The Association between Schizophrenia Clinical Severity and Obesity Risk: A Literature Review (original) (raw)
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Body mass index and prevalence of obesity in a French cohort of patients with schizophrenia
Acta Psychiatrica Scandinavica, 2008
Rouillon F. Body mass index and prevalence of obesity in a French cohort of patients with schizophrenia. Objective: To evaluate the distributions of body mass index in a large sample of patients with schizophrenia, and to examine the association between body weight and antipsychotic drugs. Method: The data source was baseline data from a national survey conducted in 2005-2006 in 5756 patients. Results: The mean age of the patients was 37.1 ± 11.8 years, and the mean BMI was 25.5 ± 5.2 kg ⁄ m 2. In the final logistic regression model, the prevalence of obesity was significantly higher in female patients, age 40-59 vs. 18-29 years, patients in sheltered employment (vs. no income), outpatients (vs. full-time in-patients) and patients treated with concomitant antidepressant. There was a higher rate of obesity, relative to an absence of antipsychotics at entry, for patients receiving the following individual drugs: clozapine, olanzapine, risperidone and amisulpride. Conclusion: In patients treated with atypical antipsychotics, we found a significantly higher prevalence of obesity than in those not treated with any antipsychotic medication.
Low prevalence of obesity and metabolic syndrome in never-treated chronic schizophrenia
Schizophrenia Research, 2010
Introduction: Antipsychotic medication and lifestyle factors are implicated in the high rates of obesity and metabolic syndrome in schizophrenia. While the two Consensus Statements made in 2004 concluded they were unclear whether psychiatric disorders per se accounted for increased prevalence of metabolic disorders several later studies have presented the case for an association between schizophrenia and metabolic disorders, especially impaired glucose metabolism and Type 2 diabetes mellitus, independent of antipsychotic drug treatment. Methods: This is a comparative study of 51 patients with chronic schizophrenia who never received antipsychotic drug treatment and 51 healthy controls. Physical and laboratory assessments were made to measure body-mass index and diagnose metabolic syndrome using the International Diabetes Federation (2006) criteria. Results: The study observed a significantly lower mean body-mass index in patients (19.4) than controls (22.7) and very low and comparable rates of metabolic syndrome (3.9% in patients, 7.8% in controls). Discussion: Economic affordability and lifestyles modified by living conditions were discussed as factors underlying the high rates of underweight in the patient population and low rates of metabolic disorders in all the study subjects. The study concluded that schizophrenia in the absence of antipsychotic drug treatment is not a factor contributing to high prevalence of metabolic abnormalities. Lifestyle factors and the social and economic circumstances that drive them should be considered for better understanding and management of excess weight gain and metabolic abnormalities in people with schizophrenia.
Journal of Child and Adolescent Psychopharmacology, 2018
Background: Antipsychotic-related weight gain is a common clinically relevant side effect when treating psychotic disorders in pediatric populations, yet few predictors and no moderators of antipsychotic-related weight gain are known. Methods: The Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study randomized 119 youths (age 8-19 years) with schizophrenia or schizoaffective disorder to 8 weeks of antipsychotic treatment with molindone, risperidone, or olanzapine and assessed treatment response and side effects. In this secondary analysis, we used multivariable linear regression and receiver operating characteristic analysis to investigate predictors and moderators of weight change and percent weight change from baseline to week 8. Results: Treatment assignment was the most discriminant predictor of weight change [F(2, 66) = 17.00, p < 0.001] and percent weight change [F(2, 66) = 16.85, p < 0.001]. Mean weight gain was 0.74 (standard deviation-3.51) kg for molindone, 4.13-3.79 kg for risperidone, and 7.29-3.44 kg for olanzapine. After adjusting for treatment assignment, lower pretreatment hemoglobin A1C (HgbA1C) predicted more weight gain [F(1, 55) = 4.71, p = 0.03]. Diagnosis (schizoaffective vs. schizophrenia) moderated weight change [F(2, 63) = 6.02, p = 0.004] and percent weight change [F(2, 63) = 5.26, p = 0.008] such that schizoaffective diagnosis predicted larger weight gain for youths in the risperidone treatment arm. Age, sex, family income, baseline weight, and symptoms neither predicted nor moderated weight change or percent weight change. Conclusion: We identified prognostic subgroups and novel risk factors for antipsychotic-related weight gain. We confirmed that antipsychotic choice is extremely important for predicting future weight gain. We also found that younger age did not predict greater weight gain, in contrast to prior studies. Our findings require replication in an independent sample because we did not adjust for multiple comparisons to minimize false negatives. ClinicalTrials.gov Identifier: NCT00053703
Atypical Antipsychotic Induced Weight Gain in Schizophrenic Patients
Indonesian Journal of Clinical Pharmacy, 2021
Atypical antipsychotics are widely prescribed and have the potential to cause weight gain, which may result in the development of metabolic syndrome. Also, it is important to monitor the use of atypical antipsychotic for metabolic disturbance. The purpose of this study is to determine the side effects of atypical antipsychotics in increasing body weight in schizophrenia patients after 4 weeks of use. Furthermore, a retrospective design was conducted and data were collected based on consecutive sampling in 80 adult psychiatric inpatients (20 women and 60 men) with initial diagnoses of schizophrenia and with the same daily nutrition. The patients were hospitalized from January to March 2019, within the term (over 4 weeks) of initiation atypical antipsychotic. The patient body weight was collected before and 4 weeks after the treatment of atypical antipsychotic. The results showed that patients (20 women and 60 men) receiving atypical antipsychotic had a mean age of 35.6 years and a pe...
Predictors of Antipsychotic-Induced Weight Gain in First-Episode Psychosis
Journal of Clinical Psychopharmacology, 2008
Background: Antipsychotic-induced weight gain is one of the most distressing adverse effects being observed in recent times. Most studies have been limited by several confounders. Aim: To evaluate the predictors of antipsychotic-induced weight gain in drug-naive patients with first-episode psychosis treated with olanzapine, risperidone, or haloperidol and compare them with a healthy matched control group. Methods: Newly diagnosed patients with first-episode schizophrenia treated with antipsychotic medication-olanzapine, risperidone, or haloperidol-and matched healthy controls were followed for 6 weeks. Body mass index (BMI), waist circumference, and weight changes and proportions of subjects with more than 7% weight gain were calculated. The predictors of weight gain were explored. Results: Ninety-nine patients with first-episode schizophrenia and 51 healthy controls were examined. Waist circumference (r = j0.25; P < 0.01) and weight (r = j0.24; P < 0.01) at baseline in addition to the disease process (P < 0.001) as well as antipsychotic use (P < 0.001) were associated with greater increases in weight and BMI. Olanzapine (77%) had greater clinically significant weight gain as compared with risperidone (63%) and haloperidol (22%). Lower BMI at baseline and a diagnosis of undifferentiated schizophrenia were associated with antipsychotic-induced weight gain. Conclusions: The results confirm clinically significant and substantial weight gain induced by antipsychotic treatment in drugnaive patients with first-episode schizophrenia and identify several risk factors for weight gain such as lower BMI scores, use of olanzapine, and a diagnosis of undifferentiated schizophrenia.
Cognitive deficits, obesity and disability in schizophrenia
2012
Despite 50 years of pharmacological and psychosocial interventions schizophrenia remains one of the leading causes of disability. The inability to function in everyday settings includes deficits in performance of social, occupational, and independent living activities. Schizophrenia is also a life-shortening illness, caused mainly by poor physical health and its complications. Dysfunctional lifestyles including sedentary behavior and lack of physical activity prevail, while treatment with adipogenic antipsychotic medication interacts with poor performance in screening, monitoring, and intervention that result in shortening of life expectancies by 25-30 years. Disability interferes with self-care and medical care, further worsening physical health to produce a vicious cycle of disability. Further, the neurobiological impact of obesity on brain functioning is substantial and relevant to schizophrenia. Decision making deficits that lead to choices resulting in obesity themselves have neurobiological determinants. Simultaneous treatment of cognitive deficits and related deficits in functional skills, ubiquitous determinants of everyday functioning in schizophrenia, and targeted interventions aimed at poor physical health, especially obesity and associated comorbidities, may lead to additive or even interactive gains in everyday functioning in patients with schizophrenia not previously realized with other interventions.
European Neuropsychopharmacology, 2006
Patients with schizophrenia have increased rates of morbidity and mortality compared with the general population, primarily due to cardiovascular disease. Thus there is an increasing need for clinicians in the psychiatric field to recognise and address cardiovascular risk factors such as abdominal obesity, dyslipidaemia, high blood pressure and elevated fasting blood glucose levels that contribute to this long-term health burden. The combination of three or more of these risk factors leads to a diagnosis of metabolic syndrome, further predisposing individuals to cardiovascular disease. A cluster of risk factors, such as in the metabolic syndrome, is being increasingly seen in patients with schizophrenia. Abdominal obesity is a key contributor to overall cardiovascular risk and is a particularly important consideration in schizophrenia as some atypical antipsychotics are associated with druginduced weight gain. Lifestyle factors such as smoking, lack of exercise and poor diet undoubtedly contribute further. Psychiatrists need to be aware of metabolic risk when initiating treatment in patients with schizophrenia and should take steps to identify and monitor patients. A first step is to establish a risk profile for the patient based on medical, lifestyle and genetic factors, and measurement of waist circumference is a good indicator of overall cardiovascular and metabolic risk. Strategies recommended to reduce risk include promoting healthy lifestyle/behavioural habits and close monitoring of weight, glucose, and lipid profiles both before and during treatment. Established risk factors should also be considered when selecting the most appropriate antipsychotic medication for an individual patient, based on differences in the potential effect of individual medications to induce weight gain, risk of diabetes or worsening lipid profile.
Journal of Clinical Psychopharmacology, 2012
Objective: Although weight gain is one of the most widely studied adverse effects of second-generation antipsychotics, only relatively few studies have specifically evaluated the long-term effect of switching antipsychotic medication on body weight. We aimed to evaluate the impact of switching antipsychotics on body mass index (BMI) during a 6-month follow-up period in a large cohort of patients with schizophrenia. Method: Data came from a 6-month prospective naturalistic survey in 6007 patients with schizophrenia. Results: We prospectively studied the effect on BMI of initiating or switching antipsychotic medication after 6 months of treatment among 3801 patients with schizophrenia in a real-life setting. Patients who were being treated with clozapine or olanzapine at baseline were more likely to experience a decrease in BMI during the follow-up period than the patients who were being treated with a conventional antipsychotic (odds ratio, 2.25 and 1.68, respectively). Patients treated with aripiprazole and, to a lesser extent, those treated with risperidone were more likely to experience a decrease in BMI during follow-up than patients treated with conventional antipsychotics (odds ratio, 2.96 and 2.06, respectively). Conclusions: Our findings suggest that switching antipsychotics could be an effective strategy for reducing or preventing weight gain.