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Bao K, Zheng K, Zhou X, Chen B, He Z, Zhu D. The effects of nicotine withdrawal on exercise-related physical ability and sports performance in nicotine addicts: a systematic review and meta-analysis. J Int Soc Sports Nutr 2024; 21:2302383. [PMID: 38213003 PMCID: PMC10791090 DOI: 10.1080/15502783.2024.2302383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Previous research has established that nicotine withdrawal can ameliorate cardiovascular and pulmonary function in smokers. Nevertheless, the impact on physical fitness and athletic performance remains under-investigated. OBJECTIVE To evaluating the impacts of nicotine withdrawal on both exercise performance and exercise-associated physical capabilities in nicotine-dependent individuals. STUDY DESIGN A comprehensive systematic review and meta-analysis. DATA SOURCES The data was compiled from databases such as PubMed, Scopus, Web of Science, Cochrane Central, and EBSCO. STUDY SELECTION The selection criteria required studies to elucidate the effects of nicotine withdrawal on exercise performance or exercise-related physical abilities. Moreover, the selected studies needed to provide discernible experimental results. DATA SYNTHESIS AND ANALYSIS The random effects model was employed in data analysis, utilizing the standardized mean difference (SMD) and the 95% confidence intervals (95% CIs) to estimate participants' exercise performance and physical abilities, referencing the Mean ±SD during baseline and withdrawal states. RESULTS Out of the selected studies, 10 trials were included, encompassing 13,538 participants aged 18 to 65 years. The findings suggest that nicotine withdrawal could potentially enhance sports performance (SMD = 0.45, 95% CI: 0.03 to 0.88; I^2 = 83%), particularly in terms of aerobic capacity. Short-term nicotine withdrawal (spanning 12 to 24 hours) might lead to a decline in participants' physical abilities in certain aspects like reaction time and sustained attention (SMD = -0.83, 95% CI: -1.91 to 0.25; I^2 = 79%), whereas long-term withdrawal (lasting 48 hours or more) demonstrated an opposing trend (SMD = 0.25, 95% CI: 0.12 to 0.39; I^2 = 81%). Overall, the results show that long-term nicotine withdrawal exhibited some positive impacts on sports performance and exercise-related physical ability, with the withdrawal duration being an indicator of subsequent physical performance. CONCLUSIONS Mid- to long-term (≥3 months) nicotine withdrawal significantly improved the exercisers' exercise-related physical ability and sports performance. Conversely, short-term (≤24 hours) nicotine withdrawal considerably hampered exercisers' performance and physical cognition. It is suggested that exercises avoid abrupt nicotine cessation prior to competitions, as long-term nicotine withdrawal has been shown to significantly enhance exercise-related physiological capacities and athletic performance. By referring to existing literatures we also found that athletes with existing nicotine addiction may could consume nicotine 15-30 minutes before competition to enhance athletic performance and physical function.PROSPERO registration number CRD42023411381.
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Affiliation(s)
- Kangzhe Bao
- Zhejiang Normal University, College of Physical Education and Health Sciences, Jinhua, China
| | - Kai Zheng
- Zhejiang Normal University, College of Physical Education and Health Sciences, Jinhua, China
| | - Xianxian Zhou
- Zhejiang Normal University, College of Physical Education and Health Sciences, Jinhua, China
| | - Baichao Chen
- Zhejiang Normal University, College of Physical Education and Health Sciences, Jinhua, China
| | - Zerui He
- Zhejiang Normal University, College of Physical Education and Health Sciences, Jinhua, China
| | - Danyang Zhu
- Zhejiang Normal University, College of Education, Jinhua, China
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Martínez-Cao C, García-Fernández A, González-Blanco L, Sáiz PA, Bobes J, García-Portilla MP. Anticholinergic load: A commonly neglected and preventable risk to cognition during schizophrenia treatment? Schizophr Res Cogn 2024; 37:100317. [PMID: 38745931 PMCID: PMC11092394 DOI: 10.1016/j.scog.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Background Cognitive impairment is a widespread feature of schizophrenia, affecting nearly 80 % of patients. Prior research has linked the anticholinergic burden of psychiatric medications to these cognitive deficits. However, the impact of the anticholinergic burden from medications for physical morbidity remains underexplored. This study aimed to evaluate the anticholinergic burden of psychiatric and physical medications in patients with schizophrenia and assess its impact on cognitive function. Methods A total of 178 patients with schizophrenia were recruited. The assessments included an ad hoc questionnaire for collecting demographic and clinical data. Anticholinergic burden was evaluated using the cumulative Drug Burden Index (cDBI) for each participant, and cognitive function was assessed using MATRICS. Psychopathology was measured using the PANSS, CDSS, CAINS, and the CGI-S. Statistical analysis included Student's t-tests, ANOVA, Pearson correlations, and multiple linear regressions. Results The average cDBI was 1.3 (SD = 0.9). The model developed explained 40.80 % of the variance. The variable with the greatest weight was the cDBI (B = -11.148, p = 0.010). Negative-expression (B = -2.740, p = 0.011) and negative-experiential (B = -1.175, p = 0.030) symptoms were also associated with lower global cognitive score. However, more years of education (B = 5.140, p < 0.001) and cigarettes per day (B = 1.331, p < 0.001) predicted a better global cognitive score. Conclusion This study identified specific predictors of global cognition in schizophrenia, with anticholinergic burden emerging as the strongest factor. Our findings underscore the importance of considering the anticholinergic burden of treatments, in addition to negative symptoms, when designing interventions to optimize or maintain cognitive function in patients with schizophrenia.
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Affiliation(s)
- Clara Martínez-Cao
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Ainoa García-Fernández
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - Pilar A. Sáiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - María Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
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Carney R, Imran S, Law H, Carmichael-Murphy P, Charlton L, Parker S. "If you're struggling, you don't really care" - what affects the physical health of young people on child and adolescent mental health inpatient units? A qualitative study with service users and staff. BMC Psychiatry 2024; 24:498. [PMID: 38982436 PMCID: PMC11234625 DOI: 10.1186/s12888-024-05858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 05/21/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15-20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. METHODS We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14-42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. . RESULTS Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. CONCLUSIONS Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.
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Affiliation(s)
- Rebekah Carney
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK.
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Shermin Imran
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, M13 3BL, UK
| | - Heather Law
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Parise Carmichael-Murphy
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| | - Leah Charlton
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, M13 9PL, UK
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Tanzer T, Pham B, Warren N, Barras M, Kisely S, Siskind D. Overcoming clozapine's adverse events: a narrative review of systematic reviews and meta-analyses. Expert Opin Drug Saf 2024; 23:811-831. [PMID: 38814794 DOI: 10.1080/14740338.2024.2362796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/29/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Clozapine is the gold standard treatment for treatment-resistant schizophrenia, however adverse events remain a clinical challenge. AREAS COVERED This review presents a narrative synthesis of systematic reviews and meta-analyses that have reported the onset, incidence, prevalence, and management of clozapine's adverse events. We conducted a systematic literature search using PubMed, Embase, PsycINFO, OvidMEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews from inception to April 2024. EXPERT OPINION Effective management of clozapine's adverse events necessitates multi-faceted, individualized, and shared-decision strategies. Despite a lack of high-quality systematic evidence, expert inter-disciplinary solutions are provided to help address a critical need for clinical guidance. This 35-year update offers an evidence-based framework to assist clinicians, patients, and caregivers navigate the adverse events associated with clozapine therapy.
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Affiliation(s)
- Timothy Tanzer
- Princess Alexandra Hospital, Department of Pharmacy, Brisbane, Australia
- Medicine, University of Queensland, Brisbane, Australia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Betty Pham
- Department of Pharmacy, Metro South Community and Oral Health, Brisbane, Australia
| | - Nicola Warren
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Michael Barras
- Princess Alexandra Hospital, Department of Pharmacy, Brisbane, Australia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Steve Kisely
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Dan Siskind
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
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Sass MR, Christensen AMB, Christensen ML, Gruber E, Nerdrum H, Pedersen LM, Resch M, Jørgensen TH, Ekstrøm CT, Nielsen J, Vilsbøll T, Fink-Jensen A. Liraglutide 3.0 mg once daily for the treatment of overweight and obesity in patients hospitalised at a forensic psychiatric department: A 26-week open-label feasibility study. Acta Psychiatr Scand 2024; 150:35-47. [PMID: 38631670 DOI: 10.1111/acps.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/23/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Overweight and obesity constitute a major concern among patients treated at forensic psychiatric departments. The present clinical feasibility study aimed at investigating the extent to which glucagon-like peptide 1 receptor agonist (GLP-1RA) treatment with once-daily liraglutide 3.0 mg could be a feasible pharmacological treatment of these conditions in patients with schizophrenia spectrum disorders hospitalised in forensic psychiatry. METHODS The 26-week, open-label feasibility study included participants aged 18-65 years diagnosed with a severe mental illness and hospitalised at a forensic psychiatric department. At the time of inclusion, all participants fulfilled the indication for using liraglutide as a treatment for overweight and obesity. Participants' baseline examinations were followed by a 26-week treatment period with liraglutide injection once daily according to a fixed uptitration schedule of liraglutide, with a target dose of 3.0 mg. Each participant attended seven visits to evaluate the efficacy and adverse events. The primary endpoint was the number of "completers", with adherence defined as >80% injections obtained in the period, weeks 12-26. Determining whether liraglutide is a feasible treatment was pre-defined to a minimum of 75% completers. RESULTS Twenty-four participants were included in the study. Sex, male = 19 (79.2%). Mean age: 42.3 [25th and 75th percentiles: 39.1; 48.4] years; body mass index (BMI): 35.7 [31.7; 37.5] kg/m2; glycated haemoglobin (HbA1c): 37 [35; 39] mmol/mol. Eleven out of 24 participants (46%) completed the study. For the completers, the median net body weight loss after 26 weeks of participation was -11.4 kg [-15.4; -5.9]. The net difference in HbA1C and BMI was -2.0 mmol/mol [-4; -1] and -3.6 kg/m2 [-4.7; -1.8], respectively. The weight change and reduction in HbA1c and BMI were all statistically significant from baseline. CONCLUSION The study did not confirm our hypothesis that liraglutide is a feasible treatment for a minimum of 75% of the patients initiating treatment with liraglutide while hospitalised in a forensic psychiatric department. The high dropout rate may be due to the non-naturalistic setting of the clinical trial. For the proportion of patients compliant with the medication, liraglutide 3.0 mg was an efficient treatment for overweight.
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Affiliation(s)
- Marie Reeberg Sass
- Psychiatric Centre Copenhagen, Mental Health Services in the Capitol Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | | | - Margit Lykke Christensen
- Psychiatric Centre Sct. Hans, Forensic Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | - Ema Gruber
- Psychiatric Centre Sct. Hans, Forensic Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | - Helle Nerdrum
- Psychiatric Centre Sct. Hans, Forensic Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | - Lone Marianne Pedersen
- Psychiatric Centre Sct. Hans, Forensic Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | - Maximilian Resch
- Psychiatric Centre Glostrup, Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
| | | | - Claus T Ekstrøm
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jimmi Nielsen
- Psychiatric Centre Glostrup, Mental Health Services in the Capitol Region of Denmark, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Anders Fink-Jensen
- Psychiatric Centre Copenhagen, Mental Health Services in the Capitol Region of Denmark, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Horska K, Kucera J, Drazanova E, Kuzminova G, Amchova P, Hrickova M, Ruda-Kucerova J, Skrede S. Potent synergistic effects of dulaglutide and food restriction in prevention of olanzapine-induced metabolic adverse effects in a rodent model. Biomed Pharmacother 2024; 176:116763. [PMID: 38805968 DOI: 10.1016/j.biopha.2024.116763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Antipsychotics are indispensable in the treatment of severe mental illneses, however adverse metabolic effects including diabetes, weight gain, dyslipidemia, and related cardiovascular morbidity are common, and current pharmacological strategies for their management are unsatisfactory. Glucagon-like 1 peptide receptor agonists (GLP-1 RAs) are approved for the treatment of type 2 diabetes and obesity hold promise for the management of antipsychotic-associated adverse metabolic effects. METHODS To characterize the molecular effects and identify biomarkers for GLP-1 RA preventive treatment, Sprague-Dawley female rats were treated with long-acting formulations of the antipsychotic olanzapine and the GLP-1 RA dulaglutide for 8 days. A pair-feeding protocol evaluated the combined effects of dulaglutide and food restriction on an olanzapine-induced metabolic phenotype. Body weight and food consumption were recorded. Biochemical analysis included a lipid profile, a spectrum of gastrointestinal and adipose tissue-derived hormones, and fibroblast growth factor 21 serum levels. RESULTS Olanzapine induced hyperphagia, weight gain, increased serum triglycerides and HDL cholesterol. Food restriction affected the OLA-induced phenotype but not serum markers. Dulaglutide led to a modest decrease in food intake, with no effect on weight gain, and did not reverse the OLA-induced changes in serum lipid parameters. Concomitant dulaglutide and food restriction resulted in weight loss, decreased feed efficiency, and lower total and HDL cholesterol. CONCLUSIONS A combined strategy of dulaglutide and food restriction manifested a massive synergistic benefit. GLP-1RAs represent a promising strategy and deserve thorough future research. Our findings underline the potential importance of lifestyle intervention in addition to GLP-1 RA treatment.
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Affiliation(s)
- Katerina Horska
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
| | - Jan Kucera
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic; Department of Physical Activities and Health, Faculty of Sports Studies, Masaryk University, Kamenice 5, Brno 62500, Czech Republic
| | - Eva Drazanova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Gabriela Kuzminova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
| | - Petra Amchova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Maria Hrickova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Ruda-Kucerova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Silje Skrede
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway/Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Section of Clinical Pharmacology, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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Castro Monteiro F, de Oliveira Silva F, Josiane Waclawovsky A, Ferreira JVA, de Jesus-Moraleida FR, Schuch FB, Ward PB, Rosenbaum S, Morell R, Carneiro L, Camaz Deslandes A. Physical activity and sedentary behavior levels among individuals with mental illness: A cross-sectional study from 23 countries. PLoS One 2024; 19:e0301583. [PMID: 38669303 PMCID: PMC11051624 DOI: 10.1371/journal.pone.0301583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
People with mental illness tend to present low levels of physical activity and high levels of sedentary behavior. The study aims to compare these levels in mental illness patients, exploring the role of socioeconomic development and treatment setting. This cross-sectional study used accelerometers and the Simple Physical Activity Questionnaire (SIMPAQ) to assess physical activity and sedentary behavior in mental illness individuals living in 23 countries. Two-way ANOVAs were used to evaluate the interaction between socioeconomic development and the treatment settings on physical activity and sedentary behavior. A total of 884 (men = 55.3%) participants, mean age of 39.3 (SD = 12.8), were evaluated. A significant interaction between socioeconomic development and treatment settings was found in sedentary behavior (F = 5.525; p = 0.019; η2p = 0.009; small effect size). Main effects were observed on socioeconomic development (F = 43.004; p < 0.001; η2p = 0.066; medium effect size) and treatment setting (F = 23.001; p < 0.001; η2p = 0.036; small effect size) for sedentary behavior and physical activity: socioeconomic development (F = 20.888; p < 0.001; η2p = 0.033; small effect size) and treatment setting (F = 30.358; p < 0.001; η2p = 0.047; small effect size), showing that HIC patients were more active, while MIC patients were more sedentary. Moreover, despite of inpatients had presented higher levels of physical activity than outpatients, they also spent more time sitting. Socioeconomic development plays an important role in sedentary behavior in patients with mental disorders, warning the need to develop new strategies to reduce these levels in this population.
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Affiliation(s)
| | | | - Aline Josiane Waclawovsky
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | - Felipe Barreto Schuch
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Federal University of Santa Maria, Santa Maria, Brazil
| | - Philip B. Ward
- School of Psychiatry, UNSW Sydney, Australia and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney, Australia and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Rachel Morell
- Mindgardens Neuroscience Network, Sydney Australia Discipline of Mental Health and Psychiatry, UNSW Sydney Australia, Sydney, Australia
| | - Lara Carneiro
- Physical Education Department, College of Education, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
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Gurusamy J, Gandhi S, Damodharan D, Palaniappan M, Ganesan V. Effect of lifestyle modification intervention (LMI) on metabolic syndrome in schizophrenia in a residential mental health care setting-A mixed method study. Schizophr Res 2024; 266:75-84. [PMID: 38377870 DOI: 10.1016/j.schres.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/18/2023] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Jothimani Gurusamy
- College of Nursing, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Sailaxmi Gandhi
- Department of Nursing, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Dinakaran Damodharan
- Center for Psychosocial Support and Disaster Management, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Marimuthu Palaniappan
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Venkatasubramanian Ganesan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Bertossi F. A Possible Role of Akkermansia muciniphila in the Treatment of Olanzapine-Induced Weight Gain. Cureus 2024; 16:e55733. [PMID: 38463411 PMCID: PMC10921070 DOI: 10.7759/cureus.55733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Second-generation antipsychotics are mainly used in both acute and long-term treatment of major psychiatric disorders. Although better tolerated than first-generation antipsychotic drugs, they can frequently induce weight gain and metabolic disorders, of these, olanzapine is one of the drugs more likely to induce these side effects. There is consistent evidence of the role of gut microbiota in modulating the gut-brain axis with complex crosstalk with the host involving satiety signaling pathways, food intake behavior, and weight and metabolic regulation. Second-generation antipsychotics induce important gut microbiota modification thus contributing together with the central and peripheral receptors blockade mechanism to weight gain induction and metabolic impairment. These drugs can alter the composition of gut microbiota and induce dysbiosis, often reducing the concentration of Akkermansia muciniphila, a bacterium that is also decreased in patients with diabetes, obesity, metabolic syndrome, or chronic inflammatory diseases. Probiotic administration can be a safe and well-tolerated approach to modulate microbiota and offer an integrative strategy in psychiatric patients suffering antipsychotic side effects. Multiple strain probiotics and Akkermansia muciniphila alone have been administered both in mice models and in clinical populations demonstrating efficacy on antipsychotic-induced metabolic impairment and showing a contribution in reducing induced weight gain. Akkermansia muciniphila can improve several parameters altered by olanzapine administration, such as weight gain, insulin resistance, hyperglycemia, liver function, systemic inflammation, and gut barrier function. Although we do not have jet trials in the psychiatric population, this probiotic may be a complementary approach to treating olanzapine-induced weight gain and metabolic side effects.
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Affiliation(s)
- Francesca Bertossi
- Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, ITA
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Solmi M, Croatto G, Fornaro M, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J, Cortese S, Dragioti E, Rietz ED, Nielsen RE, Firth J, Fusar-Poli P, Hartman C, Holt RIG, Høye A, Koyanagi A, Larsson H, Lehto K, Lindgren P, Manchia M, Nordentoft M, Skonieczna-Żydecka K, Stubbs B, Vancampfort D, Boyer L, De Prisco M, Vieta E, Correll CU. Regional differences in mortality risk and in attenuating or aggravating factors in schizophrenia: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2024; 80:55-69. [PMID: 38368796 DOI: 10.1016/j.euroneuro.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 02/20/2024]
Abstract
People with schizophrenia die prematurely, yet regional differences are unclear. PRISMA 2020-compliant systematic review/random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) versus any control group, and moderators, in people with ICD/DSM-defined schizophrenia, comparing countries and continents. We conducted subgroup, meta-regression analyses, and quality assessment. The primary outcome was all-cause mortality. Secondary outcomes were suicide-, /natural-cause- and other-cause-related mortality. We included 135 studies from Europe (n = 70), North-America (n = 29), Asia (n = 33), Oceania (n = 2), Africa (n = 1). In incident plus prevalent schizophrenia, differences across continents emerged for all-cause mortality (highest in Africa, RR=5.98, 95 %C.I.=4.09-8.74, k = 1, lowest in North-America, RR=2.14, 95 %C.I.=1.92-2.38, k = 16), suicide (highest in Oceania, RR=13.5, 95 %C.I.=10.08-18.07, k = 1, lowest in North-America, RR=4.4, 95 %C.I.=4.07-4.76, k = 6), but not for natural-cause mortality. Europe had the largest association between antipsychotics and lower all-cause mortality/suicide (Asia had the smallest or no significant association, respectively), without differences for natural-cause mortality. Higher country socio-demographic index significantly moderated larger suicide-related and smaller natural-cause-related mortality risk in incident schizophrenia, with reversed associations in prevalent schizophrenia. Antipsychotics had a larger/smaller protective association in incident/prevalent schizophrenia regarding all-cause mortality, and smaller protective association for suicide-related mortality in prevalent schizophrenia. Additional regional differences emerged in incident schizophrenia, across countries, and secondary outcomes. Significant regional differences emerged for all-cause, cause-specific and suicide-related mortality. Natural-cause death was homogeneously increased globally. Moderators differed across countries. Global initiatives are needed to improve physical health in people with schizophrenia, local studies to identify actionable moderators.
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Affiliation(s)
- Marco Solmi
- SCIENCES lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
| | - Giovanni Croatto
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Dentistry, Federico II University of Naples, Naples, Italy
| | | | | | | | | | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Philip Gorwood
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France; GHU Paris Psychiatrie et Neurosciences (CMME, Sainte-Anne Hospital), Université de Paris, Paris, France
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA; DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari Aldo Moro, Bari, Italy
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece; Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Italy; Outreach and Support in South-London (OASIS) service, South London and Maudlsey (SLaM) NHS Foundation Trust, UK; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University (LMU), Munich, Germany
| | - Catharina Hartman
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion regulation
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway and Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; The Swedish Institute for Health Economics, Lund, Sweden
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Department of Clinical Medicine, Copenhagen University Hospital, Denmark
| | | | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Centre KU Leuven, Kortenberg, Leuven, Belgium
| | - Laurent Boyer
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France; FondaMental Foundation, Creteil, France
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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11
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Zhou Z, Guan H, Xiu M, Wu F. Dance/movement therapy for improving metabolic parameters in long-term veterans with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:23. [PMID: 38388554 PMCID: PMC10884034 DOI: 10.1038/s41537-024-00435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
Accumulating evidence has supported the implementation of dance/movement therapy (DMT) as a promising intervention for patients with schizophrenia (SCZ). However, its effect on body weight and metabolic profile in SCZ remains unclear. This study aimed to evaluate the outcome of a 12-week DMT session on weight and lipid profile in patients with SCZ using a randomized, single-blinded, controlled trial design. This study encompassed two groups of long-term hospitalized patients with SCZ, who were randomly assigned to the DMT intervention (n = 30) or the treatment as usual (TAU) group (n = 30). Metabolic markers, including weight, body mass index (BMI), fasting glucose, triglycerides, and total cholesterol were measured in both groups at two measurement points (at baseline and the end of the 12-week treatment). We found that DMT intervention significantly decreased body weight (F = 5.5, p = 0.02) and BMI (F = 5.7, p = 0.02) as compared to the TAU group. However, no significance was observed in other metabolic markers, including fasting glucose, triglycerides, and total cholesterol after treatment (all p > 0.05). Our study indicates that a 12-week, 24-session DMT program may be effective in decreasing body weight and BMI in long-term hospitalized patients with SCZ. DMT intervention may be a promising treatment strategy for long-term inpatients in the psychiatric department.
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Affiliation(s)
| | | | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.
| | - Fengchun Wu
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
- Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China.
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Pieters L, Blanken T, van Lunteren K, van Harten P, Deenik J. A Network Model of Health-Related Changes after a Lifestyle-Enhancing Treatment in Patients with Severe Mental Illness: the MULTI Study VI. Int J Clin Health Psychol 2024; 24:100436. [PMID: 38226003 PMCID: PMC10788809 DOI: 10.1016/j.ijchp.2024.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
Background/Objective The effects of lifestyle interventions on physical and mental health in people with severe mental illness (SMI) are promising, but its underlying mechanisms remain unsolved. This study aims to examine changes in health-related outcomes after a lifestyle intervention, distinguishing between direct and indirect effects. Method We applied network intervention analysis on data from the 18-month cohort Multidisciplinary Lifestyle enhancing Treatment for Inpatients with SMI (MULTI) study in 106 subjects (62% male, mean age=54.7 (SD=10.8)) that evaluated changes in actigraphy-measured physical activity, metabolic health, psychopathology, psychosocial functioning, quality of life and medication use after MULTI (n=65) compared to treatment as usual (n=41). Results MULTI is directly connected to decreased negative symptoms and psychotropic medication dosage, and improved physical activity and psychosocial functioning, suggesting a unique and direct association between MULTI and the different outcome domains. Secondly, we identified associations between outcomes within the same domain (e.g., metabolic health) and between the domains (e.g., metabolic health and social functioning), suggesting potential indirect effects of MULTI. Conclusions This novel network approach shows that MULTI has direct and indirect associations with various health-related outcomes. These insights contribute to the development of effective treatment strategies in people with severe mental illness.
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Affiliation(s)
- Lydia Pieters
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
- Department of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tessa Blanken
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kirsten van Lunteren
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
| | - Peter van Harten
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
- Department of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jeroen Deenik
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
- Department of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Tien YT, Wang LJ, Lee Y, Lin PY, Hung CF, Chong MY, Huang YC. Comparative predictive efficacy of atherogenic indices on metabolic syndrome in patients with schizophrenia. Schizophr Res 2023; 262:95-101. [PMID: 37931565 DOI: 10.1016/j.schres.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 10/14/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Schizophrenia patients endure high risks of metabolic syndrome and related cardiovascular mortality. Evidence on comparing detective power among atherogenic indices of the metabolic syndrome in schizophrenia patients with antipsychotics treatment is still lacking. METHOD We recruited 128 schizophrenia patients and collected blood samples to determine plasma levels of fasting glucose, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol. Five components of metabolic syndrome were assessed. Atherogenic indices, such as atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli's risk index-I (CRI-I) and Castelli's risk index-II (CRI-II), were calculated. The area under the receiver operating characteristics curve (AUC) and regression analysis were adopted to compare the detective power of each atherogenic index for metabolic syndrome. The optimal cutoff points using maximization of Youden's index and the positive likelihood ratios were calculated. RESULTS 51 (39.8 %) had metabolic syndrome. AIP (0.2 ± 0.2 vs. 0.6 ± 0.2), AC (2.5 ± 0.9 vs. 3.4 ± 0.9), CRI-I (3.5 ± 0.9 vs. 4.4 ± 0.9,) and CRI-II (2.1 ± 0.7 vs. 2.6 ± 0.7) were higher in the group with metabolic syndrome (all p < 0.001). AIP had the highest AUC (0.845, 95 % CI: 0.770, 0.920). The optimal cut-off point of AIP to predict metabolic syndrome was 0.4 with the corresponding sensitivity 83.7 %, specificity 80.3 %, and positive likelihood ratio 4.2. Regression analysis revealed that only AIP significantly correlated with the metabolic syndrome (p < 0.001). CONCLUSION Among atherogenic indices, only AIP has superior discrimination for detecting metabolic syndrome in schizophrenia with antipsychotics treatment.
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Affiliation(s)
- Yu-Tung Tien
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Sampogna G, Di Vincenzo M, Giuliani L, Menculini G, Mancuso E, Arsenio E, Cipolla S, Della Rocca B, Martiadis V, Signorelli MS, Fiorillo A. A Systematic Review on the Effectiveness of Antipsychotic Drugs on the Quality of Life of Patients with Schizophrenia. Brain Sci 2023; 13:1577. [PMID: 38002537 PMCID: PMC10669728 DOI: 10.3390/brainsci13111577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Pharmacological antipsychotic drug interventions represent the cornerstone of the management of patients with schizophrenia and other psychotic spectrum disorders. The choice of the "best" treatment should be made on the basis of several clinical domains. However, despite available treatments, the quality of life reported by patients with schizophrenia taking antipsychotics is still very poor, and this outcome is rarely taken into account in trials assessing the efficacy and effectiveness of antipsychotic treatments. Therefore, we performed a systematic review in order to assess the impact of antipsychotic treatment on patients' quality of life. In particular, we aimed to identify any differences in the improvement in quality of life according to the (a) type of formulation of antipsychotic drugs (i.e., oral vs. depot vs. long-acting injectable); (b) type of the drug (first vs. second vs. third generation); and (c) patients' clinical characteristics. One hundred and eleven papers were included in the review. The main findings were as follows: (1) quality of life is usually considered a secondary outcome in trials on the efficacy and effectiveness of drugs; (2) second-generation antipsychotics have a more positive effect on quality of life; and (3) long-acting injectable antipsychotics are associated with a more stable improvement in quality of life and with a good safety and tolerability profile. Our systematic review confirms that quality of life represents a central element for selecting the appropriate treatment for people with schizophrenia. In particular, the availability of new treatments with a better tolerability profile, a proven effectiveness on patients' cognitive and social functioning, and with a more stable blood concentration might represent the appropriate strategy for improving the quality of life of people with schizophrenia.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Eleonora Arsenio
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Salvatore Cipolla
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Bianca Della Rocca
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
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Fernández-Abascal B, Suárez-Pinilla M, Cobo-Corrales C, Crespo-Facorro B, Suárez-Pinilla P. Lifestyle intervention based on exercise and behavioural counselling and its effect on physical and psychological health in outpatients with schizophrenia spectrum disorders. An exploratory, pragmatic randomized clinical trial. Schizophr Res 2023; 261:256-268. [PMID: 37857138 DOI: 10.1016/j.schres.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/04/2023] [Accepted: 09/24/2023] [Indexed: 10/21/2023]
Abstract
Patients with Schizophrenia Spectrum Disorders (SSD) often lead unhealthy lifestyles. This pragmatic trial evaluated the effectiveness of a lifestyle intervention, consisting of a 12-week aerobic exercise program and behavioural counselling, in SSD outpatients with metabolic syndrome (MetS). It also aimed to assess persistence of potential effects in a 24-month long-term follow-up. Effectiveness was measured in terms of a wide range of outcomes involving physical and psychological health, quality of life, physical activity and changes in motivation to exercise within the context of the self-determination theory. Our primary outcome was waist circumference change. Thirty-three out of 48 participants completed the study. No differences between groups were found in terms of BMI change or other metabolic parameters. However, the active group (AG) showed improvement regarding waist circumference, negative symptomatology and identified motivation to exercise during the study and follow-up. The AG exhibited changes toward a more active pattern of activity after intervention. Moreover, belonging to the AG was a significant predictor for achieving any degree of clinical improvement after 24-month follow-up. Combined interventions of exercise and behavioural counselling in SSD patients with MetS should be considered as an essential part of the integral treatment in the context of mental health services.
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Affiliation(s)
- Blanca Fernández-Abascal
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, University of Cantabria Medical School, Santander 39011, Spain
| | - Marta Suárez-Pinilla
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, UPM, Madrid 28223, Spain
| | | | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío - IBiS, Sevilla 41013, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Paula Suárez-Pinilla
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, University of Cantabria Medical School, Santander 39011, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid 28029, Spain.
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Riera-Molist N, Assens-Tauste M, Roura-Poch P, Guimerà-Gallent M, Santos-López JM, Serra-Millas M, Frau-Rosselló N, Gallego-Peña E, Foguet-Boreu Q. A Cardiovascular Risk Optimization Program in People With Schizophrenia: A Pilot Randomized Controlled Clinical Trial. J Psychiatr Pract 2023; 29:456-468. [PMID: 37948170 PMCID: PMC10631505 DOI: 10.1097/pra.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Cardiovascular disease is one of the leading causes of premature death in people with schizophrenia. Some modifiable factors that have been implicated include unhealthy lifestyle, medication side effects, and physical comorbidities. The goal of this study was to assess the efficacy of a 6-month, multifactorial cardiovascular risk intervention to reduce cardiovascular risk (CVR) in people with schizophrenia. METHODS We conducted a 2-arm, parallel, randomized clinical trial in a regional mental health center. Participants with at least 1 poorly controlled cardiovascular risk factor (CVRF) (hypertension, diabetes mellitus, hypercholesterolemia, or tobacco smoking) were randomly assigned to the intervention group or to a control group. The subjects in the intervention group received a patient-centered approach that included promoting a healthy lifestyle, pharmacological management of CVRFs, psychotropic drug optimization, and motivational follow-up [Programa d'optimització del RISc CArdiovascular (PRISCA)]. The main outcome was change in CVR as assessed using the Framingham-REGICOR function, after 6 months compared with the baseline in both groups. RESULTS Forty-six participants were randomly assigned to the PRISCA group (n=23) or the control group (n=23). The most prevalent CVRFs at baseline were hypercholesterolemia (84.8%) and tobacco smoking (39.1%). The PRISCA group showed a significant reduction in the REGICOR score (-0.96%; 95% CI: -1.60 to -0.32, P=0.011) after 6 months (relative risk reduction of 20.9%), with no significant changes in the control group (0.21%; 95% CI: -0.47 to 0.89, P=0.706). In the PRISCA group, low-density lipoprotein cholesterol also decreased significantly (-27.14 mg/dL; 95% CI: -46.28 to -8.00, P=0.008). CONCLUSION A patient-centered, multifactorial cardiovascular risk intervention improved CVR in people with schizophrenia after 6 months, which was achieved mainly by improving the lipid profile.
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Hawker P, Bellamy J, McHugh C, Wong TY, Williams K, Wood A, Anderson V, Tonge BJ, Ward P, Sciberras E, Bellgrove MA, Silk T, Lin PI, Eapen V. Effectiveness of lifestyle interventions for improving the physical health of children and adolescents taking antipsychotic medications: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e073893. [PMID: 37890972 PMCID: PMC10619077 DOI: 10.1136/bmjopen-2023-073893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Children and adolescents are increasingly prescribed antipsychotic medications off-label in the treatment of behavioural disorders. While antipsychotic medications are effective in managing behavioural issues, they carry a significant risk of adverse events that compromise ongoing physical health. Of particular concern is the negative impact antipsychotic medications have on cardiometabolic health. Interventions that aim to modify lifestyle habits have the potential to alleviate the adverse effects of antipsychotic medication by enhancing weight management, increasing physical activity, promoting better nutritional practices, improving dietary habits and promoting healthier sleep patterns and sleep hygiene. However, a comprehensive review has not been performed to ascertain the effectiveness of lifestyle interventions for children and adolescents who are at increased risk of antipsychotic-induced compromises to their physical health. METHODS AND ANALYSIS This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases will be searched without any year constraints to identify randomised controlled trials that are published in the English language and report a lifestyle intervention compared with usual care with any physical health outcome measure. Trial registers and results repositories will be scoured to identify additional studies. Two reviewers will independently conduct screening, data extraction and quality assessment and compare the results. Quantitative data will be synthesised, where appropriate, through a random-effects meta-analysis model. Otherwise, data will be reported in a qualitative (narrative) synthesis. Heterogeneity will be quantified using the I2 statistic. The Cochrane Risk of Bias 2 tool will be used for risk of bias assessment. The Grading of Recommendations, Assessment, Development and Evaluation system will be used to evaluate the cumulative body of evidence. ETHICS AND DISSEMINATION Ethics approval is not required. The publication plan will target high-impact, peer-reviewed journals that fall under the scope of Psychiatry and Mental Health. PROSPERO REGISTRATION NUMBER CRD42022380277.
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Affiliation(s)
- Patrick Hawker
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Jessica Bellamy
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Catherine McHugh
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Tsz Ying Wong
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
| | | | - Amanda Wood
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Philip Ward
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
| | | | | | - Tim Silk
- Deakin University, Burwood, Victoria, Australia
| | - Ping-I Lin
- UNSW, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry & Mental Health, UNSW, Sydney, New South Wales, Australia
- ICAMHS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Meepring S, Gray R, Li X, Chien WT, Li Y, Ho GWK, Kritkitrat P, Bressington D. Evaluating the efficacy of the Thai Health Improvement Profile intervention for preventing weight gain in people with early stage psychosis: A randomized controlled trial. Int J Nurs Stud 2023; 146:104570. [PMID: 37597457 DOI: 10.1016/j.ijnurstu.2023.104570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES To investigate the efficacy of the Thai Health Improvement Profile intervention for preventing clinically significant weight gain in people with early stage psychosis. METHODS We undertook a randomised controlled trial from 10/2018 to 05/2021. Participants with early stage psychosis (<5 year duration) were recruited using convenience sampling from the caseloads of community psychiatric nurses in Thailand and randomly allocated to either the Thai Health Improvement Profile intervention or treatment as usual group following baseline assessment. Outcome assessors were blind to group allocation, whereas participants were not. Participants in the intervention group received three monthly (five in total) systematic health checks using the Thai Health Improvement Profile tool, which was used to develop a personal health plan in collaboration with a family member/carer. Nurses supported participants to implement the health plan using behaviour change techniques derived from motivational interviewing. The treatment as usual group consisted of medication and psychosocial support, and no additional intervention was provided. The primary outcome was weight gain (defined as a greater or equal to 7 % increase in weight against baseline) within 1 year. RESULTS Fifty-three participants were allocated to the intervention and an equal number to the treatment as usual group. Primary outcome data were available for 30 participants in each group at the 12 month follow-up. We undertook an intention to treat analysis with multiple imputation (to handle the missing data) for the primary outcome. The treatment as usual group was found to have higher odds than the Thai Health Improvement Profile intervention group of gaining ≥7 % of baseline body weight (OR = 6.52; 95 % CI: 1.88-22.65, p = 0.004). CONCLUSIONS The Thai Health Improvement Profile intervention was effective at preventing weight gain in people with early stage psychosis at one year, though attrition was relatively high. The results highlight the need for community mental health nurses to adopt a holistic approach, the potential benefits of conducting regular comprehensive health checks and the importance of involving family members when aiming to improve the physical health of people diagnosed with early stage psychosis. A large definitive multi-site randomised controlled trial of the Thai Health Improvement Profile with a longer follow-up is now justified. TRIAL REGISTRATION Prospectively registered with the Thai Clinical Trials Registry (reference: TCTR20180305002).
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Affiliation(s)
| | | | - Xia Li
- La Trobe University, Melbourne, Australia
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Preeyakamon Kritkitrat
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros road, SriPhum District, Chiang Mai 50200, Thailand
| | - Daniel Bressington
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros road, SriPhum District, Chiang Mai 50200, Thailand; Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin 0810, Australia.
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19
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Stewart V, McMillan SS, Hu J, Collins JC, El-Den S, O'Reilly C, Wheeler AJ. Refining a taxonomy of goals planned between mental health consumers and community pharmacists. Res Social Adm Pharm 2023; 19:1391-1397. [PMID: 37468372 DOI: 10.1016/j.sapharm.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND People living with severe and persistent mental illnesses are more likely to experience co-morbid health conditions. Health-related behavior change can be promoted by the use of goal planning within community pharmacy settings. OBJECTIVES To trial and refine a recently developed taxonomy to categorize goals co-designed between community pharmacists and people living with severe and persistent mental illnesses. This study also compared the data to the previously published taxonomy data to determine if the taxonomy could be applied across a range of mental health conditions. METHODS The published goal taxonomy was refined using data from a cluster randomized controlled trial (PharMIbridge). Community pharmacists provided an individualized support service using goal planning with people living with severe and persistent mental illnesses. Goals were categorized using the existing taxonomy and inconsistencies were used to modify and refine the taxonomy. Additionally, participant characteristics and categorization of goals were compared with results from the previous study. RESULTS 512 goals were reported by 158 consumer participants and categorized into five domains that included a diverse range of health behaviors (e.g., relationships, diet). Minor refinements to the taxonomy were made by replacing, adding or removing categories/descriptors. CONCLUSIONS Significant overlap between the goals of participants and the existing taxonomy was found, supporting the application of the taxonomy across different mental health conditions.
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Affiliation(s)
- Victoria Stewart
- Centre for Mental Health, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia.
| | - Sara S McMillan
- Centre for Mental Health, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia
| | - Jie Hu
- Centre for Mental Health, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia
| | - Jack C Collins
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Claire O'Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia; Faculty of Health and Behavioural Sciences, University of Auckland, New Zealand
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20
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Mallorquí A, Oliveira C, Rios J, Isla-Pera MP, Gil-Badenes J, Amoretti S, Bernardo M, Vieta E, Parellada E, Garriga M, García-Rizo C. Nurse-led lifestyle intervention in a cohort of schizophrenia patients treated with clozapine. Arch Psychiatr Nurs 2023; 46:51-57. [PMID: 37813503 DOI: 10.1016/j.apnu.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 06/06/2023] [Accepted: 06/18/2023] [Indexed: 10/17/2023]
Abstract
Patients diagnosed with schizophrenia are characterized by early mortality compared to the general population. The main cause of this premature death reflects medical complications linked to metabolic syndrome (MetS). The use of antipsychotics such as clozapine is associated with weight gain and metabolic disturbances in certain predisposed individuals. Non-pharmacological interventions for weight control have become a key element for secondary prevention in the health of patients diagnosed with schizophrenia. Here, we aim to evaluate the physical health effects of a nurse-led non-pharmacological intervention program in patients with a diagnosis of schizophrenia treated with clozapine. Thirty-one outpatients from the outpatient clinical facility of Hospital Clinic in Barcelona, Spain diagnosed with schizophrenia and other psychotic disorders receiving clozapine treatment were enrolled in a prospective interventional study, comprising an 8-week group program of therapeutic education in a healthy lifestyle. MetS factors, physical activity, diet, and lifestyle were evaluated at baseline, post-intervention (8 weeks), and 3 months after the program. Weight, body mass index, high-density lipoprotein cholesterol, and diet patterns displayed significant differences post-intervention and after 3 months, while only waist, hip perimeter, and lifestyle improved post-intervention. Our results suggest the effectiveness of the lifestyle intervention in patients under clozapine treatment despite its long-time differential effect. Strategies to prevent weight gain and metabolic decline will help prevent premature cardiometabolic disease in this vulnerable population.
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Affiliation(s)
- Andrea Mallorquí
- Neurosciences Institute, Hospital Clinic of Barcelona, Barcelona, Spain; Jaume I University, Castellón, Spain.
| | | | - Jose Rios
- Medical Statistics Core Facility, Hospital Clinic Barcelona, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Pilar Isla-Pera
- Public Health, Mental Health and Maternal Department, Universitat de Barcelona, Campus de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Joaquin Gil-Badenes
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Silvia Amoretti
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Neurosciences Institute, Hospital Clinic Barcelona, Barcelona, Spain; University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Eduard Parellada
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Neurosciences Institute, Hospital Clinic Barcelona, Barcelona, Spain; University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Clemente García-Rizo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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21
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Hoogervorst MM, van Meijel B, Bruin EKD, Beekman A, Boonstra N, Adriaanse M. The nurse-led GILL eHealth intervention for improving physical health and lifestyle behaviours in clients with severe mental illness: design of a cluster-randomised controlled trial. BMC Psychiatry 2023; 23:672. [PMID: 37715156 PMCID: PMC10504705 DOI: 10.1186/s12888-023-05024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/13/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Clients with severe mental illness (SMI) have overall poor physical health. SMI reduces life expectancy by 5-17 years, primarily due to physical comorbidity linked to cardiometabolic risks that are mainly driven by unhealthy lifestyle behaviours. To improve physical health in clients with SMI, key elements are systematic somatic screening and lifestyle promotion. The nurse-led GILL eHealth was developed for somatic screening and the implementation of lifestyle activities in clients with SMI. Aims of this study are to evaluate the effectiveness of the GILL eHealth intervention in clients with SMI compared to usual care, and to evaluate the implementation process, and the experiences of clients and healthcare providers with GILL eHealth. METHODS The GILL study encompasses a cluster-randomised controlled trial in approximately 20 mental health care facilities in the Netherlands. The randomisation takes place at the team level, assigning clients to the eHealth intervention or the usual care group. The GILL eHealth intervention consists of two complementary modules for somatic screening and lifestyle promotion, resulting in personalised somatic treatment and lifestyle plans. Trained mental health nurses and nurse practitioners will implement the intervention within the multidisciplinary treatment context, and will guide and support the participants in promoting their physical health, including cardiometabolic risk management. Usual care includes treatment as currently delivered, with national guidelines as frame of reference. We aim to include 258 clients with SMI and a BMI of 27 or higher. Primary outcome is the metabolic syndrome severity score. Secondary outcomes are physical health measurements and participants' reports on physical activity, perceived lifestyle behaviours, quality of life, recovery, psychosocial functioning, and health-related self-efficacy. Measurements will be completed at baseline and at 6 and 12 months. A qualitative process evaluation will be conducted alongside, to evaluate the process of implementation and the experiences of clients and healthcare professionals with GILL eHealth. DISCUSSION The GILL eHealth intervention is expected to be more effective than usual care in improving physical health and lifestyle behaviours among clients with SMI. It will also provide important information on implementation of GILL eHealth in mental health care. If proven effective, GILL eHealth offers a clinically useful tool to improve physical health and lifestyle behaviours. TRIAL REGISTRATION Clinical trial registration NCT05533749, registration date: 8 September 2022.
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Affiliation(s)
- Meike M Hoogervorst
- Department of Psychiatry, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Berno van Meijel
- Department of Psychiatry, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health, Sports and Welfare, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands
| | - Esther Krijnen-de Bruin
- Department of Health, Sports and Welfare, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry, Amsterdam UMC and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nynke Boonstra
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- NHL Stenden, University of Applied Sciences, Leeuwarden, The Netherlands
- KieN VIP Mental Health Care Services, Leeuwarden, The Netherlands
| | - Marcel Adriaanse
- Department of Health Sciences, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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22
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Falkai P, Schwaiger R, Schmitt A, Röll L, Maurus I. Sports Therapy for Schizophrenia Psychoses: from the Idea to the Guideline. DAS GESUNDHEITSWESEN 2023; 85:S212-S217. [PMID: 37751760 DOI: 10.1055/a-2129-7421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Schizophrenia psychoses can be treated much better today due to the introduction of antipsychotics about 70 years ago in conjunction with the implementation of specific psychotherapies. However, current treatment options are still limited in the area of negative symptoms and disease-associated cognitive deficits. In the last 15 years, randomised controlled trials (RCTs) have been able to show that physical training and especially endurance training could represent a comprehensive complementary treatment approach and could lead to a significant improvement in positive, but especially also in negative symptoms and cognitive deficits. As a result, sports therapy for schizophrenia psychoses has found its way not only into the national treatment guidelines of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology (DGPPN), but also into European recommendations such as those of the European Psychiatric Association (EPA). With the introduction of the "Living guideline" format (here an update takes place at least once a year), a broader implementation in health care will be easier in the future. Based on a narrative review, this paper describes the process of implementing sports therapy for schizophrenia psychoses from its beginnings to its incorporation into guidelines and can be applied analogously to other forms of therapy.
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Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Rebecca Schwaiger
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
- Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of São Paulo (USP), São Paulo, Brazil
| | - Lukas Röll
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
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23
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Possidente C, Fanelli G, Serretti A, Fabbri C. Clinical insights into the cross-link between mood disorders and type 2 diabetes: A review of longitudinal studies and Mendelian randomisation analyses. Neurosci Biobehav Rev 2023; 152:105298. [PMID: 37391112 DOI: 10.1016/j.neubiorev.2023.105298] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
Mood disorders and type 2 diabetes mellitus (T2DM) are prevalent conditions that often co-occur. We reviewed the available evidence from longitudinal and Mendelian randomisation (MR) studies on the relationship between major depressive disorder (MDD), bipolar disorder and T2DM. The clinical implications of this comorbidity on the course of either condition and the impact of antidepressants, mood stabilisers, and antidiabetic drugs were examined. Consistent evidence indicates a bidirectional association between mood disorders and T2DM. T2DM leads to more severe depression, whereas depression is associated with more complications and higher mortality in T2DM. MR studies demonstrated a causal effect of MDD on T2DM in Europeans, while a suggestive causal association in the opposite direction was found in East Asians. Antidepressants, but not lithium, were associated with a higher T2DM risk in the long-term, but confounders cannot be excluded. Some oral antidiabetics, such as pioglitazone and liraglutide, may be effective on depressive and cognitive symptoms. Studies in multi-ethnic populations, with a more careful assessment of confounders and appropriate power, would be important.
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Affiliation(s)
- Chiara Possidente
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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24
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Rafn BS, Andersen MF, Sørensen V, Bjerre ED, Baandrup L, Vernal DL, Mors O, Knop FK, Wolf RT, Tolver A, Firth J, Nøhr N, Skou ST, Ebdrup BH, Midtgaard J. Value of gym-based group exercise versus usual care for young adults receiving antipsychotic medication: study protocol for the multicenter randomized controlled Vega trial. BMC Psychiatry 2023; 23:634. [PMID: 37648977 PMCID: PMC10466717 DOI: 10.1186/s12888-023-05086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Exercise is recommended to protect physical health among people with severe mental illness and holds the potential to facilitate long-term recovery. An inclusive exercise community provides an opportunity for life skill training and social connectedness and may reduce the experience of loneliness and internalized stigmatization which together may improve personal recovery. Using a pragmatic randomized design, we aim to examine the effectiveness of a gym-based exercise intervention tailored to young adults in antipsychotic treatment (i.e., Vega Exercise Community) compared to usual care. It is hypothesized that the Vega Exercise Community will be superior to usual care for personal recovery at four months. METHODS The trial will be conducted at four sites in Denmark from which 400 participants, aged 18 to 35 years, who are in current treatment with antipsychotic medications for the management of schizophrenia spectrum or affective disorders, will be recruited. Participants will be randomized (2:1) to Vega Exercise Community or usual care. Vega Exercise Community includes three weekly group-based exercise sessions hosted in commercial functional training centers delivered by certified Vega instructors. After four months, participants in Vega Exercise Community will be randomized (1:1) to minimal versus extended support with regards to sustained physical activity. Data will be collected at baseline, four, six and 12 months. The primary outcome is personal recovery assessed by Questionnaire about the Process of Recovery at four months. Behavioral symptoms, health-related quality of life, metabolic health, and program costs will be evaluated to further determine the effectiveness and cost-effectiveness of the Vega Exercise Community. Finally, the quality of life and physical and mental health of the participants' primary relative will be evaluated. DISCUSSION The results of this trial may have important implications for health, sustained physical activity, and recovery for individuals in treatment with antipsychotics. Given the pragmatic design, positive results may readily be implemented by mental health care professionals to promote exercise as an integrated part of treatment of severe mental illness. TRIAL REGISTRATION Clinical Trials.gov (NCT05461885, initial registration June 29th, 2022). WHO Universal Trial Number (UTN): U1111-1271-9928.
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Affiliation(s)
- Bolette Skjødt Rafn
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark.
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Martin Færch Andersen
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Victor Sørensen
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Eik Dybboe Bjerre
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Lone Baandrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital North, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Filip Krag Knop
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Rasmus Trap Wolf
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nikolaj Nøhr
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- , Arca, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark.
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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25
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Akinola PS, Tardif I, Leclerc J. Antipsychotic-Induced Metabolic Syndrome: A Review. Metab Syndr Relat Disord 2023; 21:294-305. [PMID: 37347965 DOI: 10.1089/met.2023.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Schizophrenia, a serious psychiatric disorder, is among the top 10 global causes of disability and affects nearly 1% of the world population. Antipsychotics constitute the best treatment for patients with schizophrenia, however, this treatment class carries a high risk of metabolic syndrome, including lipid abnormalities. Indeed, the risk of metabolic syndrome would be increased in the population with schizophrenia compared to the general population. The objective is to summarize the prevalence, the mechanisms, and the potential treatments of antipsychotic-induced metabolic syndrome. This is a narrative review of the literature. We searched the electronic database Medline, accessed through PubMed, to find studies that investigated the prevalence and treatments of metabolic syndrome in the adult population using antipsychotics. The prevalence of metabolic syndrome in patients treated with antipsychotics ranges from 37% to 63%. Antipsychotic iatrogenic effects include weight gain/increased waist circumference, dyslipidemia, insulin resistance/type 2 diabetes, and hypertension. Clozapine and olanzapine are reported to precipitate the onset of metabolic syndrome features. In patients with metabolic syndrome, an antipsychotic with less metabolic side effects such as lurasidone, lumateperone, ziprasidone, and aripiprazole should be prioritized. Unlike medications, aerobic exercise and dietetic counseling were found to be efficient as the nonpharmacologic treatment of antipsychotic-induced metabolic syndrome. Few pharmacological treatments were proven effective against weight gain in this patient population. The risk of metabolic syndrome induced by antipsychotics should be early recognized and closely monitored. Primary and secondary prevention of metabolic syndrome or onset of its feature might help reduce the risk of death for patients using antipsychotics.
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Affiliation(s)
- Pelumi Samuel Akinola
- College of Pharmacy, Rady Faculty of Health sciences, University of Manitoba, Winnipeg, Canada
| | | | - Jacinthe Leclerc
- Faculté de Pharmacie, Université Laval, Québec, Canada
- Centre de Recherche, Institut Universitaire de Cardiologie de Pneumologie de Québec-Université Laval, Québec, Canada
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26
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Meyer JM, Correll CU. Increased Metabolic Potential, Efficacy, and Safety of Emerging Treatments in Schizophrenia. CNS Drugs 2023; 37:545-570. [PMID: 37470979 PMCID: PMC10374807 DOI: 10.1007/s40263-023-01022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Abstract
Patients with schizophrenia experience a broad range of detrimental health outcomes resulting from illness severity, heterogeneity of disease, lifestyle behaviors, and adverse effects of antipsychotics. Because of these various factors, patients with schizophrenia have a much higher risk of cardiometabolic abnormalities than people without psychiatric illness. Although exposure to many antipsychotics increases cardiometabolic risk factors, mortality is higher in patients who are not treated versus those who are treated with antipsychotics. This indicates both direct and indirect benefits of adequately treated illness, as well as the need for beneficial medications that result in fewer cardiometabolic risk factors and comorbidities. The aim of the current narrative review was to outline the association between cardiometabolic dysfunction and schizophrenia, as well as discuss the confluence of factors that increase cardiometabolic risk in this patient population. An increased understanding of the pathophysiology of schizophrenia has guided discovery of novel treatments that do not directly target dopamine and that not only do not add, but may potentially minimize relevant cardiometabolic burden for these patients. Key discoveries that have advanced the understanding of the neural circuitry and pathophysiology of schizophrenia now provide possible pathways toward the development of new and effective treatments that may mitigate the risk of metabolic dysfunction in these patients. Novel targets and preclinical and clinical data on emerging treatments, such as glycine transport inhibitors, nicotinic and muscarinic receptor agonists, and trace amine-associated receptor-1 agonists, offer promise toward relevant therapeutic advancements. Numerous areas of investigation currently exist with the potential to considerably progress our knowledge and treatment of schizophrenia.
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Affiliation(s)
- Jonathan M Meyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Khaity A, Mostafa Al-dardery N, Albakri K, Abdelwahab OA, Hefnawy MT, Yousef YAS, Taha RE, Swed S, Hafez W, Hurlemann R, Elsayed MEG. Glucagon-like peptide-1 receptor-agonists treatment for cardio-metabolic parameters in schizophrenia patients: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1153648. [PMID: 37215670 PMCID: PMC10196269 DOI: 10.3389/fpsyt.2023.1153648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Aims We performed this meta-analysis to evaluate the efficacy and safety of glucagon-like peptide-1 receptor-agonists (GLP-1RA) treatment on cardio-metabolic parameters among antipsychotic-treated patients with schizophrenia. Methods We searched the Web of Science, Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, and Scopus for relevant Randomized Clinical trials (RCTs) from inception until 1 August 2022. Documents were screened for qualified articles, and all concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) in the meta-analysis models using Review Manager (RevMan version 5.4). Results Pooling data from 7 RCTs (398 patients) showed that GLP-1 RA was superior to placebo with regard to body weight [MD = - 4.68, 95% CI (-4.90,-4.46), P < 0.00001], waist circumference [MD = - 3.66, 95% CI (-3.89,-3.44), P < 0.00001], body mass index (BMI) [MD = - 1.09, 95% CI (-1.25,-0.93), P < 0.00001], systolic blood pressure (SBP) [MD = - 3.07, 95% CI (-3.61,-2.53), P < 0.00001], and diastolic blood pressure (DBP) [MD = - 2.02, 95% CI (-2.42,-1.62), P < 0.00001]. The total effect did not favor either of the two groups with respect to insulin and respiratory adverse events {[MD = - 0.06, 95% CI (-0.36, 0.24), p = 0.70], [RR = 0.66, 95% CI (0.31, 1.40), p = 0.28]; respectively}. Conclusion Our analysis revealed that GLP-1 RA treatment is safe and effective on cardio-metabolic parameters over control in antipsychotic-treated patients with schizophrenia. Nevertheless, the present evidence is not sufficient to confirm the safety and efficacy of GLP-1RA treatment on insulin and respiratory adverse events. Therefore, further studies are recommended. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022333040.
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Affiliation(s)
| | | | - Khaled Albakri
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | | | | | | | - Ruaa E. Taha
- Faculty of Medicine, Khartoum University, Khartoum, Sudan
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Wael Hafez
- NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
- Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo, Egypt
| | - Rene Hurlemann
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
- Department of Psychiatry, University Hospital Bonn, Bonn, Germany
- Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Mohamed E. G. Elsayed
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
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van de Meent I, Maat A, Boute M, van Dellen E, Cahn W. The Laban/Bartenieff Movement System in gait-analysis reveals upper-lower body movement dysconnectivity in psychotic disorders. Schizophr Res 2023; 256:47-49. [PMID: 37148574 DOI: 10.1016/j.schres.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Ilona van de Meent
- Department of Psychiatry, Brain Center at the University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Graduate School of Life Sciences, Utrecht University, Heidelberglaan 8, 5584 CS Utrecht, the Netherlands.
| | - Arija Maat
- Department of Psychiatry, Brain Center at the University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Psychiatry, Spaarne Gasthuis Haarlem, Boerhaavelaan 22, 2035 RC, Haarlem, the Netherlands
| | - Mikel Boute
- Department of Psychiatry, Brain Center at the University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, Brain Center at the University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, Brain Center at the University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Zhou T, Pu C, Huang Z, Gao T, Zhou E, Zheng Y, Zhang D, Huang B, Cheng Z, Shi C, Yu X. Weight changes following treatment with aripiprazole, risperidone and olanzapine: A 12-month study of first-episode schizophrenia patients in China. Asian J Psychiatr 2023; 84:103594. [PMID: 37094459 DOI: 10.1016/j.ajp.2023.103594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES This study aimed to assess weight changes following antipsychotic treatment in first-episode schizophrenia (FES) patients and make a comparison of aripiprazole, risperidone and olanzapine. Predictors for long-term clinically relevant weight gain (CRW, ≥7%) were examined. METHODS We carried out a second analysis of data from the Chinese First-Episode Schizophrenia Trial. Repeated measures general linear model (GLM) statistics were used to compare body weight at each follow-up point (month of 1, 2, 3, 6, 9and 12). Logistic regression models were constructed to evaluate possible predictors for CRW. RESULTS Body weight increased with an average rate of 0.93 % per month, with the fastest growth rate occurring in first 3 months. CRW was observed in 79 % of patients. Participants from olanzapine group showed significantly higher weight gain than risperidone group and aripiprozole group. Repeated measures GLM revealed a significant main effect of time (p < 0.001) and asignificant time*group interaction was revealed (p < 0.001), while the between-subject group effect was not statistically significant (p = 0.272). Multivariate logistic regressionmodel showed that with smaller baseline BMI (OR = 1.33, p < 0.001), with a family history of mental disorder (OR = 5.08, p = 0.004), receiving olanzapine (OR = 2.35, p = 0.001), and CRW at first-month (OR = 4.29, p = 0.032) were independent predictors for first-year CRW. CONCLUSION Antipsychotics are associated with a clinically significant weight gain in FES patients, which occurs mostly in first 3 months. Aripiprazole might not be an ideal choice in terms of long-term metabolic side-effects. Early and close metabolic monitoring should accompany antipsychotic prescription.
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Affiliation(s)
- Tianhang Zhou
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chengcheng Pu
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Zetao Huang
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tianqi Gao
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Enpeng Zhou
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yue Zheng
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Dan Zhang
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Bingjie Huang
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Zhang Cheng
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chuan Shi
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Yu
- Clinical Research Center, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Ye W, Xing J, Yu Z, Hu X, Zhao Y. Mechanism and treatments of antipsychotic-induced weight gain. Int J Obes (Lond) 2023; 47:423-433. [PMID: 36959286 DOI: 10.1038/s41366-023-01291-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
The long-term use of antipsychotics (APs) may cause a variety of diseases, such as metabolic syndrome, antipsychotic-induced weight gain (AIWG), and even obesity. This paper reviews the various mechanisms of AIWG and obesity in detail, involving genetics, the central nervous system, the neuroendocrine system, and the gut microbiome. The common drug and non-drug therapies used in clinical practice are also introduced, providing the basis for research on the molecular mechanisms and the future selection of treatments.
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Affiliation(s)
- Wujie Ye
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jingyu Xing
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Zekai Yu
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xingang Hu
- Internal encephalopathy of traditional Chinese medicine, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, 100078, China.
| | - Yan Zhao
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
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Wilson C, Carpenter JS, Nichles A, Zmicerevska N, Song YJC, McHugh C, Hamilton B, Hockey S, Crouse J, Koethe D, Scott EM, Hickie IB. Double-blind, randomised placebo-controlled clinical trial of metformin as an adjunct to a sleep-wake, activity and metabolically focused behavioural intervention to improve cardiometabolic outcomes and mood symptoms in youth with major mood syndromes: study protocol. BMJ Open 2023; 13:e064682. [PMID: 36810174 PMCID: PMC9945047 DOI: 10.1136/bmjopen-2022-064682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Metformin is a medication likely to improve measures of cardiometabolic disturbance in young people with mental illness. Evidence also suggests metformin may improve depressive symptoms. This 52-week double-blind randomised control trial (RCT) aims to investigate the efficacy of metformin pharmacotherapy as an adjunct to a healthy lifestyle behavioural intervention in improving cardiometabolic outcomes, and depressive, anxiety and psychotic symptoms in youth with clinically diagnosed major mood syndromes. METHODS AND ANALYSIS At least 266 young people aged 16-25 presenting for mental healthcare for major mood syndromes who are also at risk for poor cardiometabolic outcomes will be invited to participate in this study. All participants will engage in a 12-week sleep-wake, activity and metabolically focused behavioural intervention programme. As an adjunctive intervention, participants will receive either metformin (500-1000 mg) or placebo pharmacotherapy for 52 weeks.Participants will undergo a series of assessments including: (1) self-report and clinician-administered assessments; (2) blood tests; (3) anthropometric assessments (height, weight, waist circumference and blood pressure); and (4) actigraphy. Univariate and multivariate tests (generalised mixed-effects models) will be used to examine changes in primary and secondary outcomes (and associations with predetermined predictor variables). ETHICS AND DISSEMINATION This study has been approved by the Sydney Local Health District Research Ethics and Governance Office (X22-0017). The results of this double-blind RCT will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001559101p, 12 November 2019.
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Affiliation(s)
- Chloe Wilson
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Blake Hamilton
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Samuel Hockey
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Sass MR, Danielsen AA, Köhler-Forsberg O, Storgaard H, Knop FK, Nielsen MØ, Sjödin AM, Mors O, Correll CU, Ekstrøm C, Vinberg M, Nielsen J, Vilsbøll T, Fink-Jensen A. Effect of the GLP-1 receptor agonist semaglutide on metabolic disturbances in clozapine-treated or olanzapine-treated patients with a schizophrenia spectrum disorder: study protocol of a placebo-controlled, randomised clinical trial (SemaPsychiatry). BMJ Open 2023; 13:e068652. [PMID: 36720576 PMCID: PMC9890830 DOI: 10.1136/bmjopen-2022-068652] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Clozapine and olanzapine are some of the most effective antipsychotics, but both are associated with weight gain and relevant metabolic disturbances, including pre-diabetes and diabetes. Non-pharmacological/behavioural interventions have had limited effects counteracting these adverse effects. Semaglutide, a glucagon-like peptide 1 receptor agonist, is approved for the treatment of type 2 diabetes and obesity. We will investigate the long-term effects of add-on treatment with semaglutide once a week versus placebo once a week on the metabolic status in pre-diabetic (glycated haemoglobin A1c (HbA1c) 35-47 mmol/mol (5.4%-6.4%) and diabetic (HbA1c 48-57 mmol/mol (6.5%-7.4%)) patients diagnosed with a schizophrenia spectrum disorder who initiated clozapine or olanzapine treatment within the last 60 months. METHODS AND ANALYSIS This is a 26-week, double-blinded, randomised, placebo-controlled trial. Altogether, 104 patients diagnosed with a schizophrenia spectrum disorder, aged 18-65 years, with pre-diabetes or diabetes will be randomised to injections of 1.0 mg semaglutide once a week or placebo for 26 weeks. The primary endpoint is change from baseline in HbA1c. Secondary endpoints include changes in body weight, hip and waist circumference and plasma levels of insulin, glucagon, glucose, and C-peptide, insulin sensitivity, beta cell function, hepatic function, fibrosis-4 score, lipid profile, incretin hormones, bone markers, body composition, bone density, proteomic analyses and oxidative stress markers. Together with alcohol, tobacco and drug use, potential effects on the reward value of a sweet-fat stimulus, psychopathology, level of activity and quality of life will also be assessed. ETHICS AND DISSEMINATION This study is approved by the Danish Medicines Agency and the regional scientific ethics committee of the Capital Region of Denmark (committee C, #H-20019008) and will be carried out in accordance with International Council for Harmonisation Good Clinical Practice guidelines and the Helsinki Declaration. The results will be disseminated through peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04892199.
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Affiliation(s)
- Marie Reeberg Sass
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Aalkjær Danielsen
- Psychiatry, Psychosis Research Unit, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Köhler-Forsberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Psychiatry, Psychosis Research Unit, Aarhus Universitetshospital Skejby, Aarhus, Denmark
| | - Heidi Storgaard
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Mette Ødegaard Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Glostrup, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Glostrup, Denmark
| | - Anders Mikael Sjödin
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- Psychiatry, Psychosis Research Unit, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claus Ekstrøm
- Department of Biostatistics, University of Copenhagen Department of Public Health, Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center North Zeeland, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Hillerød, Denmark
| | - Jimmi Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Glostrup, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Glostrup, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anders Fink-Jensen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chen H, Cao T, Zhang B, Cai H. The regulatory effects of second-generation antipsychotics on lipid metabolism: Potential mechanisms mediated by the gut microbiota and therapeutic implications. Front Pharmacol 2023; 14:1097284. [PMID: 36762113 PMCID: PMC9905135 DOI: 10.3389/fphar.2023.1097284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
Second-generation antipsychotics (SGAs) are the mainstay of treatment for schizophrenia and other neuropsychiatric diseases but cause a high risk of disruption to lipid metabolism, which is an intractable therapeutic challenge worldwide. Although the exact mechanisms underlying this lipid disturbance are complex, an increasing body of evidence has suggested the involvement of the gut microbiota in SGA-induced lipid dysregulation since SGA treatment may alter the abundance and composition of the intestinal microflora. The subsequent effects involve the generation of different categories of signaling molecules by gut microbes such as endogenous cannabinoids, cholesterol, short-chain fatty acids (SCFAs), bile acids (BAs), and gut hormones that regulate lipid metabolism. On the one hand, these signaling molecules can directly activate the vagus nerve or be transported into the brain to influence appetite via the gut-brain axis. On the other hand, these molecules can also regulate related lipid metabolism via peripheral signaling pathways. Interestingly, therapeutic strategies directly targeting the gut microbiota and related metabolites seem to have promising efficacy in the treatment of SGA-induced lipid disturbances. Thus, this review provides a comprehensive understanding of how SGAs can induce disturbances in lipid metabolism by altering the gut microbiota.
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Affiliation(s)
- Hui Chen
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China,Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China,Institute of Clinical Pharmacy, Central South University, Changsha, China,International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, Hunan, China
| | - Ting Cao
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China,Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China,Institute of Clinical Pharmacy, Central South University, Changsha, China,International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, Hunan, China
| | - Bikui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China,Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China,Institute of Clinical Pharmacy, Central South University, Changsha, China,International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, Hunan, China,*Correspondence: Bikui Zhang, ; Hualin Cai,
| | - Hualin Cai
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China,Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China,Institute of Clinical Pharmacy, Central South University, Changsha, China,International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, Hunan, China,*Correspondence: Bikui Zhang, ; Hualin Cai,
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Campforts B, Drukker M, Crins J, van Amelsvoort T, Bak M. Association between antipsychotic medication and clinically relevant weight change: meta-analysis. BJPsych Open 2023; 9:e18. [PMID: 36651070 PMCID: PMC9885350 DOI: 10.1192/bjo.2022.619] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous meta-analyses have shown that almost all antipsychotics are associated with weight gain. However, mean weight gain is not informative about clinically relevant weight gain or weight loss. AIMS To provide further insight into the more severe body weight changes associated with antipsychotic use, we assessed the proportion of patients with clinically relevant weight gain (CRWG) and clinically relevant weight loss (CRWL), defined as ≥7% weight gain and ≥7% weight loss. METHOD We searched PubMed, Embase and PsycInfo for randomised controlled trials of antipsychotics that reported CRWG and CRWL in study populations aged 15 years or older. We conducted meta-analyses stratified by antipsychotic and study duration using a random-effects model. We performed meta-regression analyses to assess antipsychotic-naive status and psychiatric diagnosis as modifiers for CRWG. PROSPERO: CRD42020204734. RESULTS We included 202 articles (201 studies). Almost all included antipsychotics were associated with CRWG. For CRWL, available data were too limited to draw firm conclusions. For some antipsychotics, CRWG was more pronounced in individuals who were antipsychotic-naive than in individuals switching to another antipsychotic. Moreover, a longer duration of antipsychotic use was associated with more CRWG, but not CRWL. For some antipsychotics, CRWG was higher in people diagnosed with schizophrenia, but this was inconsistent. CONCLUSIONS Switching antipsychotic medication is associated with both weight gain and weight loss, but the level of CRWG is higher than CRWL in antipsychotic-switch studies. CRWG was more pronounced in antipsychotic-naive patients, highlighting their vulnerability to weight gain. The impact of diagnosis on CRWG remains inconclusive.
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Affiliation(s)
- Bea Campforts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joost Crins
- Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Godin O, Pignon B, Szoke A, Boyer L, Aouizerate B, Schorr B, André M, Capdevielle D, Chereau I, Coulon N, Dassing R, Dubertret C, Etain B, Leignier S, Llorca PM, Mallet J, Misdrahi D, Passerieux C, Rey R, Urbach M, Schürhoff F, Leboyer M, Fond G, Andre M, Andrieu-Haller C, Aouizerate B, Berna F, Blanc O, Bourguignon E, Capdevielle D, Chereau-Boudet I, Clauss-Kobayashi J, Coulon N, D'Amato T, Dassing R, Dorey JM, Dubertret C, Esselin A, Fond G, Gabayet F, Jarroir M, Lacelle D, Lançon C, Laouamri H, Leboyer M, Leignier S, Llorca, Mallet J, Metairie E, Michel T, Misdrahi D, Passerieux C, Petrucci J, Pignon B, Peri P, Portalier C, Rey R, Roman C, Schorr B, Schürhoff F, Szöke A, Tessier A, Urbach M, Wachiche G, Zinetti-Bertschy A. 3-year incidence and predictors of metabolic syndrome in schizophrenia in the national FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110641. [PMID: 36122839 DOI: 10.1016/j.pnpbp.2022.110641] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 12/01/2022]
Abstract
AIMS Metabolic Syndrome (MetS) is a major health epidemic of Western countries and patients with schizophrenia is a particularly vulnerable population due to lifestyle, mental illness and treatment factors. However, we lack prospective data to guide prevention. The aim of our study is then to determine MetS incidence and predictors in schizophrenia. METHOD Participants were recruited in 10 expert centers at a national level and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Inverse probability weighting methods were used to correct for attrition bias. RESULTS Among the 512 participants followed-up for 3 years, 77.9% had at least one metabolic disturbance. 27.5% were identified with MetS at baseline and excluded from the analyses. Among the rest of participants (N = 371, mean aged 31.2 (SD = 9.1) years, with mean illness duration of 10.0 (SD = 7.6) years and 273 (73.6%) men), MetS incidence was 20.8% at 3 years and raised to 23.6% in tobacco smokers, 29.4% in participants receiving antidepressant prescription at baseline and 42.0% for those with 2 disturbed metabolic disturbances at baseline. Our multivariate analyses confirmed tobacco smoking and antidepressant consumption as independent predictors of MetS onset (adjusted odds ratios (aOR) = 3.82 [1.27-11.45], p = 0.016, and aOR = 3.50 [1.26-9.70], p = 0.0158). Antidepressant prescription predicted more specifically increased lipid disturbances and paroxetine was associated with the highest risk of MetS onset. CONCLUSION These results are an alarm call to prioritize MetS prevention and research in schizophrenia. We have listed interventions that should be actively promoted in clinical practice.
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Affiliation(s)
- O Godin
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - B Pignon
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - A Szoke
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - L Boyer
- Fondation FondaMental, Créteil, France; AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux F-33076, France; INRAE, NutriNeuro, University of Bordeaux, U1286, Bordeaux F-33076, France
| | - B Schorr
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - M André
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - N Coulon
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - R Dassing
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - B Etain
- Fondation FondaMental, Créteil, France; Assistance Publique des Hopitaux de Paris (AP-HP), GHU Saint-Louis - Lariboisiere - Fernand Widal, DMU Neurosciences, Departement de Psychiatrie et de Medecine Addictologique, INSERM UMRS 1144, Universite de Paris, Paris, France
| | - S Leignier
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - J Mallet
- Fondation FondaMental, Créteil, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France; University of Bordeaux, CNRS UMR 5287-INCIA «Neuroimagerie et Cognition Humaine», France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Service Universitaire de psychiatrie et d'addictologie du Centre Hospitalier de Versailles, INSERM UMR1018, CESP, Team "DevPsy", Université de Versailles Saint-Quentin-en-Yvelines, Paris, Saclay, France
| | - R Rey
- Fondation FondaMental, Créteil, France; INSERM U1028 CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service Universitaire de psychiatrie et d'addictologie du Centre Hospitalier de Versailles, INSERM UMR1018, CESP, Team "DevPsy", Université de Versailles Saint-Quentin-en-Yvelines, Paris, Saclay, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - G Fond
- Fondation FondaMental, Créteil, France; AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | | | - M Andre
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - C Andrieu-Haller
- Fondation Fondamental, France; AP-HM, La Conception Hospital, Aix-Marseille Univ., School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - B Aouizerate
- Fondation Fondamental, France; University Department of General Psychiatry), Charles Perrens Hospital, F-33076 Bordeaux, France; Laboratory of Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, Bordeaux, France
| | - F Berna
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - O Blanc
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - E Bourguignon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - D Capdevielle
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau-Boudet
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - J Clauss-Kobayashi
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - N Coulon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - T D'Amato
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - R Dassing
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - J M Dorey
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - C Dubertret
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - A Esselin
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - G Fond
- Fondation Fondamental, France; AP-HM, La Conception Hospital, Aix-Marseille Univ., School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - F Gabayet
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - M Jarroir
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - D Lacelle
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - C Lançon
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | | | - M Leboyer
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - S Leignier
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - Llorca
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - J Mallet
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - E Metairie
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - T Michel
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - D Misdrahi
- Fondation Fondamental, France; University Department of General Psychiatry, Charles Perrens Hospital, F-33076, Bordeaux, France; CNRS UMR 5287-INCIA, Bordeaux, France
| | - C Passerieux
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - J Petrucci
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - B Pignon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - P Peri
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - C Portalier
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - R Rey
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - C Roman
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - B Schorr
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - F Schürhoff
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Szöke
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Tessier
- Fondation Fondamental, France; University Department of General Psychiatry, Charles Perrens Hospital, F-33076, Bordeaux, France; CNRS UMR 5287-INCIA, Bordeaux, France
| | - M Urbach
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - G Wachiche
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Zinetti-Bertschy
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
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Croatto G, Vancampfort D, Miola A, Olivola M, Fiedorowicz JG, Firth J, Alexinschi O, Gaina MA, Makkai V, Soares FC, Cavaliere L, Vianello G, Stubbs B, Fusar-Poli P, Carvalho AF, Vieta E, Cortese S, Shin JI, Correll CU, Solmi M. The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials. Mol Psychiatry 2023; 28:369-390. [PMID: 36138129 PMCID: PMC9493151 DOI: 10.1038/s41380-022-01770-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE People with mood disorders have increased risk of comorbid medical diseases versus the general population. It is paramount to identify interventions to improve physical health in this population. METHODS Umbrella review of meta-analyses of randomised controlled trials (RCTs) on pharmacological/non-pharmacological interventions for physical health outcomes/intolerability-related discontinuation in mood disorders (any age). RESULTS Ninety-seven meta-analyses were included. Among youths, against placebo, in depression, antidepressants/antipsychotics had higher discontinuation rates; in bipolar depression, olanzapine+fluoxetine worsened total cholesterol (TC)/triglycerides/weight gain (WG) (large ES). In adults with bipolar disorder, olanzapine worsened HbA1c/TC/WG (moderate/large ES); asenapine increased fasting glucose (small ES); quetiapine/cariprazine/risperidone induced WG (small/moderate ES). In bipolar depression, lurasidone was metabolically neutral. In depression, psychological interventions improved physical health-related quality of life (PHQoL) (small ES), fasting glucose/HbA1c (medium/large ES); SSRIs improved fasting glucose/HbA1c, readmission for coronary disease, pain (small ES); quetiapine/aripiprazole/olanzapine induced WG (small to large ES). Exercise improved cardiorespiratory fitness (moderate ES). In the elderly, fluoxetine yielded more detrimental cardiovascular effects than sertraline/escitalopram (large ES); antidepressants were neutral on exercise tolerance and PHQoL. In mixed age groups, in bipolar disorder aripiprazole was metabolically neutral; in depression, SSRIs lowered blood pressure versus placebo and serotonin-noradrenaline reuptake inhibitors (small ES); brexpiprazole augmentation caused WG and was less tolerated (small ES); exercise improved PHQoL (moderate ES). CONCLUSIONS Some interventions (psychological therapies, exercise and SSRIs) improve certain physical health outcomes in mood disorders, few are neutral, but various pharmacological interventions are associated with negative effects. Evidence from this umbrella review has limitations, should consider evidence from other disorders and should be integrated with recent evidence from individual RCTs, and observational evidence. Effective treatments with either beneficial or physically neutral profiles should be prioritized.
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Affiliation(s)
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven University, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Alessandro Miola
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Miriam Olivola
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | | | - Marcel A Gaina
- Institute of Psychiatry "Socola", Iasi, Romania
- Psychiatry, Department of Medicine III, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy of Iasi, Iasi, Romania
| | | | | | | | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, King's College London, London, UK
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Samuele Cortese
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jae Il Shin
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco Solmi
- The Ottawa Hospital, Ottawa, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Psychosis Studies, King's College London, London, UK.
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK.
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
- Department of Psychiatry, University of Ottawa, Ontario, Canada.
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Wilson C, Carpenter J, Park S, McHugh C, Scott EM, Hickie IB. Metabolic and clinical profiles of young people with mood or psychotic disorders who are prescribed metformin in an inpatient setting. Australas Psychiatry 2022; 30:689-693. [PMID: 35852822 DOI: 10.1177/10398562221115607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Youth with early-onset mood or psychotic disorders are occasionally prescribed metformin to manage cardiometabolic risk. This retrospective study explores the demographic, clinical and metabolic factors associated with metformin prescription youth with mood or psychotic disorders. METHOD Participants included 72 youth with mood or psychotic disorders from a young adult mental health inpatient unit, of which 18 (33%) were newly prescribed metformin, and 54 (66%) were not prescribed metformin. Demographic and clinical information were extracted from the patients' medical files along with body mass index (BMI), fasting serum bloods and calculated updated homeostatic model of insulin resistance assessment (HOMA2-IR) scores to compare profiles between groups. RESULTS Of those prescribed metformin, 83% were overweight or obese and 72% had elevated HOMA2-IR scores. Of those not receiving metformin treatment, 41% were overweight or obese and 22% had elevated HOMA2-IR scores. Youth prescribed metformin had significantly higher BMI, and elevated markers of insulin resistance, but did not differ to those not prescribed metformin on other demographic, clinical or metabolic factors. CONCLUSIONS While metformin is prescribed to some youth with mood or psychotic disorders displaying markers of cardiometabolic disturbance, there is a need to develop clearer treatment guidelines for metformin in these youth.
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Affiliation(s)
- Chloe Wilson
- Brain and Mind Centre, 4334University of Sydney, Camperdown, NSW, Australia
| | - Joanne Carpenter
- Brain and Mind Centre, 4334University of Sydney, Camperdown, NSW, Australia
| | - Shinho Park
- Brain and Mind Centre, 4334University of Sydney, Camperdown, NSW, Australia
| | - Catherine McHugh
- Brain and Mind Centre, 4334University of Sydney, Camperdown, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, 4334University of Sydney, Camperdown, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, 4334University of Sydney, Camperdown, NSW, Australia
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39
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Correll CU, Bitter I, Hoti F, Mehtälä J, Wooller A, Pungor K, Tiihonen J. Factors and their weight in reducing life expectancy in schizophrenia. Schizophr Res 2022; 250:67-75. [PMID: 36368280 DOI: 10.1016/j.schres.2022.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 09/07/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Schizophrenia is associated with a wide range of socioeconomic and health-related problems, as well as 10-25 potential life-years lost. While lifestyle choices, comorbidities, and choice of medication are associated with schizophrenia disease burden and mortality, real-world evidence on the impact of these factors on expected life-years among patients with schizophrenia is limited. METHODS In this study, register-based, nationwide data from patients with schizophrenia in Finland during 1972-2015 were analysed to determine influential factors associated with mortality and to demonstrate their impact on expected life-years in patients with schizophrenia. RESULTS Factors reducing all-cause mortality were use of antipsychotics: HR 0.46 (95 % CI: 0.45, 0.47), ever use of lipid-modifying agents: HR 0.71 (95 % CI 0.68, 0.73), antidepressants HR 0.87 (95 % CI 0.85, 0.90), and lithium HR 0.90 (95 % CI 0.86, 0.95). Factors increasing all-cause mortality were cardiovascular disease: HR 2.41 (95 % CI: 2.34, 2.49), liver disease: HR 1.98 (95 % CI: 1.78, 2.21), renal disease: HR 1.63 (95 % CI:1.56, 1.70), diabetes: HR 1.40 (95 % C:1.35, 1.45), history of switching antipsychotics: HR 1.39 (95 % CI: 1.35, 1.44), longer duration of previous hospitalisations HR 1.96 (95 % CI: 1.90, 2.02), history of substance abuse HR 1.38 (95 % CI: 1.30, 1.46), and ever use of benzodiazepines HR 1.12 (95 % CI: 1.09, 1.16). CONCLUSIONS The results from this study could serve to motivate clinicians to support and encourage patients to adhere to antipsychotic treatment and achieve a healthier lifestyle, which could, in turn, increase the expected life-years of patients with schizophrenia.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | | | | | - Katalin Pungor
- Janssen-Cilag, Medical Affairs EMEA, Dusseldorf, Germany
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Neuroscience Center, Helsinki, Finland
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40
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Smit MMC, Waal ED, Tenback DE, Deenik J. Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial. BJPsych Open 2022; 8:e201. [PMID: 36412504 PMCID: PMC9707511 DOI: 10.1192/bjo.2022.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lifestyle interventions can improve health-related outcomes for people with severe mental illness (SMI), but few studies evaluate this potential in everyday settings. After a successful approach in routine inpatient mental healthcare (MULTI), we sought to replicate this multidisciplinary lifestyle-enhancing support in people with SMI living in sheltered housing (MULTI_sh). AIMS To evaluate the effectiveness and implementation of MULTI_sh (trial registration: NCT03157557). METHOD In an effectiveness-implementation hybrid cluster-randomised controlled trial, six municipalities with sheltered housing facilities in The Netherlands were randomly assigned to MULTI_sh (n = 3) or treatment as usual (TAU, n = 3). After 12 months, we evaluated effects on metabolic health, sedentary behaviour/physical activity (ActiGraph GT3X+), quality of life (EuroQol 5D, WHOQoL-Bref) and psychopathology (Brief Psychiatric Rating Scale Expanded Version) using multiple regression, adjusting for baseline values and municipalities (intention to treat and per protocol). In addition, implementation fidelity and barriers/facilitators were evaluated (Measurement Instrument for Determinants of Innovation). RESULTS Of 177 eligible patients, 74 (42%) could be included in the analyses. Health outcomes did not substantially improve with MULTI_sh (n = 45) compared with TAU (n = 29). MULTI_sh was not implemented as intended. Most patients and all healthcare professionals believed that patients' lifestyle should be part of treatment, but implementation was primarily (in)directly hindered by organisational factors (e.g. staff shortages, complexity of participation, lack of time and difficulty getting patients involved). CONCLUSIONS MULTI_sh was not implemented as intended and no clinical health improvements were found. Organisations are decisive in the success or failure of the implementation of lifestyle interventions for people with SMI. More intensive implementation strategies on this level are warranted in sheltered housing.
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Affiliation(s)
- Marij M C Smit
- GGz Centraal, Amersfoort, The Netherlands; and Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Elze de Waal
- GGz Centraal, Amersfoort, The Netherlands; and Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik E Tenback
- Centre for Transcultural Psychiatry (CTP)Veldzicht, Balkbrug, The Netherlands
| | - Jeroen Deenik
- GGz Centraal, Amersfoort, The Netherlands; and School for Mental Health and Neuroscience, Maastricht University, Maastricht,The Netherlands
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Muva physical activity intervention to improve social functioning in people with a severe mental illness: study protocol of a pragmatic stepped wedge cluster randomized trial. BMC Psychiatry 2022; 22:695. [PMID: 36368947 PMCID: PMC9652040 DOI: 10.1186/s12888-022-04321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with severe mental illness (SMI) often suffer from long-lasting symptoms that negatively influence their social functioning, their ability to live a meaningful life, and participation in society. Interventions aimed at increasing physical activity can improve social functioning, but people with SMI experience multiple barriers to becoming physically active. Besides, the implementation of physical activity interventions in day-to-day practice is difficult. In this study, we aim to evaluate the effectiveness and implementation of a physical activity intervention to improve social functioning, mental and physical health. METHODS In this pragmatic stepped wedge cluster randomized controlled trial we aim to include 100 people with SMI and their mental health workers from a supported housing organization. The intervention focuses on increasing physical activity by implementing group sports activities, active guidance meetings, and a serious game to set physical activity goals. We aim to decrease barriers to physical activity through active involvement of the mental health workers, lifestyle courses, and a medication review. Participating locations will be divided into four clusters and randomization will decide the start of the intervention. The primary outcome is social functioning. Secondary outcomes are quality of life, symptom severity, physical activity, cardiometabolic risk factors, cardiorespiratory fitness, and movement disturbances with specific attention to postural adjustment and movement sequencing in gait. In addition, we will assess the implementation by conducting semi-structured interviews with location managers and mental health workers and analyze them by direct content analysis. DISCUSSION This trial is innovative since it aims to improve social functioning in people with SMI through a physical activity intervention which aims to lower barriers to becoming physically active in a real-life setting. The strength of this trial is that we will also evaluate the implementation of the intervention. Limitations of this study are the risk of poor implementation of the intervention, and bias due to the inclusion of a medication review in the intervention that might impact outcomes. TRIAL REGISTRATION This trial was registered prospectively in The Netherlands Trial Register (NTR) as NTR NL9163 on December 20, 2020. As the The Netherlands Trial Register is no longer available, the trial can now be found in the International Clinical Trial Registry Platform via: https://trialsearch.who.int/Trial2.aspx?TrialID=NL9163 .
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Buzea CA, Manu P, Dima L, Correll CU. Drug-drug interactions involving combinations of antipsychotic agents with antidiabetic, lipid-lowering, and weight loss drugs. Expert Opin Drug Metab Toxicol 2022; 18:729-744. [PMID: 36369828 DOI: 10.1080/17425255.2022.2147425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patients with severe mental illness (SMI) have a high risk for diabetes, dyslipidemia, and other components of metabolic syndrome. Patients with these metabolic comorbidities and cardiac risk factors should receive not only antipsychotics but also medications aiming to reduce cardiovascular risk. Therefore, many patients may be exposed to clinically relevant drug-drug interactions. AREAS COVERED This narrative review summarizes data regarding the known or potential drug-drug interactions between antipsychotics and medications treating metabolic syndrome components, except for hypertension, which has been summarized elsewhere. A literature search in PubMed and Scopus up to 7/31/2021 was performed regarding interactions between antipsychotics and drugs used to treat metabolic syndrome components, aiming to inform clinicians' choice of medication for patients with SMI and cardiometabolic risk factors in need of pharmacologic interventions. EXPERT OPINION The cytochrome P450 system and, to a lesser extent, the P-glycoprotein transporter is involved in the pharmacokinetic interactions between antipsychotics and some statins or saxagliptin. Regarding pharmacodynamic interactions, the available information is based mostly on small studies, and for newer classes, like PCSK9 inhibitors or SGLT2 inhibitors, data are still lacking. However, there is sufficient information to guide clinicians in the process of selecting safer antipsychotic-cardiometabolic risk reduction drug combinations.
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Affiliation(s)
- Catalin Adrian Buzea
- Department 5 - Internal Medicine, Carol Davila' University of Medicine and Pharmacy, 37 Dionisie Lupu, Bucharest, Romania.,Cardiology, Clinical Hospital Colentina, 19-21 Stefan cel Mare, Bucharest, Romania
| | - Peter Manu
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Medical Services, South Oaks Hospital, Northwell Health System, Amityville, NY, USA
| | - Lorena Dima
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brasov, Nicolae Balcescu Str 59, 500019, Brașov, Romania
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charite Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA
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Dodd S, Sominsky L, Siskind D, Bortolasci CC, Carvalho AF, Maes M, Walker AJ, Walder K, Yung AR, Williams LJ, Myles H, Watson T, Berk M. The role of metformin as a treatment for neuropsychiatric illness. Eur Neuropsychopharmacol 2022; 64:32-43. [PMID: 36191545 DOI: 10.1016/j.euroneuro.2022.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 12/12/2022]
Abstract
Advances in psychopharmacology have been significantly slower to evolve than in other disciplines of medicine and therefore investigation into novel therapeutic approaches is required. Additionally, concurrent metabolic conditions are prevalent among people with mental disorders. Metformin is a widely used hypoglycaemic agent that is now being studied for use beyond diabetes management. Evidence is emerging that metformin has multiple effects on diverse neurobiological pathways and consequently may be repurposed for treating mental illness. Metformin may have beneficial neuroimmunological, neuroplastic, neuro-oxidative and neuro-nitrosative effects across a range of psychiatric and neurodegenerative illnesses. Mechanisms include glucose lowering effects and effects on AMP-activated protein kinase (AMPK) signalling, however the best evidence for clinical benefit is through the glucose lowering effects, with other mechanisms less supported by the current evidence base. This narrative review aims to draw together the existing evidence for use of metformin as a psychopharmaceutical and present the role of metformin in the context of physical and psychiatric ill health, including metabolic, endocrinological and cancer domains. It not only has therapeutic potential in medical comorbidity but may have potential in core illness domains.
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Affiliation(s)
- Seetal Dodd
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, the University of Melbourne, Parkville, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.
| | - Luba Sominsky
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Barwon Health Laboratory, University Hospital Geelong, Barwon Health, VIC, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, MIRT, Level 2, 228 Logan Rd, Woolloongabba, Brisbane, Qld 4102, Australia University of Queensland School of Clinical Medicine, Brisbane, Australia Queensland Centre for Mental Health Research, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chiara C Bortolasci
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Andre F Carvalho
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Michael Maes
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Adam J Walker
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Ken Walder
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Alison R Yung
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia; School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lana J Williams
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Hannah Myles
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Northern Adelaide Mental Health Service, Salisbury, SA, Australia
| | - Tayler Watson
- Mental Health, Drugs and Alcohol Service, Barwon Health, Geelong VIC, Australia
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, the University of Melbourne, Parkville, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
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Deenik J, Koomen LEM, Scheewe TW, van Deursen FP, Cahn W. Cardiorespiratory fitness and self-reported physical activity levels of referring mental healthcare professionals, and their attitudes and referral practices related to exercise and physical health. J Psychiatr Res 2022; 154:19-27. [PMID: 35921725 DOI: 10.1016/j.jpsychires.2022.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Physical activity (PA) interventions can improve mental and physical health of people with mental illness, especially when delivered by qualified exercise professionals. Also, the behaviour, engagement and support of referring mental healthcare professionals (HCP) seem essential, but research is scarce. We aimed to study HCP physical fitness and PA, and associations with their attitudes and referral practices related to physical health and PA interventions. METHODS HCP at the Dutch Association for Psychiatry congress (2019) were invited to an online questionnaire (demographic/work characteristics, stress, PA levels, knowledge/attitudes regarding PA, referral practices) and cycle ergometer test. Strongest associations were analysed using linear and logistic regression. RESULTS Of the 115 HCP who completed the questionnaire (40 also completed the ergometer test), 43% (n = 50) met PA guidelines (i.e., ≥150min moderate-to-vigorous PA and ≥2x bone/muscle-strengthening exercises/week). Women, HCP interns/residents and HCP experiencing more stress were less active and less likely to meet PA guidelines. Conversely, there were positive associations with personal experience with an exercise professional. Knowledge/attitudes on physical health and PA were positive. HCP were more likely to refer patients to PA interventions if they met PA guidelines (OR = 2.56, 95%BI = 0.85-7.13) or had higher beliefs that exercise professionals can increase adherence to PA interventions (OR = 3.72, 95%BI = 1.52-9.14). LIMITATIONS Mainly psychiatrists, affecting generalizability. CONCLUSIONS HCP report the importance and relevance of PA in mental healthcare. Despite strong evidence and guidance for PA interventions in prevention and treatment, referral to such interventions partly depends on the PA behaviour and attitude of patient's physician/clinician.
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Affiliation(s)
- Jeroen Deenik
- GGz Centraal, Utrechtseweg 266, 3831EW, Amersfoort, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, Minderbroedersberg 4-6, 6211LK, Maastricht, the Netherlands; Windesheim University of Applied Sciences, Campus 2, 8017CA, Zwolle, the Netherlands; University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Lisanne E M Koomen
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Thomas W Scheewe
- Windesheim University of Applied Sciences, Campus 2, 8017CA, Zwolle, the Netherlands
| | - Frank P van Deursen
- Windesheim University of Applied Sciences, Campus 2, 8017CA, Zwolle, the Netherlands
| | - Wiepke Cahn
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
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Pham H, Warlick H, Bermudez R, Nguyen Q, Rey JA. Olanzapine/Samidorphan: A New Option for the Treatment of Adults With Schizophrenia or Bipolar I Disorder. J Pharm Technol 2022; 38:304-313. [PMID: 36046346 PMCID: PMC9420915 DOI: 10.1177/87551225221114281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023] Open
Abstract
Objective To review the pharmacology, pharmacokinetics, and efficacy and safety data of a combination of olanzapine and samidorphan (OLZ/SAM) for the treatment of schizophrenia and bipolar I disorder, which mitigates the possible unwanted side effects of weight gain associated with olanzapine (OLZ). Data Sources The review was done with a bibliographic survey of studies using MEDLINE/PubMed (January 1999-May 2021) database using the keywords olanzapine and samidorphan. Abstracts, scientific posters, and information from the manufacturer's product labeling were evaluated for inclusion. Inclusion criteria: phase 2, phase 3, and open-labeled studies that evaluated the use of OLZ/SAM for the treatment of schizophrenia and bipolar I disorder. Data Synthesis We have included one phase 2 dose-ranging exploratory study, two phase 3 efficacy and safety studies, and several open-label extension studies without a comparator. For the treatment of schizophrenia, OLZ/SAM and OLZ alone were analyzed in 2 randomized, double-blind comparison studies of approximately 960 patients. Analysis indicated that OLZ (5-20 mg)/SAM (10 mg) significantly mitigated the side effect of weight gain compared with OLZ alone (control) while maintaining antipsychotic efficacy. For bipolar I disorder, OLZ/SAM was approved as an acute treatment for manic or mixed episodes, as well as an adjunct to valproate or lithium for manic/mixed episodes based on bridging strategy allowed by the Food and Drug Administration. Relevance to Patient Care and Clinical Practice The combination of olanzapine and samidorphan demonstrated efficacy for the treatment of schizophrenia with a dosage range of 5 to 20 mg OLZ to a 10-mg fixed dose of samidorphan. Advantages of this drug combination include once-daily dosing, favorable tolerability, and most importantly, mitigation of weight gain, which may encourage adherence, when compared with OLZ alone. Conclusion The new combination treatment of OLZ/SAM is a unique antipsychotic formulation to provide the recognized efficacious treatment of OLZ, while mitigating the weight gain and possibly the weight-related adverse effects secondary to OLZ monotherapy.
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Affiliation(s)
- Huy Pham
- Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Halford Warlick
- Nova Southeastern University College of Osteopathic Medicine, Davie, FL, USA
| | | | - Quan Nguyen
- Memorial Healthcare System, Hollywood, FL, USA
| | - Jose A. Rey
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Davie, FL, USA
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Horska K, Ruda-Kucerova J, Skrede S. GLP-1 agonists: superior for mind and body in antipsychotic-treated patients? Trends Endocrinol Metab 2022; 33:628-638. [PMID: 35902330 DOI: 10.1016/j.tem.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
Antipsychotics (APDs) represent a core treatment for severe mental disorders (SMEs). Providing symptomatic relief, APDs do not exert therapeutic effects on another clinically significant domain of serious mental disorders, cognitive impairment. Moreover, adverse metabolic effects (diabetes, weight gain, dyslipidemia, and increased cardiovascular risk) are common during treatment with APDs. Among pharmacological candidates reversing APD-induced metabolic adverse effects, glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs), approved for both diabetes and recently for obesity treatment, stand out due to their favorable effects on peripheral metabolic parameters. Interestingly, GLP-1 RAs are also proposed to have pro-cognitive effects. Particularly in terms of dual therapeutic mechanisms potentially improving both central nervous system (CNS) deficits and metabolic burden, GLP-1 RAs open a new perspective and assume a clinically advantageous position.
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Affiliation(s)
- Katerina Horska
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic; Department of Clinical Pharmacy, Hospital Pharmacy, University Hospital Brno, Brno, Czech Republic
| | - Jana Ruda-Kucerova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Silje Skrede
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Section of Clinical Pharmacology, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.
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Solmi M, Correll CU. The antipsychotic paradox: Lessons regarding determinants of premature mortality. Eur Neuropsychopharmacol 2022; 62:1-3. [PMID: 35792424 DOI: 10.1016/j.euroneuro.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Sánchez-Ortí JV, Balanzá-Martínez V, Correa-Ghisays P, Selva-Vera G, Vila-Francés J, Magdalena-Benedito R, San-Martin C, Victor VM, Escribano-Lopez I, Hernández-Mijares A, Vivas-Lalinde J, Crespo-Facorro B, Tabarés-Seisdedos R. Specific metabolic syndrome components predict cognition and social functioning in people with type 2 diabetes mellitus and severe mental disorders. Acta Psychiatr Scand 2022; 146:215-226. [PMID: 35359023 DOI: 10.1111/acps.13433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Obesity and metabolic diseases such as metabolic syndrome (MetS) are more prevalent in people with type 2 diabetes mellitus (T2DM), major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ). MetS components might be associated with neurocognitive and functional impairments in these individuals. The predictive and discriminatory validity of MetS and its components regarding those outcomes were assessed from prospective and transdiagnostic perspectives. METHODS Metabolic syndrome components and neurocognitive and social functioning were assessed in 165 subjects, including 30 with SZ, 42 with BD, 35 with MDD, 30 with T2DM, and 28 healthy controls (HCs). A posteriori, individuals were classified into two groups. The MetS group consisted of those who met at least three of the following criteria: abdominal obesity (AO), elevated triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL), elevated blood pressure (BP), and elevated fasting glucose (FPG); the remaining participants comprised the No-MetS group. Mixed one-way analysis of covariance and linear and binary logistic regression analyses were performed. RESULTS Cognitive impairment was significantly greater in the MetS group (n = 82) than in the No-MetS group (n = 83), with small effect sizes (p < 0.05; η²p = 0.02 - 0.03). In both groups, the most robust associations between MetS components and neurocognitive and social functioning were observed with TG and FPG (p < 0.05). There was also evidence for a significant relationship between cognition and BP in the MetS group (p < 0.05). The combination of TG, FPG, elevated systolic BP and HDL best classified individuals with greater cognitive impairment (p < 0.001), and TG was the most accurate (p < 0.0001). CONCLUSIONS Specific MetS components are significantly associated with cognitive impairment across somatic and psychiatric disorders. Our findings provide further evidence on the summative effect of MetS components to predict cognition and social functioning and allow the identification of individuals with worse outcomes. Transdiagnostic, lifestyle-based therapeutic interventions targeted at that group hold the potential to improve health outcomes.
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Affiliation(s)
- Joan Vicent Sánchez-Ortí
- INCLIVA - Biomedical Research Institute, Valencia, Spain.,TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.,Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Vicent Balanzá-Martínez
- INCLIVA - Biomedical Research Institute, Valencia, Spain.,TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.,Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain.,Mental Health Unit of Catarroja, Valencia, Spain
| | - Patricia Correa-Ghisays
- INCLIVA - Biomedical Research Institute, Valencia, Spain.,TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.,Faculty of Psychology, University of Valencia, Valencia, Spain.,Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Gabriel Selva-Vera
- INCLIVA - Biomedical Research Institute, Valencia, Spain.,TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.,Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Joan Vila-Francés
- IDAL - Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | | | - Constanza San-Martin
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Víctor M Victor
- Service of Endocrinology and Nutrition, University Hospital Dr. Peset, Valencia, Spain.,Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Department of Physiology, University of Valencia, Valencia, Spain
| | - Irene Escribano-Lopez
- Service of Endocrinology and Nutrition, University Hospital Dr. Peset, Valencia, Spain
| | | | | | - Benedicto Crespo-Facorro
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.,Department of Psychiatry, Faculty of Medicine, University of Sevilla, HU Virgen del Rocío IBIS, Sevilla, Spain
| | - Rafael Tabarés-Seisdedos
- INCLIVA - Biomedical Research Institute, Valencia, Spain.,TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.,Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
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de Boer N, Cahn W. Antipsychotic-induced weight gain: Is the weight over? New guidelines needed. Acta Psychiatr Scand 2022; 146:185-189. [PMID: 35951775 DOI: 10.1111/acps.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nini de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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50
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Stogios N, Maksyutynska K, Navagnanavel J, Sanches M, Powell V, Gerretsen P, Graff-Guerrero A, Chintoh AF, Foussias G, Remington G, Hahn MK, Agarwal SM. Metformin for the prevention of clozapine-induced weight gain: A retrospective naturalistic cohort study. Acta Psychiatr Scand 2022; 146:190-200. [PMID: 35726126 DOI: 10.1111/acps.13462] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Clozapine is presently the sole antipsychotic with an indication for treatment-resistant Schizophrenia, but is associated with significant weight gain and other metabolic aberrations. This retrospective chart review aimed to evaluate the effectiveness of adjunctive metformin in preventing clozapine-induced weight gain. METHODS We conducted a retrospective chart review of patients newly initiated on clozapine at the Centre for Addiction and Mental Health in Canada, from November 2014 to April 2021. Our primary outcome was body weight at 6 and 12 months after clozapine initiation. Other metabolic parameters served as secondary outcomes. RESULTS Among 396 patients (males: 71.5%, mean age: 42.8 years) initiated on clozapine, 69 were on metformin or prescribed it ≤3 months after clozapine initiation. The clozapine+metformin group demonstrated less weight gain compared with the clozapine-only group at 6 months (clozapine+metformin: -0.15 kg [SE = 1.08] vs. clozapine-only: 2.99 kg, SE = 0.54) and 12 months after clozapine initiation (clozapine+metformin: -0.67 kg, SE = 1.22 vs. clozapine-only: 4.72 kg, SE = 0.67). Adaptive changes were also observed for fasting glucose (F = 3.10, p = 0.046) and triglycerides (F = 8.56, p < 0.001) in the clozapine+metformin group compared with clozapine only. CONCLUSION In this large retrospective naturalistic cohort study, co-prescription of clozapine and metformin was associated with less weight gain and related metabolic dysfunction at 6 and 12 months after initiation versus clozapine alone. These findings provide evidence for the effectiveness of metformin in preventing clozapine-induced weight gain; larger randomized controlled trials are needed to confirm these results.
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Affiliation(s)
- Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kateryna Maksyutynska
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
| | | | - Marcos Sanches
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Valerie Powell
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Philip Gerretsen
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ariel Graff-Guerrero
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Araba F Chintoh
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
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