Using structural equations to test for a direct effect of some antipsychotics on triglyceride levels in drug-naïve first-episode psychosis patients

Francisco J. Diaz, Rocio Perez-Iglesias, Ignacio Mata, Obdulia Martínez-Garcia, José L. Vázquez-Barquero, Jose De Leon, Benedicto Crespo-Facorro

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Some antipsychotics probably increase the risk of metabolic syndrome. Antipsychotics may differentially influence some elements of metabolic syndrome (obesity, hyperlipidemia, hyperglycemia or hypertension) through various pharmacological mechanisms. In a published study of all first psychotic episodes in a Spanish hospital's catchment area population in Cantabria (Spain), patients were randomly assigned to receive haloperidol (3-9. mg/day), olanzapine (5-20. mg/day) or risperidone (3-6. mg/day). In this article, a structural-equation modeling approach tested the mechanistic hypothesis that olanzapine directly (without the mediation of weight gain) increases triglyceride levels, whereas risperidone and haloperidol do not have these effects. A structural equation model was built using the 110 patients whose assigned antipsychotic was not changed during the first 3. months of treatment, and who provided both triglyceride and body mass index (BMI) measurements at baseline and at the end of the 3rd month of treatment. A second structural equation included 72 patients whose antipsychotic was not changed during the first year. After 3. months and controlling for confounders, olanzapine patients had triglyceride levels that were 29.2. mg/dL higher [95% confidence interval, (10.9, 47.5)] than those of risperidone patients with comparable baseline triglyceride levels. After 12. months, they were 63.1. mg/dL higher (18.6, 107.6) than those of patients with a comparable history of triglyceride values during the first 3. months. Haloperidol effects on triglyceride levels and BMI were no different from those of risperidone. In conclusion, olanzapine increased triglyceride levels without the mediation of weight gain during a one-year study in naïve patients.

Original languageEnglish
Pages (from-to)82-89
Number of pages8
JournalSchizophrenia Research
Issue number1-3
StatePublished - Sep 2011

Bibliographical note

Funding Information:
No pharmaceutical company or commercial organization had any role in the writing of this paper for publication. The original study, including collection, management, analysis, and interpretation of the data was supported by internal funding from the University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; and by general support provided to this department from the Spanish government (CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain). The current analysis and interpretation of the data, preparation, review, and approval of the current manuscript were done without external support.


  • Antipsychotics
  • Lipids
  • Metabolic syndrome
  • Schizophrenia
  • Structural equations
  • Weight gain

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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