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Kim E, Rim D, Shin JH, Wong D, Kim DW. The Use of Phentermine for Obesity in Psychiatric Patients With Antipsychotics. Psychiatry Investig 2023; 20:799-807. [PMID: 37794661 PMCID: PMC10555508 DOI: 10.30773/pi.2023.0045] [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: 02/10/2023] [Revised: 05/01/2023] [Accepted: 06/14/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Phentermine is a commonly used weight-loss agent in the United States, but there is a little information about the use of phentermine for patients with obesity taking antipsychotic medications. METHODS We gathered 57 patients with obesity taking antipsychotic medications whose phentermine treatment was simultaneous with or after any type of antipsychotic exposure and collected data of clinical information, initial/follow-up anthropometric variables, and adverse events (AEs) for the 6-month study period. RESULTS In total, the mean body weight reduction (BWR) was 4.45 (7.04) kg, and the mean BWR percent (BWR%) was 3.92% (6.96%) at 6 months. Based on the response to phentermine, the patients were classified into two groups: the responder (n=25; BWR% ≥5%) and nonresponder (n=32; BWR% <5%) groups. The responder group's mean BWR and BWR% were 10.13 (4.43) kg and 9.35% (4.09%), respectively, at 6 months. The responders had higher rates of anticonvulsant combination therapy (ACT; responder, 72.0% vs. non-responder, 43.8%; p=0.033) and a shorter total antipsychotic exposure duration (responder, 23.9 [16.9] months vs. non-responder, 37.2 [27.6] months; p= 0.039). After adjusting age, sex, and initial body weight, ACT maintained a significant association with phentermine response (odds ratio=3.840; 95% confidence interval: 1.082-13.630; p=0.037). In the final cohort, there was no report of adverse or new-onset psychotic symptoms, and the common AEs were sleep disturbances, dry mouth, and dizziness. CONCLUSION Overall, phentermine was effective and tolerable for patients with obesity taking antipsychotic medications, and ACT (predominantly topiramate) augmented the weight-loss effect of phentermine.
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Affiliation(s)
- Eunju Kim
- Section of Endocrinology, Diabetes and Weight Management, Boston University, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Mood Disorder Clinic and Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bunding Hospital, Seongnam, Republic of Korea
| | - Daniel Rim
- Section of Endocrinology, Diabetes and Weight Management, Boston University, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jeong-Hun Shin
- Section of Endocrinology, Diabetes and Weight Management, Boston University, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Denise Wong
- Section of Endocrinology, Diabetes and Weight Management, Boston University, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dong Wook Kim
- Section of Endocrinology, Diabetes and Weight Management, Boston University, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Kim DD, Lang DJ, Procyshyn RM, Woodward ML, Kaufman K, White RF, Honer WG, Warburton DER. Reduced cardiovascular fitness associated with exposure to clozapine in individuals with chronic schizophrenia. Psychiatry Res 2018; 262:28-33. [PMID: 29407565 DOI: 10.1016/j.psychres.2018.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/21/2017] [Accepted: 01/12/2018] [Indexed: 01/07/2023]
Abstract
Studies show that individuals with schizophrenia have impaired cardiovascular fitness (i.e., low peak aerobic power (VO2peak)). It is speculated that antipsychotics with adverse cardiovascular and metabolic profiles, in particular clozapine, have a significant impact on VO2peak. In this cross-sectional study, we examined whether exposure to clozapine was associated with further reduced VO2peak compared with non-clozapine antipsychotics. Thirty participants with chronic schizophrenia or schizoaffective disorder were divided into clozapine and non-clozapine groups. Mean daily doses of antipsychotics were standardized to chlorpromazine equivalents and haloperidol equivalents for antagonism of alpha1- and alpha2-adrenergic receptors. Participants completed an incremental-to-maximal symptom-limited exercise test on a cycle ergometer for the assessment of VO2peak. The clozapine group demonstrated significantly lower VO2peak than the non-clozapine group. Haloperidol equivalents for alpha-adrenergic receptor antagonism, but not chlorpromazine equivalents, demonstrated significant inverse associations with VO2peak. The clozapine group had a significantly higher amount of antagonistic activity at alpha-adrenergic receptors than the non-clozapine group. In conclusion, exposure to clozapine was associated with further reduced cardiovascular fitness, which may be explained by the drug's greater antagonistic activity at alpha-adrenergic receptors. Cardiovascular fitness needs to be promoted in individuals treated with antipsychotics, particularly clozapine, to prevent the risk of cardiovascular disease and mortality.
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Affiliation(s)
- David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Cardiovascular Physiology and Rehabilitation Laboratory, Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
| | - Donna J Lang
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L Woodward
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kai Kaufman
- Cardiovascular Physiology and Rehabilitation Laboratory, Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
| | - Randall F White
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Darren E R Warburton
- Cardiovascular Physiology and Rehabilitation Laboratory, Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada; Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Cuerda C, Velasco C, Merchán-Naranjo J, García-Peris P, Arango C. The effects of second-generation antipsychotics on food intake, resting energy expenditure and physical activity. Eur J Clin Nutr 2013; 68:146-52. [DOI: 10.1038/ejcn.2013.253] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 02/07/2023]
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Abdelrahman Y, Fararjeh M, Abdel-Razeq W, Mohammad MK, Bustanji Y. Assessment of possible immunotoxicity of the antipsychotic drug clozapine. ACTA ACUST UNITED AC 2013; 66:378-86. [PMID: 24325666 DOI: 10.1111/jphp.12150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/25/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The immunomodulatory effects of clozapine (CLZ), antipsychotic drug, were investigated in vivo using female Balb/c mice. The main aim of this study was to evaluate the immunomodulatory effects of CLZ, antipsychotic drug, following daily intraperitoneal injection to female Balb/c mice over a period of 21 days. METHODS Mice were divided into five groups, eight animals per group. Group I, served as a control group, received only the vehicle. Groups II-V received a daily intraperitoneal dose of CLZ (1, 5, 10 and 20 mg/kg, respectively) over a period of 21 days. KEY FINDINGS CLZ has shown a significant decrease in the animal body weight, and it showed a significant decrease in the percentage of circulating neutrophils and lymphocytes while circulating monocytes were increased. The immunotoxicity has been also assessed by evaluating spleen cellularity, humoral immune response to a foreign antigen using sheep red blood cells and delayed-type hypersensitivity reaction. The results showed a marked suppression in these responses in CLZ-treated mice compared with the control group. Detectable changes have also been noticed in the histology of the footpad tissue and spleen. CONCLUSIONS Results showed significant immunomodulatory effects of CLZ when used in Balb/c mice.
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Affiliation(s)
- Yaseen Abdelrahman
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, The Hashemite University, Zarqa, Jordan
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Davison KM, Kaplan BJ. Food intake and blood cholesterol levels of community-based adults with mood disorders. BMC Psychiatry 2012; 12:10. [PMID: 22333556 PMCID: PMC3315405 DOI: 10.1186/1471-244x-12-10] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 02/14/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A growing body of literature links nutrition to mood, especially in epidemiological surveys, but there is little information characterizing food intake in people with diagnosed mood disorders. METHODS Food intake obtained from 3-day food records was evaluated in 97 adults with mood disorders, whose diagnoses were confirmed in structured interviews. Information from a population nutrition survey, national guidelines for nutritional intakes (Eating Well with Canada's Food Guide) and North American dietary guidelines (Dietary Reference Intakes) was utilized to evaluate the quality of their food intake. RESULTS Compared to the regional nutrition survey data and national guidelines, a greater proportion of study participants consumed fewer of the recommended servings of grains (p < 0.001) and vegetables and fruits (p < 0.05), and less than the lower boundary of the Adequate Macronutrient Distribution Range (AMDR) for α-linolenic acid (p < 0.001). The study sample also had greater intakes of high-fat whole grain products (p < 0.01), processed meats (p < 0.00001), and higher sugar, fat or salty foods (p < 0.00001). Of the 1746 total meals and snacks consumed, 39% were from sources outside the home, suggesting a lack of time devoted to meal preparation. Finally, a subsample of 48 participants agreed to have blood tests: 44% had mild hypercholesterolemia (> 5.2 and ≤ 6.2 mmol/L) and 21% had hypercholesterolemia (> 6.2 mmol/L). CONCLUSIONS Much research has proposed multiple ways in which healthier diets may exert protective effects on mental health. The results of this study suggest that adults with mood disorders could benefit from nutritional interventions to improve diet quality.
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Affiliation(s)
- Karen M Davison
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- IMPART Program, British Columbia Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada
| | - Bonnie J Kaplan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, University of Calgary, and the Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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Cuerda C, Merchan-Naranjo J, Velasco C, Gutierrez A, Leiva M, de Castro MJ, Parellada M, Giráldez M, Bretón I, Camblor M, García-Peris P, Dulín E, Sanz I, Desco M, Arango C. Influence of resting energy expenditure on weight gain in adolescents taking second-generation antipsychotics. Clin Nutr 2011; 30:616-23. [PMID: 21492975 DOI: 10.1016/j.clnu.2011.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/11/2011] [Accepted: 03/16/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Weight gain is an undesirable side effect of second-generation antipsychotics (SGAs). We performed this study to examine the influence of SGAs on resting energy expenditure (REE) and the relationship of REE to weight gain in adolescent patients. METHODS Antipsychotic-naïve or quasi-naïve (<72 h of exposure to antipsychotics) adolescent patients taking olanzapine, quetiapine, or risperidone in monotherapy were followed up for one year. We performed a prospective study (baseline, 1, 3, 6, and 12 months after treatment) based on anthropometric measurements, bioelectrical impedance analysis, and indirect calorimetry (Deltatrac™ II MBM-200) to measure REE. We also analyzed metabolic and hormonal data and adiponectin concentrations. RESULTS Forty-six out of the 54 patients that started treatment attended at least 2 visits, and 16 completed 1 year of follow-up. Patients gained 10.8 ± 6.2 kg (60% in the form of fat mass) and increased their waist circumference by 11.1 ± 5.0 cm after 1 year of treatment. The REE/kg body mass ratio decreased (p = 0.027), and the REE/percentage fat-free mass (FFM) ratio increased (p = 0.007) following the fall in the percentage of FFM during treatment. Weight increase was significantly correlated with the REE/percentage FFM ratio at all the visits (1-3-6-12 months) (r = 0.69, p = 0.004 at 12 months). CONCLUSIONS SGAs seem to induce a hypometabolic state (reflected as decreased REE/kg body mass and increased REE/percentage FFM). This could explain, at least in part, the changes in weight and body composition observed in these patients.
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Affiliation(s)
- Cristina Cuerda
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Weston-Green K, Huang XF, Deng C. Olanzapine treatment and metabolic dysfunction: a dose response study in female Sprague Dawley rats. Behav Brain Res 2010; 217:337-46. [PMID: 21056063 DOI: 10.1016/j.bbr.2010.10.039] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 10/20/2010] [Accepted: 10/29/2010] [Indexed: 01/22/2023]
Abstract
Second generation antipsychotics are commonly prescribed for the treatment of schizophrenia, however some can induce metabolic dysfunction side-effects such as weight gain, obesity and diabetes. Clinical reports suggest olanzapine alters satiety signals, although findings appear conflicting. Previous animal model studies have utilised a range of olanzapine dosages, however the dosage that better mimics the human scenario of olanzapine-induced weight gain is unclear. Female Sprague-Dawley rats were treated orally, three times daily with olanzapine (0.25mg/kg, 0.5mg/kg, 1.0mg/kg, 2.0mg/kg), self-administered in a sweet cookie dough pellet at eight-hourly intervals) or vehicle (n=12/group) for 14-days. Olanzapine orally self-administered in multiple doses (eight-hourly intervals) may circumvent a drop in plasma drug concentration and ensure the maintenance of a consistently high olanzapine level in the rat. Olanzapine increased body weight (0.5mg/kg, 1.0mg/kg, 2.0mg/kg), food intake (2.0mg/kg) and feeding efficiency (0.5-2.0mg/kg), with no effect on water intake. Subcutaneous inguinal (1.0mg/kg, 2.0mg/kg) and intra-abdominal perirenal fat were increased (2.0mg/kg), but not interscapula brown adipose tissue. Olanzapine increased circulating ghrelin and cholecystokinin, but had no effect on peptide YY((3-36)). Olanzapine decreased insulin (0.25-2.0mg/kg) and locomotor activity in the open field arena (0.5-2.0mg/kg). A low dosage of 0.25mg/kg olanzapine had no effect on most parameters measured. Olanzapine-induced weight gain is associated with hyperphagia, enhanced feeding efficiency and adiposity, decreased locomotor activity and altered satiety signaling. The animal model used in the present study of self-administered oral olanzapine treatment (t.i.d.) at a dosage range of 0.5-2.0mg/kg (but not 0.25mg/kg) mimics aspects of the clinic.
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Affiliation(s)
- Katrina Weston-Green
- School of Health Sciences, University of Wollongong, Wollongong, 2522, NSW, Australia
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Nilsson BM, Olsson RM, Oman A, Wiesel FA, Ekselius L, Forslund AH. Physical capacity, respiratory quotient and energy expenditure during exercise in male patients with schizophrenia compared with healthy controls. Eur Psychiatry 2010; 27:206-12. [PMID: 20970966 DOI: 10.1016/j.eurpsy.2010.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 06/08/2010] [Accepted: 06/23/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite massive research on weight gain and metabolic complications in schizophrenia there are few studies on energy expenditure and no current data on physical capacity. AIM To determine oxygen uptake capacity, respiratory quotient (RQ) and energy expenditure during a submaximal exercise test in patients with schizophrenia and healthy controls. METHOD Ten male patients and 10 controls were included. RQ and energy expenditure were investigated with indirect calorimetry during a cycle ergometer test. The submaximal work level was defined by heart rate and perceived exhaustion. Physical capacity was determined from predicted maximal oxygen uptake capacity (VO(2-max)). RESULTS The patients exhibited significantly higher RQ on submaximal workloads and lower physical capacity. A significant lower calculated VO(2-max) remained after correction for body weight and fat free mass (FFM). Energy expenditure did not differ on fixed workloads. CONCLUSION RQ was rapidly increasing in the patients during exercise indicating a faster transition to carbohydrate oxidation and anaerobic metabolism that also implies a performance closer to maximal oxygen uptake even at submaximal loads. This may restrict the capacity for everyday activity and exercise and thus contribute to the risk for weight gain. Physical capacity was consequently significantly lower in the patients.
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Affiliation(s)
- B M Nilsson
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, 75185 Uppsala, Sweden.
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SHARPE JK, STEDMAN T, BYRNE NM, HILLS AP. Prediction of resting energy requirements in people taking weight-inducing antipsychotic medications. Nutr Diet 2010. [DOI: 10.1111/j.1747-0080.2010.01450.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hyperphagia and increased meal size are responsible for weight gain in rats treated sub-chronically with olanzapine. Psychopharmacology (Berl) 2009; 203:693-702. [PMID: 19052729 DOI: 10.1007/s00213-008-1415-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
Abstract
RATIONALE Atypical antipsychotic-induced weight gain is a significant impediment in the treatment of schizophrenia. OBJECTIVES In a putative model of antipsychotic drug-induced weight gain, we investigated the effects of sub-chronic olanzapine on body weight, meal patterns, the expression of genes encoding for hypothalamic feeding-related neuropeptides and the contribution of hyperphagia to olanzapine-induced weight gain in rats. MATERIALS AND METHODS In experiment 1, female rats received either olanzapine (1 mg/kg, p.o.) or vehicle, twice daily for 7 days, while meal patterns were recorded. At the end of the treatment regimen, we measured the levels of hypothalamic messenger RNAs (mRNAs) encoding neuropeptide-Y (NPY), hypocretin/orexin (HCRT), melanin concentrating hormone and pro-opiomelanocortin. NPY and HCRT mRNA levels were also assessed in a separate cohort of female rats treated acutely with olanzapine (1 mg/kg, p.o.). In experiment 2, we investigated the effect of a pair-feeding paradigm on sub-chronic (1 mg/kg, p.o.) olanzapine-induced weight gain. RESULTS In experiment 1, sub-chronic olanzapine increased body weight, food intake and meal size. Hypothalamic neuropeptide mRNA levels were unchanged after both acute and sub-chronic olanzapine treatment. In experiment 2, the restriction of food intake to the level of vehicle-treated controls abolished the sub-chronic olanzapine-induced increase in body weight. CONCLUSIONS Hyperphagia mediated by drug-induced impairments in satiety (as evidenced by increased meal size) is a key requirement for olanzapine-induced weight gain in this paradigm. However, olanzapine-induced hyperphagia and weight gain may not be mediated via alterations in the expression of the feeding-related hypothalamic neuropeptides examined in this study.
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Cooper GD, Harrold JA, Halford JCG, Goudie AJ. Chronic clozapine treatment in female rats does not induce weight gain or metabolic abnormalities but enhances adiposity: implications for animal models of antipsychotic-induced weight gain. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:428-36. [PMID: 17933447 DOI: 10.1016/j.pnpbp.2007.09.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/09/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
Abstract
The ability of clozapine to induce weight gain in female rats was investigated in three studies with progressively lowered doses of clozapine. In an initial preliminary high dose study, clozapine at 6 and 12 mg/kg (i.p., b.i.d.) was found to induce weight loss. In a subsequent intermediate dose study, we obtained no evidence for clozapine-induced weight gain despite using identical procedures and doses of clozapine (1-4 mg/kg, i.p., b.i.d.) with which we have observed olanzapine-induced weight gain, hyperphagia, enhanced adiposity and metabolic changes [Cooper G, Pickavance L, Wilding J, Halford J, Goudie A (2005). A parametric analysis of olanzapine-induced weight gain in female rats. Psychopharmacology; 181: 80-89.]. Instead, clozapine induced weight loss without alteration in food intake and muscle mass or changes in levels of glucose, insulin, leptin and prolactin. However, these intermediate doses of clozapine enhanced visceral adiposity and elevated levels of adiponectin. In a final study, low doses of clozapine (0.25-0.5 mg/kg, i.p, b.i.d.) induced weight loss. These data demonstrate that clozapine-induced weight gain can be much more difficult to observe in female rats than olanzapine-induced weight gain. Moreover, these findings contrast with clinical findings with clozapine, which induces substantial weight gain in humans. Clozapine-induced enhanced adiposity appears to be easier to observe in rats than weight gain. These findings, along with other preclinical studies, suggest that enhanced adiposity can be observed in the absence of antipsychotic-induced weight gain and hyperphagia, possibly reflecting a direct drug effect on adipocyte function independent of drug-induced hyperphagia [e.g. Minet-Ringuet J, Even P, Valet P, Carpene C, Visentin V, Prevot D, Daviaud D, Quignard-Boulange A, Tome D, de Beaurepaire R (2007). Alterations of lipid metabolism and gene expression in rat adipocytes during chronic olanzapine treatment. Molecular Psychiatry; 12: 562-571.]. These and other findings which show that the results of studies of antipsychotic treatment in animals do not always mimic clinical findings have important implications for the use of animal models of antipsychotic-induced weight gain. With regard to weight gain the results obtained appear to depend critically on the experimental procedures used and the specific drugs studied. Thus such models are not without limitations. However, they do consistently demonstrate the ability of various antipsychotics to enhance adiposity.
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Affiliation(s)
- G D Cooper
- School of Psychology, University of Liverpool, Liverpool, UK
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12
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Khazaal Y, Rothen S, Morinière Trombert N, Frésard E, Zullino DF. Dietary underreporting in women with schizophrenia requiring dietary intervention: a case control study. Eat Weight Disord 2007; 12:e83-5. [PMID: 18227631 DOI: 10.1007/bf03327600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate diet underreporting of women treated for schizophrenia undergoing dietary treatment and to compare it with nonpsychiatric women. METHODS The study included 23 women (13 with schizophrenia) who had actively sought treatment for weight loss. All subjects were smokers with low activity level. A 24-hour diet recall using standardized food models was used to collect energy intake (EI) reporting . In order to identify participants who reported low EI, we used the Goldberg cut-off methodology. RESULTS The percentage of underreporters was higher in patients with schizophrenia [77%, 95% confidence interval (46-95%)] than in controls [50%, 95% confidence interval (19-81%)]. CONCLUSIONS Diet underreporting is a frequent phenomenon in women with schizophrenia requiring dietary intervention.
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Affiliation(s)
- Y Khazaal
- Division of Substance Abuse, Geneva University Hospitals, CH-1205 Geneva, Switzerland.
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Soreca I, Mauri M, Castrogiovanni S, Simoncini M, Cassano GB. Measured and expected resting energy expenditure in patients with bipolar disorder on maintenance treatment. Bipolar Disord 2007; 9:784-8. [PMID: 17988371 DOI: 10.1111/j.1399-5618.2007.00426.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patients with bipolar disorder (BD) on long-term maintenance treatment represent a clinical population with peculiar characteristics, for which available equations to estimate resting energy expenditure (REE) are not suitable. The aim of this study was to measure REE by means of indirect calorimetry in bipolar patients on maintenance treatment and in controls, and to estimate the agreement between measured and predicted REE in both groups. METHODS Patients diagnosed with BD I and healthy controls were assessed for height, weight and body mass index (BMI). Predicted REE was calculated using Harris-Benedict, Schofield, Recommended Nutrients Assumption Levels (LARN), and OUR equations; measurements of REE were performed using a portable indirect calorimeter. RESULTS Results for our sample show the most commonly used formulas give a systematic overestimation of REE with respect to measured basal metabolic rate in the patient group. The mean bias was considerably greater for bipolar subjects than for controls. CONCLUSIONS These results suggest that patients with severe mental illness on long-term psychopharmacologic treatment may have reduced basal energy expenditure that may be a cause of weight gain.
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Affiliation(s)
- Isabella Soreca
- Department of Neuroscience, Psychiatry Unit, University of Siena, Siena, Italy
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Fan X, Anderson EJ, Copeland PM, Borba CP, Nguyen DD, Freudenreich O, Goff DC, Henderson DC. Higher fasting serum insulin is associated with increased resting energy expenditure in nondiabetic schizophrenia patients. Biol Psychiatry 2006; 60:1372-7. [PMID: 16920075 DOI: 10.1016/j.biopsych.2006.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 04/10/2006] [Accepted: 05/10/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insulin has emerged as an important determinant of food intake, energy expenditure, and weight control. This study examined the relationship between fasting serum insulin level and resting energy expenditure (REE) in a cross-sectional sample of nondiabetic schizophrenia patients. METHODS Subjects were recruited from an urban community mental health clinic. Each subject underwent a series of anthropometric measures and an indirect calorimetry measure. A fasting blood sample was taken for plasma glucose, serum insulin, and lipid profile. RESULTS Seventy-one subjects (54 male, 17 female) were included in the study. There was a significant positive relationship between REE and fasting serum insulin level (r = .39, p = .001). Stepwise multiple regression analysis was performed with various characteristics such as age, race, antipsychotic agent used, fat-free mass, BMI, waist circumference, waist-hip ratio, physical activity level, and fasting serum insulin as candidate predictors for REE. Only fat-free mass and insulin were able to enter into the regression model, which indicates that higher fat-free mass and higher fasting serum insulin level predict increased REE. CONCLUSIONS A higher fasting serum insulin level is associated with an increased REE, which may prevent further weight gain in nondiabetic patients with schizophrenia.
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Affiliation(s)
- Xiaoduo Fan
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts 02114, USA.
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Müller DJ, Kennedy JL. Genetics of antipsychotic treatment emergent weight gain in schizophrenia. Pharmacogenomics 2006; 7:863-87. [PMID: 16981847 DOI: 10.2217/14622416.7.6.863] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Classic and modern antipsychotics can induce substantial weight gain causing diabetes, lipid abnormalities and psychological distress. Treatment emergent weight gain varies within the broad class of antipsychotics; however, an individual's propensity to develop weight gain largely depends on genetic factors. The first part of this review highlights current ideas and concepts related to antipsychotic-induced weight gain, including principles on energy homeostasis. The second part summarizes genetic findings emphasizing studies published after 2003 as prior studies have been reviewed in detail elsewhere. Candidate gene studies have produced significant findings in the 5-hydroxytryptamin 2C (5HT2C) and adrenergic alpha2a (ADRalpha2a) receptor genes, as well as in the leptin, guanine nucleotide binding protein (GNB3) and synaptomal-associated protein 25kDa (SNAP25) genes. Results from genome-wide association and linkage studies point to several chromosomal regions (e.g., 12q24) and some specific genes (e.g., promelanin concentrating hormone [PMCH], polycyctic kidney and hepatic disease 1 [PKHD1], peptidylglycine alpha-amidating monooxygenase [PAM]). However, more efforts are needed before risk prediction and personalized medicine can be made available for antipsychotic-induced weight gain.
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Affiliation(s)
- Daniel J Müller
- Charité University Medicine Berlin, Department of Psychiatry, Campus Charité Mitte, St. Hedwig KlinikTurmstrasse 21, 10559 Berlin, Germany.
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Theisen FM, Haberhausen M, Firnges MA, Gregory P, Reinders JH, Remschmidt H, Hebebrand J, Antel J. No evidence for binding of clozapine, olanzapine and/or haloperidol to selected receptors involved in body weight regulation. THE PHARMACOGENOMICS JOURNAL 2006; 7:275-81. [PMID: 16983399 DOI: 10.1038/sj.tpj.6500418] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The underlying mechanisms of antipsychotic (AP)-induced weight gain are unknown, but both central and peripheral AP target receptors could potentially be involved. This study used radioligand binding assays to compare the binding affinities of clozapine, olanzapine and haloperidol for candidate receptors potentially involved in AP-induced weight gain. Selected candidates derived from known pathways involved in body weight regulation included receptors classified as anorexigenic (bombesin receptor subtype 3, calcitonin gene-related peptide receptor, cholecystokinin receptor, melanocortin-4 receptor, neurotensin receptor 1) or orexigenic (cannabinoid receptor 1, galanin 1 receptor, melanin-concentrating hormone receptor (MCHR), neuropeptide Y1 receptor) as well as receptors involved in physiological actions related to digestion and fluid homeostasis (angiotensin II type 1 receptor, bradykinin B2 receptor, endothelin receptor, neurokinin 1 receptor, vasoactive intestinal polypeptide receptor 1). Clozapine, olanzapine and haloperidol exhibited negligible affinities to all of these receptors except for the MCHR (Ki=501 nM; haloperidol). With respect to other candidates from (neuro)transmitter systems already suggested to be involved in AP-induced weight gain, the binding profile of olanzapine resembled that of clozapine, with high affinity (Ki<10 nM) for serotonin (5-HT) 5-HT2A, 5-HT2C and 5-HT6, muscarinic M1 and histamine H1 receptors. In contrast, the binding profile of haloperidol was substantially different (high affinity only for the dopamine D1 receptor). In conclusion, we have not identified a novel binding site of the two investigated atypical AP that could contribute to the induced weight gain.
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Affiliation(s)
- F M Theisen
- Clinical Research Group, Department of Child and Adolescent Psychiatry, University of Marburg, Marburg, Germany.
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Fitzsimons J, Berk M, Lambert T, Bourin M, Dodd S. A review of clozapine safety. Expert Opin Drug Saf 2006; 4:731-44. [PMID: 16011451 DOI: 10.1517/14740338.4.4.731] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Clozapine is a distinctive antipsychotic agent, having a unique clinical profile and an idiosyncratic safety profile. More so than with other agents, the weighting of its adverse event profile is critical, in order to counterbalance its clear clinical advantages. The safety issues with clozapine are in a number of areas, some of which are considered medical emergencies and potentially life-threatening. These include haematological (neutropenia and agranulocytosis), CNS (seizures), cardiovascular (myocarditis and cardiomyopathy), metabolic (diabetes), gastrointestinal and neuromuscular. Understanding the safety profile of clozapine allows an informed use of the agent that can maximise its clear clinical benefit and minimise the known risks.
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Affiliation(s)
- Joanna Fitzsimons
- Department of Clinical and Biomedical Sciences, Barwon Health, Swanston Centre, University of Melbourne, PO Box 281, Geelong, Victoria 3220, Australia
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Abstract
Novel 'atypical' antipsychotic drugs represent a substantial improvement on older 'typical' drugs. However, clinical experience has shown that some, but not all, of these drugs can induce substantial weight gain. This interferes with compliance with drug taking and has expected effects on morbidity and mortality. In this review, we summarize current thinking on: (i) the extent to which different 'atypical' drugs induce weight gain; (ii) the possible roles of various neurotransmitters and neuropeptides in this adverse drug reaction; and (iii) the state of development of animal models in this area. We also outline major areas for future research.
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Affiliation(s)
- A J Goudie
- School of Psychology, Liverpool University, Liverpool, UK.
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