"Clinical Management of Metabolic Problems in Patients with Schizophrenia: Switching to Aripiprazole versus Continued Treatment with Olanzapine, Quetiapine, or Risperidone"

Metabolic abnormalities (e.g., elevated glucose, triglyceride and non-HDL cholesterol levels, decreased HDL cholesterol level, and elevated blood pressure) are associated with cardiovascular morbidity and premature mortality. All of these indicators of cardiovascular risk are more common in patients with schizophrenia than in matched controls. Although there is evidence suggesting that some patients with schizophrenia have intrinsic abnormalities in lipid and carbohydrate metabolism, some second-generation antipsychotics (i.e., clozapine, olanzapine, quetiapine, and risperidone) are associated with increased rates of metabolic abnormalities that predispose patients to cardiovascular disease (American Diabetes Association 2004).

The most appropriate treatment strategies for patients with schizophrenia and metabolic risk factors for cardiovascular disease have not been established. Switching patients who are taking an antipsychotic with a high liability for producing metabolic side effects to an antipsychotic with a low liability is a commonly chosen option with uncertain effectiveness. This is of particular interest when individuals with schizophrenia or schizoaffective disorder have had a good therapeutic response to an antipsychotic medication with a relatively high risk of metabolic side effects. The possible benefits of switching to a medicine with more advantageous metabolic effects must be weighed against the risk of clinical instability associated with changing treatment.