Changes in metabolic syndrome parameters in patients with schizoaffective disorder who participated in a randomized, placebo-controlled trial of topiramate

This study evaluated changes in the metabolic syndrome (MetS) parameters among patients with schizoaffective disorder-bipolar type who had previously participated in a randomized, placebo-controlled study of topiramate (Chengappa et al., 2007). Topiramate (or placebo) was added to pre-existing mood-stabilizer and/or antipsychotic treatment. Nearly 41% of the 46 participants with fully available data met criteria for MetS at the pre-study baseline, and six (13%) additional subjects met criteria for MetS during the 16-week study. Several subjects (mostly topiramate treated) showed the hypothesized and expected loss in body weight and this correlated with improved glycosylated hemoglobin or systolic and diastolic blood pressure measurements or improvements in lipid levels, whereas a few patients had inconsistent results. Limitations of the study include the lack of targeted treatments for specific components of the metabolic syndrome, and no controls for exercise, diet or concomitant medications. Nevertheless, screening, monitoring and targeted treatment for the metabolic syndrome in psychiatric patients is increasingly becoming the standard of practice. Moreover and especially pertinent to the readership of this journal is that as the prevalence of overweight and MetS have increased worldwide, the World Health Organization has proposed lower cut-off thresholds for obesity in Asia. Furthermore, lower thresholds for waist circumference have also been recommended for Asians.