Metabolic adverse effects of antipsychotics: the state of the problem and management options

Antipsychotic  drugs are widely used for many psychiatric disorders, such as schizophrenia, bipolar affective disorder, delusions and hallucinations  due to neurological  disorders, depression with severe psychotic  symptoms. Metabolic disorders including  weight gain, dyslipidemia and hyperglycemia  are one of the most common side effects of antipsychotic therapy. Psychiatric patients have higher risk of cardiovascular disease, so that the development of metabolic side effects is an important clinical problem that should be solved. Antipsychotic-induced weight gain may cause distress that leads to antipsychotics withdraw and repeated hospitalizations.Lifestyle changes, correction of the antipsychotic treatment, additional medications and their combination are the possible solutions of antipsychotic metabolic side effects. Lifestyle modification is a first-line therapy that should complement other options, when it feasible. At the same time, it can be extremely difficult for patients receiving antipsychotic to adhere dietary and physical activity recommendations. Replacing an antipsychotic with a milder drug is not always possible and may not be enough effective. Metformin seems to be the most well-studied, safe and effective agent that is prescribed to deal with antipsychotic-induced weight gain and associated metabolic disorders. Glucagon-like peptide type 1 receptor agonists and thiazolidinediones  are mentioned as alternative medications, but clinical data on their efficacy and safety in this patient group are extremely limited. Dyslipidemia can develop as an independent antipsychotic side effect even without an increase in body weight. The most effective treatment, as in the general population, is statin therapy. However, the joint appointment of statins and antipsychotic significantly  increases the risk of adverse reactions, such as myalgia, myopathy, increased creatine kinase levels, due to the competition of drugs for the cytochrome system.It is still unknown what scales should be used for cardiovascular risk stratification in patients taking antipsychotic and whether it is possible to use metformin to prevent antipsychotic-induced weight gain, and if so, how to select patients for whom such therapy can be indicated. Finally, more clinical trials are needed to evaluate the efficacy and safety of other classes of hypoglycemic and lipid-lowering drugs in patients on antipsychotics

The role of IGF-1/GH in the aging process and the development of age-related diseases

One of the most important trends in geroscience is the search for the biomechanisms of aging and geroprotective methods. In recent years, more and more attention has been paid to the role of age-related decline in IGF-1 levels; processes that start with a decrease in the activity of the GH/IGF-1 axis. IGF-1 levels correlate differently with many age-associated diseases: diabetes mellitus, cancer, cardiovascular disease. A decrease in the level of IGF-1 and growth hormone in the elderly can contribute to the deterioration of the course of some pathologies, and also have a protective effect in the occurrence of different nosologies. The possibility of slowing down aging with the help of IGF-1 in basic research led to research aimed at studying the possibility of using IGF-1 preparations and growth hormone in clinical practice to slow down aging. We have studied the literature on the Pubmed platform, Scopus for the past 10 years in order to find some new information regarding influence of IGF-1 on aging, about the association between IGF-1 levels and major age-related diseases. We analyzed data of publications on the role of IGF-1 in aging and the development of age-related diseases. The search was carried out using key words: IGF-1, growth hormone, aging, the review included data from more than 60 publications

Antihypertensive therapy: controlling the processes of replicative cell senescence

The review includes data over the past 20 years on the mechanisms of the influence of hypertension and related interdependent conditions, such as insulin resistance, chronic inflammation and oxidative stress on the vascular ageing. The review also discusses modern concepts of the interaction of biological and vascular aging, as well as possible ways of their reversal. The central indicators of biological aging in this review are telomere length and telomerase activity. The article discusses antihypertensive therapy as a possible way to slow down both vascular and biological aging, and describes the results of modern studies on the effect of various antihypertensives, including angiotensin-converting enzyme inhibitors, sartans and others, on the telomeres