Alterações metabólicas e composição corporal na esquizofrenia responsiva ao tratamento e resistente em uso de Clozapina: um estudo transversal utilizando ressonância magnética

Abstract

Schizophrenia is a serious and disabling mental disorder. Patients with this disorder have a shorter life expectancy and early mortality due to cardiovascular (CVD) and metabolic diseases. Schizophrenia is treated with antipsychotic drugs, but 30% of patients do not respond to treatment with at least two different antipsychotics used in adequate doses and for adequate duration. This condition is classified as treatment-resistant schizophrenia (TRS). TRS is characterized by persistent positive symptoms, such as delusions and hallucinations. The main antipsychotic medication prescribed for TRS is clozapine, an antipsychotic with significant side effects, such as agranulocytosis, weight gain, hyperglycemia, and dyslipidemia. In this context, the aim of this study was to evaluate metabolic and body composition changes in patients with schizophrenia who responded to treatment (RT) and with treatment-resistant schizophrenia using clozapine (ERT-C). A cross-sectional study with 73 patients with schizophrenia. We evaluated anthropometric, biochemical and body composition measurements by magnetic resonance imaging (MRI). We observed differences in waist circumference (WC), hip circumference (HC), neck circumference (NC), waist-to-hip ratio (WHR) and heart rate (HR) between the groups (RT and ERT-C). Based on BMI, 69.9% (51) of the patients were overweight or grade II obese. We also observed a 28% increase in the neutrophil-lymphocyte ratio (NLR) in the ERT-C group (p= 0.046). The lipid profile revealed a significant increase of 30.17% for the ERT-C group for triglycerides (p= 0.035) and 25.22% for fasting glucose (p< 0.001). The frequency of metabolic syndrome (MS) was 57.5% (n=42), of which 38.1% (n=16) for the RT group and 61.9% (n=26) for the ERT-C group (p>0.05), with a significant association between MS and the ERT-C group (P = 0.026). A significant difference of 47.18% was observed in the Visceral Adiposity Index (VAI) for males in the ERT-C group (p= 0.028). The MRI images revealed significant differences of 58.1% in visceral fat (VF) for the ERT-C group (p<0.001). Regarding VF, the men in the ERT-C group showed an increase of 87.75% (p<0.001) in relation to the RT group. Based on the MRI images, it was identified that 32.9% (24) of the patients had some degree of Hepatic Steatosis (HS). We can conclude that the results of the present study indicate the presence of changes in anthropometric measurements and body composition mainly in ERT-C patients. These changes have a negative prognosis and are associated with the development of cardiovascular disease.