A Comparative study Between First Generation and Second Generation Antipsychotics over the Development of Metabolic Syndrome in persons with First Episode Drug Naïve Schizophrenia.

INTRODUCTION: Schizophrenia is a variable, significant and disruptive psychopathology, affecting every aspect of human life experiences like perception, cognition, emotion and behaviour, resulting in profound and often long lasting impairment, not only for persons affected, but also for the family and society, causing huge consumption of health costs, distress, loss of manpower, quality of life and productivity and ‘arguably the worst disease affecting mankind, even AIDS not exempted’ [Nature 1988]. It has puzzled physicians, philosophers and general public alike for centuries, as if it is a single disease, but it is probably comprises a group of syndromes due to multifactorial aetiology involving genetic, developmental, psychoneuroimmunological and environmental interactions in manifesting the disease. Schizophrenia affects approximately 1% of the population, involving all cultures, society, race and nations, and commonly affecting during the fertile period of adolescent and young adulthood with a tendency for chronic course. The treatment of schizophrenia has evolved over a long period of history with ancient remedies of plant extracts,with the revolutionary introduction of chlorpromazine in the 1950’s and the beginning of research on psychopharmacology. Based on the clinical improvement of psychotic Symptoms and molecular studies of neurotransmitters and receptors,the dopaminergic hypothesis of schizophrenia was proposed for these early indroduction of psychotropic drugs, following the indroduction of chlorpromazine, preferentially blocking dopamine 2 receptors, hence these drugs were called dopamine antagonists or typical or first generations antipsychotics. Apart from the effectiveness, it caused movement disorders of both acute and chronic [Tardive dyskinesias] in addition to other side effects, prompting research for drugs with minimum side effect profile resulting in the introduction of Dopamine-serotonin antagonists or atypical or second generation [preferentially blocking serotonin receptors] antipsychotics with different side effect profiles and equal efficacy except clozapine with much enthusiasm. [Canadian journal of psychiatry 2005;50;703-14. ] Although they were associated with less incidence of dyskinesias, soon it was found that they cause various derangements in metabolic parameters like weight gain, hypertension, dyslipidemia and dysregulation of glucose metabolism, which are established risk factors for cardiac and cerebrovascular complications, which causes catastrophic implications and premature death, requiring long term prophylaxis, dispelling the myth of superiority of atypicals over the typical antipsychotics. [schizophrenia Research 2004;71;195-212]. So the rational of the study is to find out the emergence of metabolic syndrome, which was established in various studies in the past, of the second generation antipsychotics and comparing it against first generation antipsychotics, in individuals with drug naive first episode of schizophrenia to avoid the disease effect, in our Institute of mental health, Madras Medical College, Chennai-10.