Orexin-a elevation in antipsychotic-treated compared to drug-free patients with schizophrenia: A medication effect independent of metabolic syndrome

Po-Yu Chen; Chin-Kuo Chang; Chun-Hsin Chen; Su-Chen Fang; Valeria Mondelli; Chih-Chiang Chiu; Mong-Liang Lu; Ling-Ling Hwang; Ming-Chyi Huang

Journal of the Formosan Medical Association (Nov 2022)

Orexin-a elevation in antipsychotic-treated compared to drug-free patients with schizophrenia: A medication effect independent of metabolic syndrome

Po-Yu Chen,
Chin-Kuo Chang,
Chun-Hsin Chen,
Su-Chen Fang,
Valeria Mondelli,
Chih-Chiang Chiu,
Mong-Liang Lu,
Ling-Ling Hwang,
Ming-Chyi Huang

Affiliations

Po-Yu Chen: Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Chin-Kuo Chang: Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Chun-Hsin Chen: Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Department of Psychiatry, Wan Fang Hospital, Taipei, Taiwan; Psychiatric Research Center, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
Su-Chen Fang: Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Valeria Mondelli: Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Chih-Chiang Chiu: Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
Mong-Liang Lu: Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Department of Psychiatry, Wan Fang Hospital, Taipei, Taiwan
Ling-Ling Hwang: Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Corresponding author. Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan.
Ming-Chyi Huang: Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Psychiatric Research Center, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Corresponding author. Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Song-de Road, Taipei, 110, Taiwan.

Journal volume & issue: Vol. 121, no. 11
pp. 2172 – 2181

Abstract

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Background/Purpose: Orexin-A levels are reportedly increased in antipsychotic (APD)-treated patients with schizophrenia compared to healthy controls and have been associated with metabolic abnormalities. It is not clear whether the orexin-A elevation is related specifically to the drug (APDs) effect, which should be clarified by including a drug-free group for comparison, or related to drug-induced metabolic abnormalities. Methods: Blood orexin-A levels and metabolic profiles were compared between 37 drug-free, 45 aripiprazole-treated, and 156 clozapine-treated patients with schizophrenia. The association between orexin-A and metabolic outcomes were examined. We explored the effects of APDs treatment and metabolic status on orexin-A levels by linear regression. Results: Patients under APDs treatment had increased orexin-A levels compared to drug-free patients, with aripiprazole-treated group having higher orexin-A levels than clozapine-treated group. Higher orexin-A levels reduced the risks of metabolic syndrome (MS) and type 2 diabetes mellitus, indicating a relationship between orexin-A levels and metabolic problems. After adjusting the effect from metabolic problems, we found APD treatment is still associated with orexin-A regulation, with aripiprazole more significantly than clozapine. Conclusion: With the inclusion of drug-free patients rather than healthy controls for comparison, we demonstrated that orexin-A is upregulated following APD treatment even after we controlled the potential effect from MS, suggesting an independent effect of APDs on orexin-A levels. Furthermore, the effect differed between APDs with dissimilar obesogenicity, i.e. less obesogenicity likely associated with higher orexin-A levels. Future prospective studies exploring the causal relationship between APDs treatment and orexin-A elevation as well as the underlying mechanisms are warranted.

Published in Journal of the Formosan Medical Association

ISSN: 0929-6646 (Print)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General)
Website: http://www.journals.elsevier.com/journal-of-the-formosan-medical-association/

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