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Kalinowska S, Trześniowska-Drukała B, Kłoda K, Safranow K, Misiak B, Cyran A, Samochowiec J. The Association between Lifestyle Choices and Schizophrenia Symptoms. J Clin Med 2021; 10:jcm10010165. [PMID: 33466547 PMCID: PMC7796511 DOI: 10.3390/jcm10010165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/24/2022] Open
Abstract
Due to poor eating habits, insufficient physical activity, and nicotine use, schizophrenia patients are at increased risk of lifestyle diseases. Factors contributing to unhealthy behaviors include lower socioeconomic status and level of education as well as social isolation. Schizophrenia manifestations such as amotivation, apathy, and cognitive deficits can further hinder development of proper health habits. The aim of this study was to assess the possible association between lifestyle-related choices and schizophrenia symptoms severity. This observational study enrolled 106 patients with schizophrenia (42 Males/64 Females), 18–69 years (mean: 41.89 ± 9.7 years). Mean duration of schizophrenia was 14.61 ± 9.7 years. Multiple significant correlations were found between patients’ lifestyle and their biochemical laboratory parameters (lipid profile and fasting glucose). Most importantly, a significant link emerged between presented habits and schizophrenia symptom severity. There were also significant gender differences in the intake of sweets and sweet beverages. Quite unexpectedly, a behavioral shift towards more healthy lifestyle choices was observed after completion of questionnaires on lifestyle and health habits. There are clear benefits to systematic provision of educational interventions concerning physical activity and proper eating habits to schizophrenia patients. These simple preventive measures could significantly improve both mental and physical health outcomes in schizophrenia patient populations.
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Affiliation(s)
- Sylwia Kalinowska
- Department of Psychiatry, Pomeranian Medical University, 26 Broniewskiego Street, 71-460 Szczecin, Poland; (B.T.-D.); (J.S.)
- Correspondence: ; Tel.: +48-91454-1507; Fax: +48-91454-0733
| | - Beata Trześniowska-Drukała
- Department of Psychiatry, Pomeranian Medical University, 26 Broniewskiego Street, 71-460 Szczecin, Poland; (B.T.-D.); (J.S.)
| | - Karolina Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, 1 Rybacka Street, 70-204 Szczecin, Poland;
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 72 Powstancow Wlkp Street, 70-111 Szczecin, Poland;
| | - Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteura Street, 50-367 Wroclaw, Poland; (B.M.); (A.C.)
| | - Agnieszka Cyran
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteura Street, 50-367 Wroclaw, Poland; (B.M.); (A.C.)
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, 26 Broniewskiego Street, 71-460 Szczecin, Poland; (B.T.-D.); (J.S.)
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Aucoin M, LaChance L, Clouthier SN, Cooley K. Dietary modification in the treatment of schizophrenia spectrum disorders: A systematic review. World J Psychiatry 2020; 10:187-201. [PMID: 32874956 PMCID: PMC7439299 DOI: 10.5498/wjp.v10.i8.187] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/25/2020] [Accepted: 07/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Schizophrenia spectrum disorders impact functioning, reduce quality of life and increase the risk of physical illness and premature mortality. Nutritional intervention studies aimed at decreasing body weight have demonstrated efficacy in improving metabolic outcomes; however, few studies have explored the impact of interventions designed to modify diet on mental health outcomes.
AIM To synthesize the existing experimental studies of adjunctive diet modification as an intervention in the treatment of psychotic disorders, analyze findings related to effectiveness and safety, highlight knowledge gaps and limitations, and set forward recommendations for future research studies.
METHODS An extensive a priori search strategy was developed and the databases Embase, Embase Classic, Ovid MEDLINE were searched. Screening and data extraction were completed in duplicate. Studies included in this analysis were experimental studies of an adjunctive dietary intervention (overall dietary pattern or education on dietary change) for treatment of schizophrenia spectrum disorders. No restrictions were placed on control groups or blinding. The studies were required to report a mental health outcome.
RESULTS Twenty-five clinical trials were identified, along with two additional protocols and two meta-analyses. Nineteen of the clinical trials reported improvement in one or more mental health domain including psychosis symptoms, cognition, and quality of life. A high level of heterogeneity was found with respect to patient population, intervention, and study design. All of the studies included lifestyle or psychosocial components in addition to dietary modification. The nutrition advice provided to participants was poorly described overall and compliance was not assessed. The studies that showed benefit tended to have a smaller sample size and were less likely to be randomized but were more likely to use a group delivery intervention.
CONCLUSION Further research assessing effectiveness and efficacy of clearly reported dietary interventions is warranted, especially those using rigorous methodology, modifying diet in isolation and assessing participant compliance.
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Affiliation(s)
- Monique Aucoin
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto M2K 1E2, Canada
| | - Laura LaChance
- Department of Psychiatry, McGill University, Montreal H3A 0G4, Canada
- Centre for Addiction and Mental Health, Toronto M6R 1A1, Canada
| | - Sam N Clouthier
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto M2K 1E2, Canada
| | - Kieran Cooley
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto M2K 1E2, Canada
- Department of Public Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo 2007, Australia
- Department of Doctoral Acupuncture and Chinese Medicine, Pacific College of Health Science, San Diego, CA 92108, United States
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Wharton S, Kuk JL, Petrova L, Rye PI, Taylor VH, Christensen RAG. Effectiveness of a Community-Based Weight Management Program for Patients Taking Antidepressants and/or Antipsychotics. Obesity (Silver Spring) 2019; 27:1539-1544. [PMID: 31441235 DOI: 10.1002/oby.22567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to compare weight loss (WL) outcomes for patients taking antidepressants and/or antipsychotics with those not taking psychiatric medication. METHODS A total of 17,519 adults enrolled in a lifestyle WL intervention at the Wharton Medical Clinics in Ontario, Canada, were analyzed. Sex-stratified multivariable linear regression analysis was used to examine the association of taking antidepressants, antipsychotics, both, or neither with WL when adjusting for age, initial weight, and treatment time. RESULTS Twenty-three percent of patients were taking at least one psychiatric medication. Patients lost a significant amount of weight (P < 0.0001) regardless of psychiatric medication use. Women taking psychiatric medications lost a similar amount of weight as women who were not (P > 0.05). Conversely, men taking antidepressants lost only slightly less weight than men taking both classes or neither class of psychiatric medication (3.2 ± 0.3 kg vs. 5.6 ± 0.9 kg and 4.3 ± 0.1 kg; P < 0.05). However, taking psychiatric medications that cause weight gain was associated with similar significant decreases in weight as taking medications that are weight neutral or associated with WL for both sexes (P > 0.05). CONCLUSIONS Results of this study suggest that those who participate in a weight management program can lose significant amounts of weight regardless of psychiatric medication use.
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Affiliation(s)
- Sean Wharton
- Wharton Medical Clinic, Toronto, Ontario, Canada
- Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Jennifer L Kuk
- Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Lana Petrova
- Wharton Medical Clinic, Toronto, Ontario, Canada
| | - Peter I Rye
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie H Taylor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ban C, Zhang Q, Feng J, Li H, Qiu Q, Tian Y, Li X. Low prevalence of lipid metabolism abnormalities in APOE ε2-genotype and male patients 60 years or older with schizophrenia. BMC Psychiatry 2017; 17:399. [PMID: 29233125 PMCID: PMC5727937 DOI: 10.1186/s12888-017-1530-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/07/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Schizophrenia is a serious mental disorder largely manageable with atypical antipsychotics; however, these drugs have been associated with glucose/lipid metabolism issues such as diabetes and hyperlipidaemia. Apolipoprotein E (APOE) is the most abundant apolipoprotein, and APOE genotypes have been correlated with lipid metabolism phenotypes in an age-dependent manner. Studies examining the relationship between the APOE genotype and lipid abnormalities in patients with schizophrenia have been inconclusive, but primarily focused on adult patient populations. Therefore, we explored the correlations between the APOE genotype and glucose/lipid metabolism indicators and abnormalities in hospitalized patients 60 years or older with schizophrenia with a history of long-term antipsychotics use. METHODS We assessed APOE genotype, age, weight, height, blood glucose, triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein in a total of 294 patients. APOE genotypes were divided into three groups: APOE ε2 (ε2/ε2 and ε2/ε3), APOE ε3 (ε3/ε3), and APOE ε4 (ε3/ε4 and ε4/ε4), and comparisons were conducted among these groups or according to ε2 carrier status. RESULTS APOE ε3/ε3 was the most common genotype (68.3%) and at least one ε3 allele was present in 81.8% of patients. There were no differences in antipsychotics type or dose according to the APOE genotype, but serum cholesterol values varied near significantly (P = 0.052) and low-density lipoprotein values varied significantly according to genotype (P < 0.05, lowest in the APOE ε2 genotype). Men had lower cholesterol and low-density lipoprotein levels (P < 0.05) than women. Compared to patients administered typical antipsychotics, those administered atypical antipsychotics had higher triglyceride, cholesterol, and low-density lipoprotein levels (P < 0.05). Stepwise linear regressions showed that cholesterol and low-density lipoprotein levels were influenced by sex, the APOE ε2 genotype, and atypical antipsychotics use. CONCLUSIONS In the context of atypical antipsychotics use, carriers of the APOE ε2-genotype and male patients with schizophrenia 60 years or older may be less likely to develop a lipid metabolism abnormality.
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Affiliation(s)
- Chunxia Ban
- 0000 0004 0368 8293grid.16821.3cDepartment of Psychogeriatrics, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, South Wanping Road 600, Shanghai, 200030 China ,Mental Health Center of Jiading District in Shanghai, Shanghai, 201800 China
| | - Qunying Zhang
- Mental Health Center of Fengxian District in Shanghai, Shanghai, 201400 China
| | - Jie Feng
- Mental Health Center of Jiading District in Shanghai, Shanghai, 201800 China
| | - Huijuan Li
- Mental Health Center of Jiading District in Shanghai, Shanghai, 201800 China
| | - Qi Qiu
- 0000 0004 0368 8293grid.16821.3cDepartment of Psychogeriatrics, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, South Wanping Road 600, Shanghai, 200030 China
| | - Yuan Tian
- Mental Health Center of Jiading District in Shanghai, Shanghai, 201800, China.
| | - Xia Li
- Department of Psychogeriatrics, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, South Wanping Road 600, Shanghai, 200030, China.
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Carson NE, Blake CE, Saunders R. Perceptions and dietary intake of self-described healthy and unhealthy eaters with severe mental illness. Community Ment Health J 2015; 51:281-8. [PMID: 25535051 DOI: 10.1007/s10597-014-9806-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 12/08/2014] [Indexed: 12/01/2022]
Abstract
The aim of this exploratory study was to examine how community-dwelling adults with severe mental illness describe themselves as eaters and how these eating identities relate to dietary intake. Twenty participants completed one in-depth qualitative interview and three 24-h dietary recalls. Two distinct groups were identified; self-described healthy eaters (n = 10) and self-described unhealthy eaters (n = 10). Healthy eaters emphasized fruits and vegetables, limiting sweets, three meals a day, overcoming cost concerns, and benefits of healthy eating. Unhealthy eaters emphasized junk foods, fried foods, few fruits and vegetables, cost and household barriers to healthy eating, and concerns about consequences of unhealthy eating. Self-described healthy eaters consumed significantly more vegetables and less kilocalories, carbohydrates, fat, and saturated fat than self-described unhealthy eaters. Understanding how eating identities relate to dietary intake provides important insights for development of more effective approaches to promote healthy eating in this high risk population.
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Affiliation(s)
- Nancy E Carson
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA,
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Soundy A, Roskell C, Stubbs B, Vancampfort D. Selection, use and psychometric properties of physical activity measures to assess individuals with severe mental illness: a narrative synthesis. Arch Psychiatr Nurs 2014; 28:135-51. [PMID: 24673789 DOI: 10.1016/j.apnu.2013.12.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/21/2013] [Accepted: 12/14/2013] [Indexed: 12/13/2022]
Abstract
This research provides a critical consideration of the outcome measures used to assess physical activity in individuals with severe mental illness. A narrative synthesis was utilised to provide a simple juxtapose of the current research. A sensitive topic-based search strategy was conducted in order to identify studies that met the eligibility criteria. Fifty two studies met the inclusion criteria and 5 were identified specially as validation studies. The current research identified several methodological shortcomings. The justification and choice of outcome measure used is often weak and only five studies have validated a specific outcome measure of physical activity. Within these validation studies, the validation process often lacked a consideration of agreement between measures. Accelerometers have been most frequently used as a criterion measure, notably the RT3 tri-axial accelerometer. Objective based measures may be best placed to consider physical activity levels, although, methodological considerations for the utilization of such tools is required. Self-report questionnaires have benefits for use in this population but require further validation. Researchers and clinicians need to carefully consider what outcome measure they are using and be aware of the development, scope and purpose of that measure.
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Affiliation(s)
- Andrew Soundy
- School of Health and Population Sciences, College of Medicine and Dentistry, 52 Pritchatts Road, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Carolyn Roskell
- School of Health and Population Sciences, College of Medicine and Dentistry, 52 Pritchatts Road, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Brendon Stubbs
- School of Health and Social Care, University of Greenwich, Southwood Site, Avery Hill Road, Eltham, London, UK
| | - Davy Vancampfort
- University Psychiatric Center, Catholic University Leuven, Campus Kortenberg, Leuvensesteenweg 517, Kortenberg, Belgium.
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Abstract
The metabolic syndrome (MetS) is an increasingly prevalent condition in people with schizophrenia. It remains highly prevalent in the general population in developed countries, but recently health promotion campaigns and greater awareness of the high associated mortality rates have resulted in improvements in the rates of cardiovascular risk factors. This is not the case for people with schizophrenia who continue to have more than twice the rates of MetS and significantly higher mortality rates than the general population. Various behavioural and pharmacological interventions have been used to improve conditions that are linked to MetS, mainly smoking and obesity. This review aims to provide an update of the latest knowledge about the behavioural, pharmacological and other interventions that might help to combat this life-threatening problem in people with schizophrenia.
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Affiliation(s)
- Evangelos Papanastasiou
- CSI Lab, Department of Psychosis Studies, Institute of Psychiatry, KCL, De Crespigny Park, PO63, Denmark Hill, London SE5 8AF, UK
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Lally J, McDonald C. Dramatic weight loss associated with commencing clozapine. BMJ Case Rep 2011; 2011:bcr.09.2011.4790. [PMID: 22674113 DOI: 10.1136/bcr.09.2011.4790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors report the case of a 44-year-old man with a long history of chronic enduring schizophrenia who experienced dramatic weight loss after commencing treatment with clozapine, an antipsychotic medication characteristically associated with the greatest degree of weight gain among medical treatments for schizophrenia. He was obese with a body mass index (BMI) of 41.5 kg/m(2), but after commencing clozapine therapy he experienced an improvement in psychotic symptoms and 40% loss of his body weight attained through an altered diet and exercise regime, which resulted in him attaining a normal BMI of 24.8 kg/m(2).
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Affiliation(s)
- John Lally
- Department of Psychiatry, National University of Ireland Galway (NUIG), Galway, Ireland.
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Verhaeghe N, De Maeseneer J, Maes L, Van Heeringen C, Annemans L. Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review. Int J Behav Nutr Phys Act 2011; 8:28. [PMID: 21481247 PMCID: PMC3094265 DOI: 10.1186/1479-5868-8-28] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 04/11/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is a high prevalence of overweight and obesity in persons with severe mental disorders and this has serious implications on the short and long term health outcomes of these patients. The aim of this review was to evaluate the effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders. Special attention was given if any of the included studies in the review also examined the cost-effectiveness of these health promotion interventions. METHODS A systematic search through the electronic databases Medline, Web of Science, CINAHL and Cohrane Library was conducted, and by hand-searching the reference lists of the retrieved articles from the electronic databases. Studies were included if they examined effectiveness and/or cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders, with primary outcome changes in Body Mass Index and body weight. RESULTS Fourteen studies met the inclusion criteria. Weight loss and Body Mass Index decrease were observed in intervention groups in 11 studies. The difference in weight change between intervention and control groups was statistically significant in nine studies. Differences in mean Body Mass Index between intervention and control groups were statistically significant in eight studies. Five studies reported improvements in quality of life and general health. In none of the studies cost-effectiveness of lifestyle interventions was examined. CONCLUSION Further research on both effectiveness and cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders is required to assist in the development of new health promotion interventions in this population.
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Affiliation(s)
- Nick Verhaeghe
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Jan De Maeseneer
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Lea Maes
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Cornelis Van Heeringen
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 B-1090 Brussel, Belgium
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Ball M, Warren K, Feldman S, McMahon R, Kelly D, Buchanan R. Placebo-Controlled Trial of Atomoxetine for Weight Reduction in People with Schizophrenia Treated with Clozapine or Olanzapine. ACTA ACUST UNITED AC 2011; 5:17-25. [DOI: 10.3371/csrp.5.1.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cabassa LJ, Ezell JM, Lewis-Fernández R. Lifestyle interventions for adults with serious mental illness: a systematic literature review. Psychiatr Serv 2010; 61:774-782. [PMID: 20675835 PMCID: PMC3632414 DOI: 10.1176/appi.ps.61.8.774] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The promotion of healthy lifestyles among persons with serious mental illness is an integral part of their recovery. The aims of this systematic literature review were to rate the methodological quality of lifestyle intervention outcome studies for persons with serious mental illness, summarize intervention strategies, examine physical health outcomes, and evaluate the inclusion of racial and ethnic minority groups in these studies. METHODS Electronic bibliographic database searches were performed to locate studies conducted in the United States. Articles written in English and published in peer-reviewed journals between 1980 and 2009 were included. The authors used a standardized instrument to rate studies' methodological quality. RESULTS Twenty-three articles were reviewed. Based on studies' methodological quality, three levels of evidence were found: single-group reports, quasi-experimental studies, and randomized controlled trials. Most interventions used behavioral techniques to improve dietary habits and increase physical activity. Twelve studies reported significant improvements in either weight loss or metabolic syndrome risk factors associated with receiving a lifestyle intervention. Persons from racial and ethnic minority groups were underrepresented, especially Hispanics and Asian Americans. Only one study included non-English-speaking participants. CONCLUSIONS Lifestyle interventions adapted to persons with serious mental illness show promise in reducing weight loss and some risk factors for metabolic syndrome. The underrepresentation of persons from racial or ethnic minority groups in this literature limits its generalizability. Implications for research and practice are discussed.
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Cabassa LJ, Ezell JM, Lewis-Fernández R. Lifestyle interventions for adults with serious mental illness: a systematic literature review. Psychiatr Serv 2010; 61:774-82. [PMID: 20675835 PMCID: PMC3632414 DOI: 10.1176/ps.2010.61.8.774] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The promotion of healthy lifestyles among persons with serious mental illness is an integral part of their recovery. The aims of this systematic literature review were to rate the methodological quality of lifestyle intervention outcome studies for persons with serious mental illness, summarize intervention strategies, examine physical health outcomes, and evaluate the inclusion of racial and ethnic minority groups in these studies. METHODS Electronic bibliographic database searches were performed to locate studies conducted in the United States. Articles written in English and published in peer-reviewed journals between 1980 and 2009 were included. The authors used a standardized instrument to rate studies' methodological quality. RESULTS Twenty-three articles were reviewed. Based on studies' methodological quality, three levels of evidence were found: single-group reports, quasi-experimental studies, and randomized controlled trials. Most interventions used behavioral techniques to improve dietary habits and increase physical activity. Twelve studies reported significant improvements in either weight loss or metabolic syndrome risk factors associated with receiving a lifestyle intervention. Persons from racial and ethnic minority groups were underrepresented, especially Hispanics and Asian Americans. Only one study included non-English-speaking participants. CONCLUSIONS Lifestyle interventions adapted to persons with serious mental illness show promise in reducing weight loss and some risk factors for metabolic syndrome. The underrepresentation of persons from racial or ethnic minority groups in this literature limits its generalizability. Implications for research and practice are discussed.
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Affiliation(s)
- Leopoldo J. Cabassa
- Dr. Cabassa and Dr. Lewis-Fernández are with the Department of Psychiatry and Mr. Ezell is with the Mailman School of Public Health, all at Columbia University, 1051 Riverside Dr., Room 1715, Unit 11, New York, NY 10032 (). Dr. Cabassa and Dr. Lewis-Fernández are also with the New York State Psychiatric Institute, New York City
| | - Jerel M. Ezell
- Dr. Cabassa and Dr. Lewis-Fernández are with the Department of Psychiatry and Mr. Ezell is with the Mailman School of Public Health, all at Columbia University, 1051 Riverside Dr., Room 1715, Unit 11, New York, NY 10032 (). Dr. Cabassa and Dr. Lewis-Fernández are also with the New York State Psychiatric Institute, New York City
| | - Roberto Lewis-Fernández
- Dr. Cabassa and Dr. Lewis-Fernández are with the Department of Psychiatry and Mr. Ezell is with the Mailman School of Public Health, all at Columbia University, 1051 Riverside Dr., Room 1715, Unit 11, New York, NY 10032 (). Dr. Cabassa and Dr. Lewis-Fernández are also with the New York State Psychiatric Institute, New York City
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Protection from olanzapine-induced metabolic toxicity in mice by acetaminophen and tetrahydroindenoindole. Int J Obes (Lond) 2010; 34:970-9. [PMID: 20065957 DOI: 10.1038/ijo.2009.291] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE In mice and in humans, treatment with the second-generation antipsychotic drug olanzapine (OLZ) produces excessive weight gain, adiposity and secondary metabolic complications, including loss of glucose and insulin homeostasis. In mice consuming a high-fat (HF) diet, a similar phenotype develops, which is inhibited by the analgesic acetaminophen (APAP) and by the antioxidant tetrahydroindenoindole (THII). Therefore, we examined the ability of APAP and THII to prevent metabolic changes in mice receiving OLZ. DESIGN AND MEASUREMENT C57BL/6J mice received either a normal diet or a HF diet, and were administered daily dosages of OLZ (3 mg kg(-1) body weight), alone or with APAP (30 mg kg(-1) body weight) or THII (4.5 mg kg(-1) body weight), for 10 weeks. Parameters of body composition and metabolism, including glucose and insulin homeostasis and oxidative stress, were examined. RESULTS OLZ treatment doubled the HF diet-induced increases in body weight and percent body fat. These increases were partially prevented by both APAP and THII, although food consumption was constant in all groups. The THII protection was associated with an increase in whole body and mitochondrial respiration. OLZ also exacerbated, and both APAP and THII prevented, HF diet-induced loss of glucose tolerance and insulin resistance. As increased body fat promotes insulin resistance by a pathway involving oxidative stress, we evaluated production of reactive oxygen and lipid peroxidation in white adipose tissue (WAT). HF diet caused an increase in lipid peroxidation, NADPH-dependent O(2) uptake and H(2)O(2) production, which were further exacerbated by OLZ. APAP, THII and the NADPH oxidase inhibitor, diphenyleneiodonium chloride, each abolished oxidative stress in WAT. CONCLUSIONS We conclude that both APAP and THII intervene in the development of obesity and metabolic complications associated with OLZ treatment.
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Miller LJ. Management of Atypical Antipsychotic Drug–Induced Weight Gain: Focus on Metformin. Pharmacotherapy 2009; 29:725-35. [DOI: 10.1592/phco.29.6.725] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Khazaal Y, Chatton A, Claeys F, Ribordy F, Zullino D, Cabanac M. Antipsychotic drug and body weight set-point. Physiol Behav 2008; 95:157-60. [PMID: 18582910 DOI: 10.1016/j.physbeh.2008.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 05/08/2008] [Accepted: 05/19/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Antipsychotic (AP) drugs frequently induce weight gain. The present study aimed at exploring a potential association between antipsychotic-induced weight gain and delayed negative alliesthesia for sweet stimuli. RESEARCH METHODS AND PROCEDURES The study aimed at recruiting patients undergoing AP treatment, half of them with stable weight and the other half with documented weight gain. Negative alliesthesia to sweet stimuli was assessed through a specific procedure. RESULTS A multivariate regression of the data obtained from the entire sample was performed to establish the relationship between alliesthesia dependent variables and weight gain as a predictor. The overall F statistic shows that there was a significant association between delayed negative alliesthesia for sweet stimuli and weight gain. CONCLUSION Atypical antipsychotic drug-induced weight gain seems to result from a raised body weight set-point.
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Affiliation(s)
- Yasser Khazaal
- Division of substance abuse, University Hospitals of Geneva, Switzerland.
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Direk N, Ucok A. Effectiveness of a structured diet program in antipsychotic-induced weight gain in patients with schizophrenia. Int J Psychiatry Clin Pract 2008; 12:238-40. [PMID: 24931664 DOI: 10.1080/13651500701574554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective.The aim of this study was to evaluate the effectiveness of a structured diet program in weight loss in patients with schizophrenia. Methods. A total of 38 outpatients diagnosed with schizophrenia according to DSM-IV and who had complaints of weight gain during treatment with various antipsychotic drugs were invited to participate in a 3-month structured diet program. Thirty-two patients and another 40 patients were included as the control group. At the beginning of the diet program, the patients were given a form in order to evaluate their eating habits, and blood samples were taken to measure plasma lipid profile, and fasting blood glucose (FBG) level. Patients' baseline weight, body mass index (BMI), and basal metabolism rate (BMR) were recorded. Results. Thirty-two patients with schizophrenia, who attended a 3-month structured diet program had mean weight loss of 6.19 kg, whereas patients in the control group gained 1.6 kg. Conclusion. Our findings show that a diet program is effective in managing antipsychotic-induced weight gain. The degree of weight loss seems to be correlated with the duration in which the patient is on the diet program. However; younger patients had less benefit from the diet program.
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Affiliation(s)
- Nese Direk
- Department of Psychiatry, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Poulin MJ, Chaput JP, Simard V, Vincent P, Bernier J, Gauthier Y, Lanctôt G, Saindon J, Vincent A, Gagnon S, Tremblay A. Management of antipsychotic-induced weight gain: prospective naturalistic study of the effectiveness of a supervised exercise programme. Aust N Z J Psychiatry 2007; 41:980-9. [PMID: 17999270 DOI: 10.1080/00048670701689428] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the potential effectiveness of a behavioural weight control programme including physical exercise in the prevention of antipsychotic-induced weight gain and associated comorbid conditions in outpatients with schizophrenia and mood disorders. METHODS A prospective, comparative, open and naturalistic study was carried out for a total of 110 patients with schizophrenia, schizoaffective or bipolar disorders (DSM-IV), on treatment with atypical antipsychotics. Of these, 59 patients participated in an 18 month weight control programme that included an educational activity about dietary and physical activity counselling as well as a structured, supervised, facility-based exercise programme. The control group consisted of 51 patients with the same baseline characteristics who did not receive the clinical programme. Anthropometric measurements, plasma lipid-lipoprotein profile, and fasting plasma glucose concentrations were assessed at 11 time-points over the study. In addition, serum concentrations of prolactin, thyrotropin-stimulating hormone (TSH), and glycated haemoglobin (HbA1c) were assessed at four time-points. Finally, the Clinical Global Impression scale (CGI), the Brief Psychiatric Rating Scale (BPRS) and the Short Form (SF)-36 Health Survey were used. RESULTS The adherence rate of patients was 85%, both in the active and in the control group. Whereas the control group experienced a significant increase in bodyweight (4.1%), body mass index (BMI; 5.5%) and waist circumference (WC; 4.2%), the active group significantly reduced their bodyweight (-3.5%), BMI (-4.4%), and WC (-4.6%) at the study end-point. In addition, a significant increase in low-density lipoprotein (LDL)-cholesterol (14.8%) and in triglyceride concentrations (12.3%) was observed at month 18 in the control group. In contrast, high-density lipoprotein-cholesterol (HDL) significantly increased (21.4%), and LDL cholesterol (-13.7%), triglycerides (-26.2%), total cholesterol (-12.1%), fasting glucose concentrations (-12.0%), and HbA1c (-11.4%) significantly decreased compared to baseline in the active group. No significant changes were observed regarding serum concentrations of prolactin and TSH during the study. In regard to the changes observed in psychological measures, no between-group differences were seen in the clinical ratings of CGI and BPRS. However, the SF-36 showed that physical health was improved only for subjects in the active group at months 12 and 18 compared to baseline (p<0.05), and mental health was significantly improved for both groups at months 12 and 18 compared to baseline. CONCLUSION Bodyweight and metabolic risk profile in patients receiving atypical antipsychotic medications can be effectively managed with a weight control programme including physical activity.
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Affiliation(s)
- Marie-Josée Poulin
- Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus and Centre Hospitalier Robert-Giffard, Quebec City, Quebec, Canada
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18
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Strassnig M, Ganguli R. Weight Loss Interventions for Patients with Schizophrenia. ACTA ACUST UNITED AC 2007. [DOI: 10.3371/csrp.1.1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Khazaal Y, Fresard E, Rabia S, Chatton A, Rothen S, Pomini V, Grasset F, Borgeat F, Zullino D. Cognitive behavioural therapy for weight gain associated with antipsychotic drugs. Schizophr Res 2007; 91:169-77. [PMID: 17306507 DOI: 10.1016/j.schres.2006.12.025] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 12/22/2006] [Accepted: 12/23/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Overweight and obesity are common concerns in individuals with severe mental disorders. In particular, antipsychotic drugs (AP) frequently induce weight gain. This phenomenon lacks current management and no previous controlled studies seem to use cognitive therapy to modify eating and weight-related cognitions. Moreover, none of these studies considered binge eating or eating and weight-related cognitions as possible outcomes. AIM The main aim of this study is to assess the effectivity of cognitive and behavioural treatment (CBT) on eating and weight-related cognitions, binge eating symptomatology and weight loss in patients who reported weight gain during AP treatment. METHOD A randomized controlled study (12-week CBT vs. Brief Nutritional Education) was carried out on 61 patients treated with an antipsychotic drug who reported weight gain following treatment. Binge eating symptomatology, eating and weight-related cognitions, as well as weight and body mass index were assessed before treatment, at 12 weeks and at 24 weeks. RESULTS The CBT group showed some improvement with respect to binge eating symptomatology and weight-related cognitions, whereas the control group did not. Weight loss occurred more progressively and was greater in the CBT group at 24 weeks. CONCLUSION The proposed CBT treatment is particularly interesting for patients suffering from weight gain associated with antipsychotic treatment.
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Affiliation(s)
- Yasser Khazaal
- Department of Psychiatry, University Hospital of Vaud, Lausanne, Switzerland.
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20
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Cope MB, Jumbo-Lucioni P, Walton RG, Kesterson RA, Allison DB, Nagy TR. No effect of dietary fat on short-term weight gain in mice treated with atypical antipsychotic drugs. Int J Obes (Lond) 2007; 31:1014-22. [PMID: 17224931 DOI: 10.1038/sj.ijo.0803533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
RATIONALE Atypical antipsychotic drugs (AAD) induce significant weight gain in female C57BL/6J mice. The effect of dietary fat on weight gain and serum lipids in this model is unknown. OBJECTIVES Test the hypothesis that the obesigenic effects of these drugs are greater in the presence of a high-fat diet. METHODS Female C57BL/6J mice were treated with atypical antipsychotics for 3 weeks and fed either a low-fat or high-fat diet (4.6 vs 15.6% fat by wt). Food intake (FI), body weight (BW), body composition, and serum lipids were measured during treatment with optimized doses of olanzapine, quetiapine, and risperidone. Energy intake (EI) and feed efficiency (FE) were calculated. Group differences in change were analyzed via repeated measures analysis of variance (ANOVA). Serum lipid concentrations, EI and FE were compared using two-way ANOVA. RESULTS AAD-treated mice gained significantly more weight than controls after 3 weeks (P<0.001). Treatment and diet had significant effects on FI and EI over time (P<0.001). AAD-treated mice had significantly higher FE than controls (P<0.05); however, there was no significant drug by diet interaction (P=0.65). Risperidone low-fat mice gained significantly more absolute fat mass than placebo low-fat mice (P<0.05). All treatment groups, except quetiapine low-fat and olanzapine high-fat, gained significantly more absolute lean mass than placebo controls (P<0.05). Cholesterol levels were significantly lower in quetiapine and risperidone than placebo (P<0.05). Risperidone low-fat mice had significantly higher triglyceride levels than placebo and risperidone high-fat mice (P<0.05). CONCLUSIONS A high-fat diet does not increase AAD-induced BW gain in female mice during a 3-week treatment period.
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Affiliation(s)
- M B Cope
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294-3360, USA
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21
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Centorrino F, Wurtman JJ, Duca KA, Fellman VH, Fogarty KV, Berry JM, Guay DM, Romeling M, Kidwell J, Cincotta SL, Baldessarini RJ. Weight loss in overweight patients maintained on atypical antipsychotic agents. Int J Obes (Lond) 2007; 30:1011-6. [PMID: 16432547 DOI: 10.1038/sj.ijo.0803222] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Weight gain and associated medical morbidity offset the reduction of extrapyramidal side effects associated with atypical antipsychotics. Efforts to control weight in antipsychotic-treated patients have yielded limited success. METHODS We studied the impact of an intensive 24-week program of diet, exercise, and counseling in 17 chronically psychotic patients (10 women, seven men) who entered at high average body weight (105.0+/-18.4 kg) and body mass index (BMI) (36.6+/-4.6 kg/m(2)). A total of 12 subjects who completed the initial 24 weeks elected to participate in an additional 24-week, less intensive extension phase. RESULTS By 24 weeks, weight-loss/patient averaged 6.0 kg (5.7%) and BMI decreased to 34.5 (by 5.7%). Blood pressure decreased from 130/83 to 116/74 (11% improvement), pulse fell slightly, and serum cholesterol and triglyceride concentrations changed nonsignificantly. With less intensive management for another 24 weeks, subjects regained minimal weight (0.43 kg). CONCLUSIONS These findings add to the emerging view that weight gain is a major health problem associated with modern antipsychotic drugs and that labor-intensive weight-control efforts in patients requiring antipsychotic treatment yield clinically promising benefits. Improved treatments without weight-gain risk are needed.
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Affiliation(s)
- F Centorrino
- Consolidated Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA.
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Khazaal Y, Frésard E, Borgeat F, Zullino D. Binge eating symptomatology in overweight and obese patients with schizophrenia: a case control study. Ann Gen Psychiatry 2006; 5:15. [PMID: 16968528 PMCID: PMC1570457 DOI: 10.1186/1744-859x-5-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 09/12/2006] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess whether severe overweight schizophrenic treated patients differ from controls and from pairs in binge eating symptomatology. METHOD Current body mass index (BMI) and the binge eating status were assessed cross-sectionally in 40 schizophrenic outpatients and 40 non-psychiatric controls. In each group half of the subjects were severe overweight (BMI > or = 28) or obese. RESULTS Pearson Chi-square analysis shows a higher number of subjects with binge symptomatology in the group of patients with schizophrenia having BMI > or = 28 (Pearson Chi-square = 8.67, p = 0.034). Among subjects with BMI > or = 28, 60% of patients with schizophrenia and 30% of controls have binge eating symptomatology. CONCLUSION This result may odds to the understanding of weight gain associated with antipsychotics and underscores the importance of assessing binge eating behaviour during treatment and prevention of obesity in this population.
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Affiliation(s)
- Yasser Khazaal
- Department of Psychiatry, University Hospital of Vaud, Echallens 9, 1004 Lausanne, Switzerland
| | - Emmanuelle Frésard
- Department of Psychiatry, University Hospital of Vaud, Echallens 9, 1004 Lausanne, Switzerland
| | - François Borgeat
- Department of Psychiatry, University Hospital of Vaud, Echallens 9, 1004 Lausanne, Switzerland
| | - Daniele Zullino
- University Hospitals of Geneva, Division of Substance Abuse, Rue Verte 2, 1205 Geneva, Switzerland
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Gentile S. Long-term treatment with atypical antipsychotics and the risk of weight gain : a literature analysis. Drug Saf 2006; 29:303-19. [PMID: 16569080 DOI: 10.2165/00002018-200629040-00002] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this review is to analyse and summarise the literature data about the incidence of weight gain in patients exposed to atypical antipsychotics during long-term (>or=1 year) treatment regimens. Despite the clinical relevance of the topic, the vast majority of reviewed studies showed methodological limitations. Some trials had retrospective analysis, and concomitant medications also associated with an increased risk of weight gain, such as antidepressants and mood stabilisers, were often prescribed. Results were obtained from clinical trials conducted using flexible dosages; thus, the relationship between dosage and weight change was not explored adequately. Also, in a large number of studies, the average antipsychotic daily dose was lower than the usual dosage in clinical practice. Moreover, weight gain was evaluated by different measures, such as mean weight gain in the enrolled population, percentage of patients who gained >7% of basal weight or body mass index (BMI) variations from baseline. In short-term studies, a definite rank order of weight-gain potential among atypical antipsychotics has been demonstrated: clozapine is related to the highest risk of weight gain, followed in decreasing order of magnitude by olanzapine, quetiapine, risperidone, amisulpride, aripiprazole and ziprasidone. However, in long-term studies, except for clozapine at one end of the scale and ziprasidone at the other, the differences in weight-gain liability showed by the other atypical antipsychotics became less intense. Differences between short-term and long-term treatment could be due to a complex overlapping of different factors, both drug-specific (relative receptorial affinity; timing of weight change plateau; and drug-specific/dose-dependent weight gain), and patient-specific (genetic vulnerability; sex; age; BMI; weight before starting antipsychotic treatment; type of psychiatric disorder; and individual lifestyle). There is an urgent need for well designed, randomised controlled trials to assess firmly both the differential effects of atypical antipsychotics on weight and the role of other factors in contributing to iatrogenic unwanted weight changes. Meanwhile, the well known benefits shown by some atypical antipsychotics in reducing akathisia and other extrapyramidal adverse effects and improving cognition should be carefully balanced with the problems of weight gain, other metabolic complications and higher health care costs.
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Affiliation(s)
- Salvatore Gentile
- Department of Mental Health ASL Salerno 1, Mental Health Center n. 4, Cava de' Tirreni, Salerno, Italy.
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24
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Wu RR, Zhao JP, Liu ZN, Zhai JG, Guo XF, Guo WB, Tang JS. Effects of typical and atypical antipsychotics on glucose-insulin homeostasis and lipid metabolism in first-episode schizophrenia. Psychopharmacology (Berl) 2006; 186:572-8. [PMID: 16601995 DOI: 10.1007/s00213-006-0384-5] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 03/09/2006] [Indexed: 10/24/2022]
Abstract
RATIONALE Glucose and lipid metabolism dysfunction is a significant side effect associated with antipsychotics. Although there are many studies about the linkages between drugs and metabolic dysfunction, most of these studies have compared the effects of two antipsychotics on only one metabolic measure: either glucose or lipid metabolism. OBJECTIVES The present study aimed to investigate the effects of clozapine, olanzapine, risperidone, and sulpiride on glucose and lipid metabolism in first-episode schizophrenia. MATERIALS AND METHODS One hundred twelve schizophrenics were assigned randomly to receive clozapine, olanzapine, risperidone, or sulpiride for 8 weeks. Planned assessments included body mass index (BMI), waist-to-hip ratio, fasting glucose, insulin, C-peptide, insulin resistance index (IRI), cholesterol, and triglyceride. All measures were collected at baseline and at the end of the 8-week treatment. RESULTS After treatment, insulin, C-peptide, and IRI were significantly increased in the four groups, but not fasting glucose levels. Cholesterol and triglyceride levels were significantly increased in the clozapine and olanzapine groups. Patients treated with clozapine and olanzapine had higher fasting insulin, C-peptide, and IRI levels than those treated with risperidone and sulpiride. Among the four antipsychotics, the increases of mean BMI from high to low were as follows: clozapine, olanzapine, sulpiride, and risperidone. CONCLUSIONS This study confirmed that the four antipsychotic drugs were associated with an increase of insulin, C-peptide, and IRI. It was found that clozapine and olanzapine were associated with an increase in cholesterol and triglyceride levels. The effects of clozapine and olanzapine on the glucose and lipid metabolism outweighed those of risperidone and sulpiride.
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Affiliation(s)
- Ren-Rong Wu
- Institute of Mental Health of The Second Xiangya Hospital, Central South University, #139 Renmin Middle Road, Changsha, Hunan, 410011, China
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Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: long-term treatment of schizophrenia. World J Biol Psychiatry 2006; 7:5-40. [PMID: 16509050 DOI: 10.1080/15622970500483177] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A-D). This second part of the guidelines covers the long-term treatment as well as the management of relevant side effects. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia.
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Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, University of Saarland, Homburg/Saar, Germany
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Baptista T, De Mendoza S, Beaulieu S, Bermúdez A, Martinez M. The Metabolic Syndrome During Atypical Antipsychotic Drug Treatment: Mechanisms and Management. Metab Syndr Relat Disord 2004; 2:290-307. [DOI: 10.1089/met.2004.2.290] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Trino Baptista
- Department of Physiology, Los Andes University Medical School, Mérida, Venezuela
| | | | - Serge Beaulieu
- Douglas Hospital Research Center, McGill University, Verdun, Quebec, Canada
| | - Andrés Bermúdez
- Department of Endocrinology, Los Andes University, Mérida, Venezuela
| | - Maritza Martinez
- Department of Psychiatry, Los Andes University, Mérida, Venezuela
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Haw C, Merriman S, Kirk J, Stubbs J. Screening long-stay psychiatric patients for risk factors for coronary heart disease. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2004. [DOI: 10.12968/ijtr.2004.11.3.13382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Jean Stubbs
- St Andrew’s Hospital, Northampton NN1 5DG, UK
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Abstract
OBJECTIVE The major aim of this paper is to review findings from weight management intervention studies to consider clozapine and/or olanzapine induced weight gain. A parallel aim is to summarize the challenges facing future research and provide an overview of best practice in the management of weight in mental health patients. METHOD A systematic literature search was conducted using Medline, Cinahl and PsychINFO data bases and reference lists from relevant published articles. Five studies which reported weight control practices in patients taking atypical antipsychotic medications were located and reviewed. RESULTS The studies reviewed provide some important descriptive clinical insights; however, common shortcomings include small subject numbers and methodological drawbacks such as lack of a control group. CONCLUSIONS There is some evidence that weight gain associated with atypical antipsychotic medication can be ameliorated by lifestyle changes such as improved nutritional practices and increased physical activity. Lifestyle interventions for individuals with psychotic disorders may need to be adapted to be most effective; for example, using strategies to counter increased appetite and to enhance physical activity. Clinicians need to be vigilant and persistent in monitoring and intervening if weight gain occurs. A standardized screening tool and clinical pathway would help clinicians to target appropriate interventions for each person prescribed atypical antipsychotic medication.
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Affiliation(s)
- Jenny-Kay Sharpe
- General Health Services, The Park Centre for Mental Health, Wacol, Queensland, Australia.
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Faulkner G, Soundy AA, Lloyd K. Schizophrenia and weight management: a systematic review of interventions to control weight. Acta Psychiatr Scand 2003; 108:324-32. [PMID: 14531752 DOI: 10.1034/j.1600-0447.2003.00218.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Weight gain is a frequent side effect of antipsychotic medication which has serious implications for a patient's health and well being. This study systematically reviews the literature on the effectiveness of interventions designed to control weight gain in schizophrenia. METHOD A systematic search strategy was conducted of major databases in addition to citation searches. Study quality was rated. RESULTS Sixteen studies met the inclusion criteria. Five of eight pharmacological intervention studies reported small reductions in weight (<5% baseline body weight). All behavioural (including diet and/or exercise) interventions reported small reductions in, or maintenance of, weight. CONCLUSION Weight loss may be difficult but it is not impossible. Given the inconsistent results, the widespread use of pharmacological interventions cannot be recommended. Both dietary and exercise counselling set within a behavioural modification programme is necessary for sustained weight control.
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Affiliation(s)
- G Faulkner
- Faculty of Physical Education and Health, University of Toronto, Toronto, Ontario, Canada.
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30
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Werneke U, Taylor D, Sanders TAB, Wessely S. Behavioural management of antipsychotic-induced weight gain: a review. Acta Psychiatr Scand 2003; 108:252-9. [PMID: 12956825 DOI: 10.1034/j.1600-0447.2003.00190.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although psychiatrists are aware of weight gain induced by atypical antipsychotics, only few studies on behavioural interventions in this patient group are published. This review aims to summarize the evidence on effectiveness of behavioural interventions for weight gain in the general population and in-patients treated with atypical antipsychotics. METHOD Medline and Cochrane databases search for evidence on effectiveness of behavioural interventions. RESULTS In general, behavioural approaches including, diet, exercise and drug treatments may be effective. There were only 13 studies of behavioural interventions for patients taking antipsychotic medication. No study met the criteria for a RCT. Calorie restriction in a controlled ward environment, structured counselling combined with cognitive behavioural therapy and counselling on life style and provision of rewards may potentially lead to weight loss. CONCLUSION Currently only limited, methodologically flawed, evidence is available that behavioural interventions in overweight patients treated with antipsychotics, although intuitively appealing, actually work.
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Affiliation(s)
- U Werneke
- Centre for the Economics in Mental Health, Institute of Psychiatry, Maudsley Hospital, London, UK.
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