with Quetiapine is low compared to Olanzapine and Risperidone, yet, included as it is statistically viable, but, this needs to be taken into consideration while interpreting the results. It should be noted that polypharmacy and ethnicity were not taken into consideration.

The study reveals that more males were treated with atypical antipsychotics than females. Descriptive projection of drugs, age, gender and diagnosis can be seen in tables 1–4 & Figure 1. The age group under 19 years had been treated mostly with risperidone. A higher percentage of obesity 42.42% has been seen in schizophrenic patients and this validates the question of whether it is due to drugs or lifestyle or disease related. The mean weight gain more in females with risperidone , 7.57 kg SD 8.34 and more in females with olanzapine 4.71 kg SD 4.67.

**Figure 1 :**Mean age by drug and gender for all follow ups and all age groups.

Figure 1 :Mean age by drug and gender for all follow ups and all age groups.

**Table 1:**Frequency distribution of antipsychotic drug use by gender.

Number of patients

F

M

Clozapine

Olanzapine

Quetiapine

Risperidone

1

20

5

22

0

31

3

37

Table 1:Frequency distribution of antipsychotic drug use by gender.

**Table 2:**Frequency distribution of antipsychotic drug use by age-groups and drugs for gender combined.

Number of patients

Age-groups

Olanzapine

Quetiapine

Risperidone

0-19

3

2

20

20-40

18

1

14

41-60

17

5

16

61+

13

9

Total

51

8

59

Table 2:Frequency distribution of antipsychotic drug use by age-groups and drugs for gender combined.

**Table 3:**Frequency (count and percentage) distribution of patients by diagnosis.

Frequency

Percent

Attention Deficit Disorder (ADD)17

14.29

Anxiety Disorder (Anx)4

3.36

Behavioural Disorder (Beh)2

1.68

Bipolar Disorder (Bipolar)21

17.65

Mood Disorder (Mood)23

19.33

Organic Brain Syndrome (OBS)9

7.56

PDD1

0.84

Schizophrenia (Schizo)41

34.45

Schizophrenia With Diabetes (Schizo with Dia)1

0.84

Total119

100

Table 3:Frequency (count and percentage) distribution of patients by diagnosis.

**Table 4:**Mean age by drug and gender for all follow ups and age-groups.

Female

Msale

Olanzapine

Risperidone

Olanzapine

Risperidone

Age51

47

41

28

Table 4:Mean age by drug and gender for all follow ups and age-groups.

The percentage of weight gain distribution seen more in males with risperidone 94.5% CI 79.87,99.10 than with Olanzapine 51.61% CI, 31.67 to 71.55 (Tables 5–11; Figures 2–5).

**Figure 2:**Mean weight gain within 12 months by drugs for gender combined.

Figure 2:Mean weight gain within 12 months by drugs for gender combined.

**Figure 3:**Mean weight gain within 12 months by drugs for males.

Figure 3:Mean weight gain within 12 months by drugs for males.

**Figure 4:**Mean weight gain within 12 months by drugs for females.

Figure 4:Mean weight gain within 12 months by drugs for females.

**Figure 5:**Percentage distribution of weight gain by drugs with 95% confidence interval.

Figure 5:Percentage distribution of weight gain by drugs with 95% confidence interval.

**Table 5:**Descriptive statistics of weight gain by drugs.

Mean

Standard Deviation

Maximum

Olanzapine5.02

4.57

18

Quetiapine4.1

3.06

9.6

Risperidone6.06

7.27

40.92

Table 5:Descriptive statistics of weight gain by drugs.

**Table 6:**Descriptive statistics of weight gain by drugs for males.

Mean

Standard Deviation

Maximum

Olanzapine5.35

4.58

15.00

Quetiapine4.43

4.57

9.60

Risperidone7.57

8.34

40.92

Table 6:Descriptive statistics of weight gain by drugs for males.

**Table 7:**Descriptive statistics of weight gain by drugs for females.

Mean

Standard Deviation

Maximum

Olanzapine4.71

4.67

18

Quetiapine3.85

2.14

5.46

Risperidone3.14

3.03

12.82

Table 7:Descriptive statistics of weight gain by drugs for females.

**Table 8:**Percentage distribution of weight gain by drugs.

Weight gain

Lower Cl

Upper Cl

Olanzapine64.71

50.29

79.13

Quetiapine87.50

40.25

99.52

Risperidone89.83

78.23

95.87

Table 8:Percentage distribution of weight gain by drugs.

**Table 9:**Significance testing of percentages of weight gain by drugs.

Total in sample

Number with weight gain

Proportions with weight gain

Olanzapine51

33

0.647

Quetiapine8

7

0.875

Risperidone59

53

0.898

Overall118

93

0.788

Table 9:Significance testing of percentages of weight gain by drugs.

**Table 10:**Conclusion: The three proportions are significantly different at 0.01 level.

pi

0.788

qi0.212

n1.*(p1-p(total))^21.015035402

n2.*(p2-p(total))^20.060363401

n3.*(p3-p(total))^20.716101695

Table 10:Conclusion: The three proportions are significantly different at 0.01 level.

**Table 11:**Significance testing of percentages of weight gain by drugs for males.

Total in sample

Number with weight gain

Proportions with weight gain

Olanzapine31

16

0.516

Quetiapine3

3

1.000

Risperidone37

35

0.946

Overall71

54

0.761

Table 11:Significance testing of percentages of weight gain by drugs for males.

**Figure 6:**Percentage distribution of weight gain by drugs for males with 95% confidence interval.

Figure 6:Percentage distribution of weight gain by drugs for males with 95% confidence interval.

**Figure 7:**Percentage distribution of weight gain by drugs for females with 95% confidence interval.

Figure 7:Percentage distribution of weight gain by drugs for females with 95% confidence interval.

Weight gain more than 7% has been seen in males with risperidone 46% , with quetiapine 33% and with olanzapine 16% and in females , quetiapine 40% ,with Olanzapine 35% and risperidone 9% (Tables 12–16; Figures 8–10).

**Figure 8:**Percentage distribution of weight gain >7% by drugs.

Figure 8:Percentage distribution of weight gain >7% by drugs.

**Figure 9:**Percentage distribution of weight gain >7% with 12 months by drugs for males.

Figure 9:Percentage distribution of weight gain >7% with 12 months by drugs for males.

**Figure 10:**Percentage of weight gain >7% by drugs for females.

Figure 10:Percentage of weight gain >7% by drugs for females.

**Table 12:**Conclusion: The three proportions for males are significantly different at 0.01 level.

pi

0.761

qi0.239

n1.*(p1-p(total))^21.852192665

n2.*(p2-p(total))^20.086917157

n3.*(p3-p(total))^20.499235315

Total2.438345137

X213.40641381s

Table 12:Conclusion: The three proportions for males are significantly different at 0.01 level.

**Table 13:**Significance testing of percentages of weight gain by drugs for females.

Total in sample

Number with weight gain

Proportions with weight gain

Olanzapine20

17

0.850

Quetiapine5

4

0.800

Risperidone22

18

0.818

Overall47

39

0.830

Table 13:Significance testing of percentages of weight gain by drugs for females.

**Table 14:**Conclusion: The three proportions for females are not significantly different at 0.01 level.

pi

0.83

qi0.17

n1.*(p1-p(total))^20.008171118

n2.*(p2-p(total))^20.004436397

n3.*(p3-p(total))^20.002963085

Total0.0155706

X20.110351521

Table 14:Conclusion: The three proportions for females are not significantly different at 0.01 level.

**Table 15:**Percent distribution of weight gain >7% within 12 months by drugs.

Counts with weight gain > 7%

Total in sample

Percent

Olanzapine12

51

0.24

Quetiapine3

8

0.38

Risperidone19

59

0.32

Total34

118

0.29

Table 15:Percent distribution of weight gain >7% within 12 months by drugs.

**Table 16:**Percent distribution of weight gain >7% within 12 months by drugs for males.

Counts with weight gain > 7%

Total in sample

Percent

Olanzapine5

31

0.16

Quetiapine1

3

0.33

Risperidone17

37

0.46

Table 16:Percent distribution of weight gain >7% within 12 months by drugs for males.

Overweight range has been seen in males with quetiapine 100% , with olanzapine 58.06% and with risperidone 51.35% and in females with Quetiapine 90% , with Risperidone 51.35% and in females with Quetiapine 45% . OR is equal to 1.31%, 95% CI (.14,1.51 for gender combined) (Tables 17–22; Figures 11–15).

**Figure 11:**Mean BMI by drugs and gender for all age groups and all followups.

Figure 11:Mean BMI by drugs and gender for all age groups and all followups.

**Figure 12:**Percentage distribution of overweight by drugs with 95% confidence interval.

Figure 12:Percentage distribution of overweight by drugs with 95% confidence interval.

**Figure 13:**Percentage distribution of obesity by drugs with 95% confidence interval.

Figure 13:Percentage distribution of obesity by drugs with 95% confidence interval.

**Figure 14:**Percentage distribution of overweight by drugs for females with 95% confidence interval.

Figure 14:Percentage distribution of overweight by drugs for females with 95% confidence interval.

**Figure 15:**Percentage distribution of obesity by drugs for females with 95% confidence interval.

Figure 15:Percentage distribution of obesity by drugs for females with 95% confidence interval.

**Table 17:**Percent distribution of weight gain >7% within 12 months by drugs for females.

Counts with weight gain > 7%

Total in sample

Percent

Olanzapine7

20

0.35

Quetiapine2

5

0.40

Risperidone2

22

0.09

Table 17:Percent distribution of weight gain >7% within 12 months by drugs for females.

**Table 18:**For gender combined.

Total in sample

Number with weight gain > 7%

Number with weight gain <=7%

Proportions with weight gain > 7%

Olanzapine51

12

39

0.235

Quetiapine8

3

5

0.375

Risperidone59

19

40

0.322

Overall118

34

84

0.288

Table 18:For gender combined.

**Table 19:**Conclusion: The three proportions for gender combined are significantly different at 0.01 level.

pi

0.288135593

qi0.711864407

n1.*(p1-p(total))^22.823529412

n2.*(p2-p(total))^21.125

n3.*(p3-p(total))^26.118644068

Total10.06717348

X249.08099563

Table 19:Conclusion: The three proportions for gender combined are significantly different at 0.01 level.

**Table 20:**For male.

Total in sample

Number with weight gain > 7%

Number with weight gain <=7%

Proportions with weight gain > 7%

Olanzapine31

5

26

0.161

Quetiapine3

1

2

0.333

Risperidone37

17

20

0.459

Overall71

23

48

0.324

Table 20:For male.

**Table 21:**Conclusion: The three proportions for males are significantly different at 0.01 level.

pi

0.761

qi0.239

n1.*(p1-p(total))^20.806451613

n2.*(p2-p(total))^20.333333333

n3.*(p3-p(total))^27.810810811

Total8.950595757

X249.21181531

Table 21:Conclusion: The three proportions for males are significantly different at 0.01 level.

**Table 22:**Mean BMI by drugs and gender for all age-groups and all follow-ups.

Olanzapine

Quetiapine

F25.22

30.31

M28.24

25.88

Table 22:Mean BMI by drugs and gender for all age-groups and all follow-ups.

Obesity range has been seen in males with quetiapine 33.33%, with Olanzapine 32.26% and with Risperidone 16.22% and with females with Risperidone 50% , olanzapine 20% and with Quetiapine 20% . OR is 1.12, 95%CI (–4.81 ,2.34).

It is interesting to note that the mean of triglycerides for males with Risperidone 1.92 > Olazapine 1.7 and in female Olanzapine 1.97> Risperidone 1.78 and this correlates with the observed weight gain pattern as shown above (Tables 23–28; Figures16–19).

**Figure 16:**Mean triglycerides by drugs and age groups for gender combined and all follow ups.

Figure 16:Mean triglycerides by drugs and age groups for gender combined and all follow ups.

**Figure 17:**Percentage distribution of dyslipidemia by drugs and dender.

Figure 17:Percentage distribution of dyslipidemia by drugs and dender.

**Figure 18:**Percentage distribution of dyslipidemia by drugs with 95% confidence interval.

Figure 18:Percentage distribution of dyslipidemia by drugs with 95% confidence interval.

**Figure 19:**Percentage distribution of dyslipidemia by drugs for females with 95% confidence interval.

Figure 19:Percentage distribution of dyslipidemia by drugs for females with 95% confidence interval.

**Table 23:**Percentage distribution of overweight and obesity by drugs and gender.

Overweight

obesity

Olanzapine

F

45

20

M

58.06

32.26

Quetiapine

F

80

20

M

100

33.33

Risperidone

F

50

50

M

51.35

16.22

Table 23:Percentage distribution of overweight and obesity by drugs and gender.

**Table 24:**Significance testing of percentages of overweight by drugs.

Total in sample

Number with over weight

Proportions with over weight

Olanzapine51

27

0.529

Quetiapine8

7

0.875

Risperidone59

30

0.508

Overall118

64

0.542

Table 24:Significance testing of percentages of overweight by drugs.

**Table 25:**Conclusion: The three proportions are not significantly different at 0.01 level.

pi

0.542

qi0.457627119

n1.*(p1-p(total))^20.008567518

n2.*(p2-p(total))^20.8851264

n3.*(p3-p(total))^20.06779661

Total0.961490528

X23.87378302

Table 25:Conclusion: The three proportions are not significantly different at 0.01 level.

**Table 26:**Significance testing of percentages of overweight by drugs for females.

Total in sample

Number with over weight

Proportions with over weight

Olanzapine20

9

0.450

Quetiapine5

4

0.800

Risperidone22

11

0.500

Overall47

24

0.511

Table 26:Significance testing of percentages of overweight by drugs for females.

**Table 27:**Conclusion: The three proportions for females are not significantly different at 0.01 level.

pi

0.510638298

qi0.489361702

n1.*(p1-p(total))^20.073540063

n2.*(p2-p(total))^20.418650973

n3.*(p3-p(total))^20.002489814

Total0.494680851

X21.979619565

Table 27:Conclusion: The three proportions for females are not significantly different at 0.01 level.

**Table 28:**Significance testing of percentages of obesity by drugs.

Total in sample

Number with obesity

Proportions with obesity

Olanzapine51

14

0.275

Quetiapine8

2

0.250

Risperidone59

17

0.288

Overall118

33

0.280

Table 28:Significance testing of percentages of obesity by drugs.

**Figure 20:**Mean triglycerides by drugs and gender for all follow ups and all age groups.

Figure 20:Mean triglycerides by drugs and gender for all follow ups and all age groups.

**Figure 21:**Mean triglycerides by drugs and follow ups fro gender combined and all age groups.

Figure 21:Mean triglycerides by drugs and follow ups fro gender combined and all age groups.

**Figure 22:**Mean of triglycerides by drugs and follow ups for male and all age groups.

Figure 22:Mean of triglycerides by drugs and follow ups for male and all age groups.

**Figure 23:**Mean triglycerides by drugs and follow ups for females and all age–groups.

Figure 23:Mean triglycerides by drugs and follow ups for females and all age–groups.

**Table 29:**Conclusion: The three proportions are significantly different at 0.01 level.

pi

0.280

qi0.720338983

n1.*(p1-p(total))^23.659282041

n2.*(p2-p(total))^20.683855214

n3.*(p3-p(total))^23.813559322

Total8.156696577

X240.48978365

Table 29:Conclusion: The three proportions are significantly different at 0.01 level.

**Table 30:**Significance testing of percentages of obesity by drugs for males.

Total in sample

Number with obesity

Proportions with obesity

Olanzapine31

10

0.323

Quetiapine3

1

0.333

Risperidone37

6

0.162

Overall71

17

0.239

Table 30:Significance testing of percentages of obesity by drugs for males.

**Table 31:**Conclusion: The three proportions for males are significantly different at 0.01 level.

pi

0.239

qi0.76056338

n1.*(p1-p(total))^21.797518414

n2.*(p2-p(total))^20.094311151

n3.*(p3-p(total))^24.493117835

Total6.3849474

X235.06156846

Table 31:Conclusion: The three proportions for males are significantly different at 0.01 level.

**Table 32:**Mean triglycerides by drugs and age-groups for gender combined and all follow ups.

0-19

20-40

41-60

61+

Olanzapine1.49

1.70

1.76

2.07

Risperidone1.07

3.03

2.00

1.57

Table 32:Mean triglycerides by drugs and age-groups for gender combined and all follow ups.

**Table 33:**Percentage distribution of dyslipidemia by gender and groups.

F

M

Olanzapine65

54.84

Quetiapine80

33.33

Risperidone45.45

43.24

Table 33:Percentage distribution of dyslipidemia by gender and groups.

**Table 34:**Percentage distribution of dyslipidemia by drugs.

dyslipidemia

Lower Cl

Upper Cl

Olanzapine58.82

43.99

73.65

Quetiapine62.5

21.75

91.75

Risperidone44.07

30.28

57.86

Table 34:Percentage distribution of dyslipidemia by drugs.

**Table 35:**Significance testing of percentages of dyslipidemia by drugs for males.

Total in sample

Number with dyslipidemia

Proportions with dyslipidemia

Olanzapine31

17

0.548

Quetiapine3

1

0.333

Risperidone37

16

0.432

Overall71

34

0.479

Table 35:Significance testing of percentages of dyslipidemia by drugs for males.

**Table 36:**Conclusion: The three proportions for males are not significantly different at 0.01 level.

pi

0.479

qi0.521126761

n1.*(p1-p(total))^20.149797467

n2.*(p2-p(total))^20.174437906

n3.*(p3-p(total))^20.746442685

Total1.070678058

X24.290372091

Table 36:Conclusion: The three proportions for males are not significantly different at 0.01 level.

**Table 37:**Significance testing of percentages of dyslipidemia by drugs for females.

Total in sample

Number with dyslipidemia

Proportions with dyslipidemia

Olanzapine20

13

0.650

Quetiapine5

4

0.800

Risperidone22

10

0.455

Overall47

27

0.574

Table 37:Significance testing of percentages of dyslipidemia by drugs for females.

**Table 38:**Conclusion: The three proportions for females are not significantly different at 0.01 level.

pi

0.574

qi0.425531915

n1.*(p1-p(total))^20.114101403

n2.*(p2-p(total))^20.254323223

n3.*(p3-p(total))^20.316391621

Total0.684816248

X22.801405724

Table 38:Conclusion: The three proportions for females are not significantly different at 0.01 level.

**Table 39:**Mean triglycerides by drug and gender for all follow ups and all age groups.

F

M

Olanzapine

Risperidone

Olanzapine

Risperidone

1.97

1.78

1.70

1.92

Table 39:Mean triglycerides by drug and gender for all follow ups and all age groups.

**Table 40:**Mean triglycerides by drugs and follow ups for gender combined and all age groups.

3 Months

6 Months

9 Months

12 Months

Olanzapine1.79

1.75

1.87

1.82

Risperidone1.95

2.00

1.76

1.76

Table 40:Mean triglycerides by drugs and follow ups for gender combined and all age groups.

**Table 41:**Mean triglycerides by drugs and follow ups for males and all age groups.

3 Months

6 Months

9 Months

12 Months

Olanzapine1.64

1.62

1.78

1.77

Risperidone1.94

2.14

1.82

1.77

Table 41:Mean triglycerides by drugs and follow ups for males and all age groups.

**Table 42:**Mean triglycerides by follow ups and drugs for females and all age groups.

3 Months

6 Months

9 Months

12 Months

Olanzapine2.02

1.95

2.00

1.90

Risperidone1.98

1.76

1.67

1.74

Table 42:Mean triglycerides by follow ups and drugs for females and all age groups.

**Table 43:**The standard error is used to gauge the precision of the estimated odds ratio. OR represents Odds Ratio. s.e.(o) represents standard error of the odds ratio.

dyslipidemia

Normal triglycerides

Olanzapine30

21

Risperidone26

33

OR1.81

s.e.(o)0.70034827

Table 43:The standard error is used to gauge the precision of the estimated odds ratio. OR represents Odds Ratio. s.e.(o) represents standard error of the odds ratio.

The percentage of hyper lipidemia for males with Olanzipine 54.84%> Risperidone 43.24% > Quetiapine 33.33% and for females Quetiapine 80%> Olanzapine 65% > Risperidone 45.45%.

## Age related incidence

The highest incidence of hyperlipidemia seen between the age group of 20 to 40 years with Risperidone and for Olanzapine it has been evidenced in the age group of 61 +.

It is evidenced higher incidence of weight gain and hyperlipidemia in schizophrenia and bipolar disorder compared to other conditions (Tables 29–32; Figures 20–23).

The Odd Ratio for hyperlipidemia with Olanzapine Vs Risperidone is 1.81(SE (O) .77034827)

## Discussion

This is the only study, to the author’s knowledge which examined the effects of treatment with, atypical anti psychotics in both schizophrenic and non–schizophrenic patients in a non– academic community setting and attempted to examine the effects in relation to age, gender and disease.

The study reveals alterations in weight seen from the baseline in all three atypical anti–psychotics but showing a differential trend in relation to age, gender and disease. It shows that males gain more weight with risperidone and females gain more weight with Olanzapine.

It is also evidenced that all three drugs induce hyperlipidemia in varying degree, but, showing a differential trend in relation to age, gender and disease.

One could see that male seems to be having more propensities with Risperidone and female with Olanzapine and similar pattern is shown with the weight gain. This reveals probable correlation exists between weight gain and hyperlipidemia.

In terms of age, it is quite interesting to note that the highest propensity for hyper lipidemia is seen in the age group of 20 to 40 years with Risperidone and Quetiapine, whereas, the highest incidence seen in the age group of 61 years plus with Olanzapine. This may signify importance in the clinical scenario and may enhance physicians decision making in their clinical management enlightening the need to do close monitoring when they prescribe either of the atypical for any particular gender or the age group.

## Conclusion

This is the first study to the author’s knowledge revealing varying effects with atypical anti–psychotics treatment on weight, and triglycerides and in relationship to age, gender and disease.

It is evidenced in this prospective study that atypical antipsychotics do affect weight, BMI and triglycerides at varying degrees and there is no conclusive explanation to date of these effects attributed solely to the pharmacodynamic profile of the drugs.

It may be beneficial to be cognizant of these adverse varying effects of the drugs, in relation to age, gender and disease which may induce metabolic or cardiovascular morbidities. It is prudent to advocate individual close monitoring with ongoing education on life style, diet, and exercise rather discriminating the drugs with heightened risk and discarding their clinical efficacy in various psychiatric conditions.

In every clinical management, it is the benefit and risk discretion values the judgment and this valued clinical prudence advocates the wisdom of heuristic attitude in following up the patients on atypical antipsychotics, on an individual basis.

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