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Costa GPA, Moraes VRY, Assunção BR, Burns N, Laique S, Sengupta S, Anand A, Nunes JC. Efficacy of topiramate in reducing second-generation antipsychotic-associated weight gain among children: A systematic review and meta-analysis. Diabetes Obes Metab 2024; 26:2292-2304. [PMID: 38477159 DOI: 10.1111/dom.15543] [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: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
AIMS To conduct a systematic review and meta-analysis with the aim of synthesizing existing data on the efficacy and safety of topiramate as an adjunctive treatment for reducing second-generation antipsychotic (SGA)-associated weight gain in children aged 4-18 years. METHODS We conducted a comprehensive search of PubMed, Embase, PsychNet and Web of Science from time of their inception up to 12 February 2024, including randomized controlled trials that compared SGA treatment with and without topiramate co-administration in children. The primary outcomes were changes in body weight and body mass index (BMI). Heterogeneity was assessed using I2 statistics. RESULTS This systematic review included five randomized trials, totalling 139 participants (43.9% female; mean [SD] age 11.9 [3.5] years). Four of these trials were included in the meta-analysis, comprising 116 subjects. We found that topiramate was significantly effective both in reducing SGA-associated weight gain, with a mean difference of -2.80 kg (95% confidence interval [CI] -5.28 to -0.31; p = 0.037, I2 = 86.7%) and a standardized mean difference (SMD) of -1.33 (95% CI -2.14 to -0.51; p = 0.014, I2 = 31.7%), and in reducing BMI change compared to placebo (SMD -1.90, 95% CI -3.09 to -0.70; p = 0.02, I2 = 0%). Sedation risk was lower with topiramate than with placebo (odds ratio 0.19, 95% CI 0.11-0.32; p < 0.01, I2 = 0%). No significant differences were found in dropouts, any other side effects, and metabolic parameters, such as triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein, and glucose. None of the included studies reported assessments on cognitive side effects. CONCLUSION This meta-analysis suggests that topiramate is an effective and safe option for mitigating SGA-associated weight gain in children.
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Affiliation(s)
- Gabriel P A Costa
- Faculty of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Vitor R Y Moraes
- Faculty of Medicine, Evangelical University of Goias, Anápolis, Brazil
| | - Beatriz R Assunção
- Department of Endocrinology, University of São Paulo, Ribeirão Preto, Brazil
| | - Nora Burns
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sobia Laique
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shreya Sengupta
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Akhil Anand
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Psychiatry, University Hospitals Medical Center, Cleveland, Ohio, USA
| | - Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Kaur Sodhi R, Kumar H, Singh R, Bansal Y, Singh Y, Kiran Kondepudi K, Bishnoi M, Kuhad A. Allyl isothiocyanate, a TRPA1 agonist, protects against olanzapine-induced hypothalamic and hepatic metabolic aberrations in female mice. Biochem Pharmacol 2024; 222:116074. [PMID: 38395265 DOI: 10.1016/j.bcp.2024.116074] [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: 10/16/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
Olanzapine, a widely prescribed atypical antipsychotic, poses a great risk to the patient's health by fabricating a plethora of severe metabolic and cardiovascular adverse effects eventually reducing life expectancy and patient compliance. Its heterogenous receptor binding profile has made it difficult to point out a specific cause or treatment for the related side effects. Growing body of evidence suggest that transient receptor potential (TRP) channel subfamily Ankyrin 1 (TRPA1) has pivotal role in pathogenesis of type 2 diabetes and obesity. With this background, we aimed to investigate the role of pharmacological manipulations of TRPA1 channels in antipsychotic (olanzapine)-induced metabolic alterations in female mice using allyl isothiocyanate (AITC) and HC-030031 (TRPA1 agonist and antagonist, respectively). It was found that after 6 weeks of treatment, AITC prevented olanzapine-induced alterations in body weight and adiposity; serum, and liver inflammatory markers; glucose and lipid metabolism; and hypothalamic appetite regulation, nutrient sensing, inflammatory and TRPA1 channel signaling regulating genes. Furthermore, several of these effects were absent in the presence of HC-030031 (TRPA1 antagonist) indicating protective role of TRPA1 agonism in attenuating olanzapine-induced metabolic alterations. Supplementary in-depth studies are required to study TRPA1 channel effect on other aspects of olanzapine-induced metabolic alterations.
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Affiliation(s)
- Rupinder Kaur Sodhi
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, Panjab University, Sector 14, Chandigarh, India
| | - Hemant Kumar
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, Panjab University, Sector 14, Chandigarh, India
| | - Raghunath Singh
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Yashika Bansal
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Yuvraj Singh
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, Panjab University, Sector 14, Chandigarh, India
| | - Kanthi Kiran Kondepudi
- TR(i)P for Health Laboratory, Centre of Excellence in Functional Foods, National Agri-Food Biotechnology Institute (NABI), Knowledge City-Sector 81, Sahibzada Ajit Singh Nagar (SAS Nagar), Punjab, India
| | - Mahendra Bishnoi
- TR(i)P for Health Laboratory, Centre of Excellence in Functional Foods, National Agri-Food Biotechnology Institute (NABI), Knowledge City-Sector 81, Sahibzada Ajit Singh Nagar (SAS Nagar), Punjab, India.
| | - Anurag Kuhad
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, Panjab University, Sector 14, Chandigarh, India.
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Nian SY, Hirani V, Ardill-Young O, Ward PB, Curtis J, Teasdale SB. The resting metabolic rate of people with severe mental illness: a systematic review and meta-analysis. Br J Nutr 2023; 130:2025-2038. [PMID: 37157830 DOI: 10.1017/s0007114523001162] [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] [Indexed: 05/10/2023]
Abstract
People with severe mental illness (SMI), including schizophrenia and related psychoses and bipolar disorder, are at greater risk for obesity compared with people without mental illness. An altered resting metabolic rate (RMR) may be a key driving factor; however, published studies have not been systematically reviewed. This systematic review and meta-analysis aimed to determine whether the RMR of people with SMI assessed by indirect calorimetry differs from (i) controls, (ii) predictive equations and (iii) after administration of antipsychotic medications. Five databases were searched from database inception to March 2022. Thirteen studies providing nineteen relevant datasets were included. Study quality was mixed (62 % considered low quality). In the primary analysis, RMR in people with SMI did not differ from matched controls (n 2, standardised mean difference (SMD) = 0·58, 95 % CI -1·01, 2·16, P = 0·48, I2 = 92 %). Most predictive equations overestimated RMR. The Mifflin-St. Jeor equation appeared to be most accurate (n 5, SMD = -0·29, 95 % CI -0·73, 0·14, P = 0·19, I2 = 85 %). There were no significant changes in RMR after antipsychotic administration (n 4, SMD = 0·17, 95 % CI -0·21, 0·55, P = 0·38, I2 = 0 %). There is little evidence to suggest there is a difference in RMR between people with SMI and people without when matched for age, sex, BMI and body mass, or that commencement of antipsychotic medication alters RMR.
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Affiliation(s)
- Serena Y Nian
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown2006, NSW, Australia
| | - Vasant Hirani
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown2006, NSW, Australia
| | - Oliver Ardill-Young
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany St, Kensington2031, NSW, Australia
- Mindgardens Neuroscience Network, Margarete Ainsworth Building, Barker St, Randwick2031, NSW, Australia
| | - Philip B Ward
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany St, Kensington2031, NSW, Australia
- Schizophrenia Research Unit, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Liverpool Hospital, Liverpool2170, NSW, Australia
| | - Jackie Curtis
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany St, Kensington2031, NSW, Australia
- Mindgardens Neuroscience Network, Margarete Ainsworth Building, Barker St, Randwick2031, NSW, Australia
| | - Scott B Teasdale
- Discipline of Psychiatry and Mental Health, University of New South Wales, Botany St, Kensington2031, NSW, Australia
- Mindgardens Neuroscience Network, Margarete Ainsworth Building, Barker St, Randwick2031, NSW, Australia
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Mueller-Stierlin AS, Cornet S, Peisser A, Jaeckle S, Lehle J, Moerkl S, Teasdale SB. Implications of Dietary Intake and Eating Behaviors for People with Serious Mental Illness: A Qualitative Study. Nutrients 2022; 14:nu14132616. [PMID: 35807799 PMCID: PMC9268504 DOI: 10.3390/nu14132616] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
The impact of poor diet quality and nutritional inadequacies on mental health and mental illness has recently gained considerable attention in science. As the opinions and experiences of people living with serious mental illness on dietary issues are unknown, we aimed to understand the role of nutrition in a biopsychosocial approach. In total, 28 semi-structured interviews were conducted with people living with serious mental illness (SMI) in Australia, Germany and Austria, and a generic thematic analysis approach was applied. Four positive (positive effects on the body and mind, therapeutic effects in treating somatic illnesses, pleasure and opportunity for self-efficacy) and three negative (impairment related to mental illness and its treatment, perceived stigma and negative effects on the body and mind) implications of diet were identified. A key issue for most of the participants was the mental burden arising from their body weight. This might indicate that negative implications, such as guilt and stigma, were of primary importance for people with SMI when talking about their dietary behavior. In conclusion, diet-related support is urgently needed for people with SMI. However, especially participants from Germany and Austria reported that this is not yet widely available in mental health settings, leading to hopelessness and resignation.
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Affiliation(s)
- Annabel S. Mueller-Stierlin
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany; (A.S.M.-S.); (S.C.); (S.J.); (J.L.)
| | - Sebastian Cornet
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany; (A.S.M.-S.); (S.C.); (S.J.); (J.L.)
| | - Anna Peisser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Selina Jaeckle
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany; (A.S.M.-S.); (S.C.); (S.J.); (J.L.)
| | - Jutta Lehle
- Department of Psychiatry and Psychotherapy II, Ulm University, 89070 Ulm, Germany; (A.S.M.-S.); (S.C.); (S.J.); (J.L.)
| | - Sabrina Moerkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria;
- Correspondence:
| | - Scott B. Teasdale
- Discipline of Psychiatry and Mental Health, University of New South Wales (UNSW) Sydney, Sydney, NSW 2052, Australia;
- Mindgardens Neuroscience Network, Sydney, NSW 2052, Australia
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Qiu Y, Li M, Zhang Y, Liu Y, Zhao Y, Zhang J, Jia Q, Li J. Berberine treatment for weight gain in patients with schizophrenia by regulating leptin rather than adiponectin. Asian J Psychiatr 2022; 67:102896. [PMID: 34773803 DOI: 10.1016/j.ajp.2021.102896] [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: 05/27/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Berberine could improve antipsychotic-induced weight gain in obese cell lines and animal models. This study aimed to exam the effect of berberine on weight gain in patients with schizophrenia. METHODS Each subject who met DSM-IV-TR criteria for schizophrenia had been on stable dose of a single antipsychotic for at least one month. In an 8-week randomized, double-blind, placebo-controlled study, subjects received either berberine (900 mg per day) or placebo. Anthropometric parameters, leptin and adiponectin were measured at baseline, week 4, and week 8. RESULTS A total of 65 patients were enrolled, 49 of which completed the treatment. At the 8th week, the mean weight of patients in the berberine group (N = 27) lost 1.10 kg, while in the placebo group (N = 22) gained 1.45 kg. There were significant differences in body weight (Ftime*group=10.493, P = 0.001), BMI (Ftime*group=9.344, P = 0.002) and leptin (Ftime*group=6.265, P = 0.003). Further, the change of leptin had significant positive correlations with the changes of body weight(r = 0.395, P = 0.041) and BMI(r = 0.389, P = 0.045). There was no significant difference in adverse events between the two groups (P > 0.05). CONCLUSION This study suggests that berberine is a potential weight loss and weight maintenance drug for patients with schizophrenia. The effect of berberine on weight gain may be related to the regulation of leptin, but not adiponectin.
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Affiliation(s)
- Yuying Qiu
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Meijuan Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Yonghui Zhang
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Ying Liu
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Yongping Zhao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Jing Zhang
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qiong Jia
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China.
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Galal A, El-Bakly WM, El-Kilany SS, Ali AA, El-Demerdash E. Fenofibrate ameliorates olanzapine's side effects without altering its central effect: emphasis on FGF-21-adiponectin axis. Behav Pharmacol 2021; 32:615-629. [PMID: 34637209 DOI: 10.1097/fbp.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present work was designed to investigate whether fenofibrate could ameliorate olanzapine deleterious effect on insulin resistance via its effect on fibroblast growth factor-21 (FGF-21)-adiponectin axis without affecting olanzapine antipsychotic effect in postweaning socially isolated reared female rats. Treatment with olanzapine (6 mg/kg, intraperitoneally) or fenofibrate (100 mg/kg, orally) have been started 5 weeks after isolation, then behavioral tests, hippocampal content of neurotransmitters, and brain-derived neurotrophic factor (BDNF) were assessed. Moreover, insulin resistance, lipid profile, FGF-21, adiponectin, inflammatory, and oxidative stress markers of adipose tissue were assessed. Treatment of isolated-reared animals with olanzapine, or fenofibrate significantly ameliorated the behavioral and biochemical changes induced by postweaning social isolation. Co-treatment showed additive effects in improving hippocampal BDNF level. Besides, fenofibrate reduced the elevation in weight gain, adiposity index, insulin resistance, lipid profile, and FGF-21 level induced by olanzapine treatment. Also, fenofibrate increased adiponectin level which was reduced upon olanzapine treatment. Moreover, fenofibrate improved both adipose tissue oxidative stress and inflammatory markers elevation as a result of olanzapine treatment. Fenofibrate could ameliorate olanzapine-induced insulin resistance without affecting its central effect in isolated reared rats via its action on FGF-21-adiponectin axis.
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Affiliation(s)
- Aya Galal
- Cardiac Surgery Hospital, Ain Shams University
| | | | - Sara S El-Kilany
- Department of Anatomy, Faculty of Medicine, Ain Shams University
| | - Azza A Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar university (Girls Branch)
| | - Ebtehal El-Demerdash
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Abbasia, Cairo, Egypt
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The Development of a Nutrition Screening Tool for Mental Health Settings Prone to Obesity and Cardiometabolic Complications: Study Protocol for the NutriMental Screener. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111269. [PMID: 34769787 PMCID: PMC8583622 DOI: 10.3390/ijerph182111269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
People living with serious mental illness (SMI) experience physical health complications at disproportionate rates to people without an SMI. Unhealthy dietary intake and disordered eating behaviors are key driving factors. There is a lack of valid nutrition-risk screening tools targeted to mental health services, and typically used nutrition-risk screening tools are not suitable for mental health services. This paper details the rationale and study protocol for development and validation of the NutriMental screener, a tool for use in clinical practice to identify service users who are at risk for common nutrition issues experienced by this population group and trigger referral to a specialist clinician. The development process includes five phases. Phase I is the development of nutrition-related domains of interest from screening tools used in mental health services. Phase II involves a literature review and service-user interviews to identify additional domains. Phase III consists of international workshops with relevant clinicians and persons with SMI to gain a consensus on questions to be included in the draft tool. Phase IV involves conducting multinational feasibility and preliminary validation studies. Phase V consists of performing formal validation studies. The development of a nutrition-risk screening tool for mental health services is a necessary step to help rectify the physical-health disparities and life-expectancy gap for people with SMI.
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8
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Kandola AA, Osborn DPJ. Physical activity as an intervention in severe mental illness. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYPhysical activity is a modifiable risk factor for several physical and mental health conditions. It is well established that people with severe mental illness have increased risk of physical health complications, particularly cardiovascular disease. They are also more likely to be physically inactive, contributing to the elevated cardiovascular and metabolic risks, which are further compounded by antipsychotic medication use. Interventions involving physical activity are a relatively low risk and accessible way of reducing physical health problems and weight in people with severe mental illness. They also have wider benefits for mental health symptoms and quality of life. However, many barriers still exist to the widespread implementation of physical activity interventions in the treatment of severe mental illness. A more concerted effort is needed to facilitate their translation into routine practice and to increase adherence to activity interventions.
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Romo-Nava F, Buijs RM, McElroy SL. The use of melatonin to mitigate the adverse metabolic side effects of antipsychotics. HANDBOOK OF CLINICAL NEUROLOGY 2021; 179:371-382. [PMID: 34225976 DOI: 10.1016/b978-0-12-819975-6.00024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antipsychotic drugs are efficacious first-line treatments for many individuals diagnosed with a psychiatric illness. However, their adverse metabolic side-effect profile, which resembles the metabolic syndrome, represents a significant clinical problem that increases morbidity and limits treatment adherence. Moreover, the mechanisms involved in antipsychotic-induced adverse metabolic effects (AMEs) are unknown and mitigating strategies and interventions are limited. However, recent clinical trials show that nightly administration of exogenous melatonin may mitigate or even prevent antipsychotic-induced AMEs. This clinical evidence in combination with recent preclinical data implicate the circadian system in antipsychotic-induced AMEs and their mitigation. In this chapter, we provide an overview on the circadian system and its involvement in antipsychotic-induced AMEs, as well as the potential beneficial effect of nightly melatonin administration to mitigate them.
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Affiliation(s)
- Francisco Romo-Nava
- Lindner Center of HOPE Research Institute, Lindner Center of HOPE, Mason, OH, United States; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Ruud M Buijs
- Hypothalamic Integration Mechanisms Laboratory, Department of Cellular Biology and Physiology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Susan L McElroy
- Lindner Center of HOPE Research Institute, Lindner Center of HOPE, Mason, OH, United States; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Wiedeman AM, Panagiotopoulos C, Devlin AM. Treatment-related weight gain and metabolic complications in children with mental health disorders: potential role for lifestyle interventions. Appl Physiol Nutr Metab 2020; 46:193-204. [PMID: 33226841 DOI: 10.1139/apnm-2020-0259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Over 1 million Canadian children are estimated to have a mental health disorder, which are commonly treated with medications, such as second-generation antipsychotics (SGAs). Estimates suggest that SGA prescriptions to children are increasing in Canada. Although these medications are important and lifesaving components of psychiatric treatment, they are not without side effects. For some children, SGA treatment is associated with adverse metabolic complications including rapid weight gain, dyslipidemia, elevated blood pressure, and risk for type 2 diabetes. It is not clear why these complications develop, but it is assumed that SGAs stimulate appetite and food intake, and reduce resting energy expenditure leading to weight gain and that the metabolic complications occur secondary to the weight gain. Understanding the mechanisms underlying these complications is key to being able to identify children at risk and prevent and optimize treatment. In this narrative review, we provide an overview of the literature pertaining to the weight gain and metabolic complications in children treated with SGAs, highlighting the scope of the problem and the current limited research on how diet and physical activity can be used to prevent or lessen the severity of the metabolic complications and improve the long-term health trajectories of SGA-treated children. Novelty: Children are increasingly being treated with second-generation antipsychotics for mental health disorders. Dietary and physical activity assessments are not commonly considered in clinical settings. Randomized controlled trials of lifestyle interventions are needed to determine the effectiveness of mitigating the cardiometabolic complications in second-generation antipsychotic-treated children.
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Affiliation(s)
- Alejandra M Wiedeman
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Angela M Devlin
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
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Canal-Rivero M, Ruiz-Veguilla M, Labad J, Ayesa-Arriola R, Vázquez-Bourgon J, Mayoral-van Son J, Setién-Suero E, Ortiz-García de la Foz V, Crespo-Facorro B. Predictors of weight acquisition induced by antipsychotic treatment and its relationship with age in a sample of first episode non-affective psychosis patients: A three-year follow-up study. Schizophr Res 2020; 222:462-464. [PMID: 32600780 DOI: 10.1016/j.schres.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022]
Affiliation(s)
- M Canal-Rivero
- Department of Psychiatry, Hospital Universitari Germans Trías I Pujol, Badalona, Spain.
| | - M Ruiz-Veguilla
- Hospital Universitario Virgen del Rocío, Sevilla, Spain; Departament of Psychiatry, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain.
| | - J Labad
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychiatry, Corporació Sanitària Universitaria Parc Taulí, I3PT, UAB, Sabadell, Spain
| | - R Ayesa-Arriola
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - J Vázquez-Bourgon
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - J Mayoral-van Son
- Hospital Universitario Virgen del Rocío, Sevilla, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
| | - E Setién-Suero
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - V Ortiz-García de la Foz
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - B Crespo-Facorro
- Hospital Universitario Virgen del Rocío, Sevilla, Spain; Departament of Psychiatry, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
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Zapata RC, Osborn O. Susceptibility of male wild type mouse strains to antipsychotic-induced weight gain. Physiol Behav 2020; 220:112859. [PMID: 32156556 DOI: 10.1016/j.physbeh.2020.112859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 12/19/2022]
Abstract
While both men and women gain weight as a side effect of antipsychotic (AP) treatment, studies in mice have found only female mice are susceptible to weight gain. Therefore, to we set out to identify a strain of male mice that gain significant weight in response to APs which could better model AP-induced weight gain observed in humans. These studies determined that male Balb/c mice developed late onset olanzapine-induced weight gain. Patients often take APs for many years and thus understanding AP-mediated changes in food intake, energy expenditure and body weight regulation is particularly important.
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Affiliation(s)
- Rizaldy C Zapata
- Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, CA 92093, United States
| | - Olivia Osborn
- Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, CA 92093, United States.
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Singh R, Bansal Y, Sodhi RK, Singh DP, Bishnoi M, Kondepudi KK, Medhi B, Kuhad A. Berberine attenuated olanzapine-induced metabolic alterations in mice: Targeting transient receptor potential vanilloid type 1 and 3 channels. Life Sci 2020; 247:117442. [PMID: 32081663 DOI: 10.1016/j.lfs.2020.117442] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/14/2020] [Indexed: 02/08/2023]
Abstract
Transient receptor potential vanilloid type 1 (TRPV1) channels are emerging therapeutic targets for metabolic disorders. Berberine, which is a modulator of TRPV1, has proven antiobesity and antidiabetic potentials. The present study was aimed to investigate the protective effects of berberine in olanzapine-induced alterations in hypothalamic appetite control, inflammation and metabolic aberrations in mice targeting TRPV1 channels. Female BALB/c mice (18-23 g) were treated with olanzapine (6 mg/kg, p.o.) for six weeks to induce metabolic alterations, while berberine (100 and 200 mg/kg, p.o.) and metformin (100 mg/kg, p.o) were used as test and standard interventions respectively. Weekly assessment of feed-water intake, body temperature and body weight was done, while locomotion was measured at the end of week 1 and 6. Serum glucose and lipid profile were assessed by biochemical methods, while other serum biomarkers were assessed by ELISA. qPCR was used to quantify the mRNA expression in the hypothalamus. Olanzapine treatment significantly increased the feed intake, weight gain, adiposity index, while reduced body temperature and locomotor activity which were reversed by berberine treatment. Berberine treatment reduced serum ghrelin and leptin levels as well decrease in hypothalamic mRNA expression of orexigenic neuropeptides, inflammatory markers and ghrelin receptor in olanzapine-treated mice. Olanzapine treatment increased expression of TRPV1/TRPV3 in the hypothalamus which was significantly decreased by berberine treatment. Our results suggest that berberine, by TRPV1/TRPV3 modulation, attenuated the olanzapine-induced metabolic alterations in mice. Hence berberine supplementation in psychiatric patients could be a preventive approach to reduce the metabolic adverse effects of antipsychotics.
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Affiliation(s)
- Raghunath Singh
- Pharmacology Research Lab, University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh 160014, India
| | - Yashika Bansal
- Pharmacology Research Lab, University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh 160014, India
| | - Rupinder Kaur Sodhi
- Pharmacology Research Lab, University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh 160014, India
| | - Dhirendra Pratap Singh
- Pharmacology Research Lab, University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh 160014, India; Food and Nutritional Biotechnology Division, National Agri-Food Biotechnology Institute (NABI), SAS Nagar, Punjab 140306, India; ICMR-National Institute of Occupational Health (NIOH), Ahmedabad 380016, India
| | - Mahendra Bishnoi
- Food and Nutritional Biotechnology Division, National Agri-Food Biotechnology Institute (NABI), SAS Nagar, Punjab 140306, India
| | - Kanthi Kiran Kondepudi
- Food and Nutritional Biotechnology Division, National Agri-Food Biotechnology Institute (NABI), SAS Nagar, Punjab 140306, India
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Anurag Kuhad
- Pharmacology Research Lab, University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh 160014, India.
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Food craving and consumption evolution in patients starting treatment with clozapine. Psychopharmacology (Berl) 2019; 236:3317-3327. [PMID: 31197435 DOI: 10.1007/s00213-019-05291-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Antipsychotic-induced weight gain has been especially related to clozapine and olanzapine. Underlying mechanisms in relation to food preferences with an increased food craving and consumption of specific nutrients have not been extensively studied in patients with serious mental illness (SMI). We aim to describe specific food preferences (craving) and subsequent food consumption in SMI patients starting clozapine, as well as their possible relation to weight and body mass index (BMI). METHODS An observational prospective follow-up study (18 weeks) was conducted in a cohort of 34 SMI patients who started clozapine due to resistant-psychotic symptoms. Anthropometric measures, Food Craving Inventory (FCI), and a food consumption frequency questionnaire were evaluated at baseline, weeks 8 and 18 of treatment. Statistical analysis included generalized estimating equations models with adjustment for potential confounding factors. RESULTS No longitudinal changes over time were found across the different food craving scores after 18 weeks of treatment. However, adjusted models according to BMI status showed that the normal weight (NW) group presented an increased score for the "complex carbohydrates/proteins" food cravings (- 0.67; 95% CI [- 1.15, - 0.19]; P = 0.010), while baseline scores for "fast-food fats" cravings were significantly higher in the overweight/obese (OWO) group in comparison with NW patients (NW, 2.05; 95% CI [1.60, 2.49]; OWO, 2.81, 95% CI [2.37, 3.25]; P = 0.016). When considering if food craving could predict weight gain, only increments in "fast-food fats" cravings were associated (β = - 5.35 ± 1.67; 95% CI [- 8.64, - 2.06]; P = 0.001). CONCLUSIONS No longitudinal differences were found for any of the food craving scores evaluated; however, in the NW group, food craving for "complex carbohydrates/proteins" changed. Thus, changes in "fast-food fats" cravings predicted weight increase in this sample. Interventions targeting food preferences may help to mitigate weight gain in patients starting treatment with clozapine.
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Second-Generation Antipsychotics and Dysregulation of Glucose Metabolism: Beyond Weight Gain. Cells 2019; 8:cells8111336. [PMID: 31671770 PMCID: PMC6912706 DOI: 10.3390/cells8111336] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 02/06/2023] Open
Abstract
Second-generation antipsychotics (SGAs) are the cornerstone of treatment for schizophrenia because of their high clinical efficacy. However, SGA treatment is associated with severe metabolic alterations and body weight gain, which can increase the risk of type 2 diabetes and cardiovascular disease, and greatly accelerate mortality. Several underlying mechanisms have been proposed for antipsychotic-induced weight gain (AIWG), but some studies suggest that metabolic changes in insulin-sensitive tissues can be triggered before the onset of AIWG. In this review, we give an outlook on current research about the metabolic disturbances provoked by SGAs, with a particular focus on whole-body glucose homeostasis disturbances induced independently of AIWG, lipid dysregulation or adipose tissue disturbances. Specifically, we discuss the mechanistic insights gleamed from cellular and preclinical animal studies that have reported on the impact of SGAs on insulin signaling, endogenous glucose production, glucose uptake and insulin secretion in the liver, skeletal muscle and the endocrine pancreas. Finally, we discuss some of the genetic and epigenetic changes that might explain the different susceptibilities of SGA-treated patients to the metabolic side-effects of antipsychotics.
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Costa R, Teasdale S, Abreu S, Bastos T, Probst M, Rosenbaum S, Ward PB, Corredeira R. Dietary Intake, Adherence to Mediterranean Diet and Lifestyle-Related Factors in People with Schizophrenia. Issues Ment Health Nurs 2019; 40:851-860. [PMID: 31339786 DOI: 10.1080/01612840.2019.1642426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to examine the dietary intake of both inpatients and outpatients with schizophrenia in the Portuguese population as a potential key contributing factor to the poor physical health profiles, and understand the relationship of diet quality to other lifestyle factors. Participants of this cross-sectional study completed a semi quantitative food frequency questionnaire. Diet quality was determined by adherence to the Mediterranean Diet. In addition participants completed the International Physical Activity Questionnaire-Short-Form and Pittsburgh Sleep Quality Index. Tobacco smoking was assessed through a series of general questions. A total of 100 patients (50% inpatients and 28% female) with schizophrenia were included in the final analysis. Patients reported a high consumption of caffeine, while deficits were evident for fibre and folate intakes, when compared to the European Food Safety Authority recommendations. Both inpatients and outpatients reported poor to moderate diet quality. Smokers reported poorer diet quality when compared to non-smokers (p < 0.001). Dietary intake, and its relationship to other lifestyle components, should be considered for intervention, in order to improve physical health of people living with schizophrenia.
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Affiliation(s)
- Raquel Costa
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
| | - Scott Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District , Bondi Junction , Australia.,School of Psychiatry, UNSW Sydney , Australia
| | - Sandra Abreu
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
| | - Tânia Bastos
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto , Porto , Portugal.,Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI , Maia , Portugal
| | - Michel Probst
- Faculty of Kinesiology and Rehabilitation Sciences, Research Group for Adapted Physical Activity and Psychomotor Rehabilitation , KU Leuven , Leuven , Belgium
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney , Australia.,Black Dog Institute, Prince of Wales Hospital, Sydney , Randwick , Australia
| | - Philip B Ward
- School of Psychiatry, UNSW Sydney , Australia.,Schizophrenia Research Unit, South Western Sydney Local Health District & Ingham Institute for Applied Medical Research , Liverpool , Australia
| | - Rui Corredeira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
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Singh R, Bansal Y, Sodhi RK, Saroj P, Medhi B, Kuhad A. Modeling of antipsychotic-induced metabolic alterations in mice: An experimental approach precluding psychosis as a predisposing factor. Toxicol Appl Pharmacol 2019; 378:114643. [DOI: 10.1016/j.taap.2019.114643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023]
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18
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Castellani LN, Costa-Dookhan KA, McIntyre WB, Wright DC, Flowers SA, Hahn MK, Ward KM. Preclinical and Clinical Sex Differences in Antipsychotic-Induced Metabolic Disturbances: A Narrative Review of Adiposity and Glucose Metabolism. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2019; 4:e190013. [PMID: 31555747 PMCID: PMC6760310 DOI: 10.20900/jpbs.20190013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Antipsychotic (AP) medications are associated with an increased risk of developing metabolic side effects including weight gain, type 2 diabetes (T2D), dyslipidemia, and hypertension. In the majority of clinical studies, females on APs are noted to gain more weight, and are more likely to be diagnosed with metabolic syndrome when compared to males. However, the data is less clear when comparing sex disparities associated with other specific AP-induced metabolic risk factors. Accumulating evidence has demonstrated a role for AP-induced adipose tissue accumulation as well as whole body glucose dysregulation in male models that is independent of changes in body weight. The purpose of this narrative review is to explore the susceptibility of males and females to changes in adiposity and glucose metabolism across clinical and preclinical models of AP treatment. It is important that future research examining AP-induced metabolic side effects analyzes outcomes by sex to help clarify risk and identify the mechanisms of adverse event development to improve safe prescribing of medications.
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Affiliation(s)
| | - Kenya A. Costa-Dookhan
- Centre for Addition and Mental Health, Toronto, ON M5T1L8, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON M5S3K1, Canada
| | | | - David C. Wright
- Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G1Y2, Canada
| | | | - Margaret K. Hahn
- Centre for Addition and Mental Health, Toronto, ON M5T1L8, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON M5S3K1, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T1R8, Canada
- Banting and Best Diabetes Centre, University of Toronto, ON M5G2C4, Canada
| | - Kristen M. Ward
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
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19
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The effects of antipsychotic medications on microbiome and weight gain in children and adolescents. BMC Med 2019; 17:112. [PMID: 31215494 PMCID: PMC6582584 DOI: 10.1186/s12916-019-1346-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children and adolescents with behavioral problems. However, in many cases, second-generation antipsychotics have unwanted side effects, such as weight gain, potentially further increasing risk for morbidities including obesity, diabetes, and cardiovascular disease. While various mechanisms for this weight gain have been proposed, including effects on metabolic hormone signaling, recent evidence points to the importance of the gut microbiome in this process. The microbial communities residing within the gut are affected by second-generation antipsychotics and can confer weight gain. MAIN TEXT This review summarizes recent findings and presents data linking second-generation antipsychotics, gut microbiota alterations and weight gain. The review focuses on children and adolescent populations, which have not previously received much attention, but are of great interest because they may be most vulnerable to gut microbiome changes and may carry long-term metabolic effects into adulthood. CONCLUSIONS We present correlations between second-generation antipsychotics, gut microbiota alterations and weight gain, and suggest some mechanisms that may link them. A better understanding of the underlying mechanisms may lead to the design of improved treatments for psychotic disorders with fewer harmful side effects.
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Vantaggiato C, Panzeri E, Citterio A, Orso G, Pozzi M. Antipsychotics Promote Metabolic Disorders Disrupting Cellular Lipid Metabolism and Trafficking. Trends Endocrinol Metab 2019; 30:189-210. [PMID: 30718115 DOI: 10.1016/j.tem.2019.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/04/2018] [Accepted: 01/03/2019] [Indexed: 12/21/2022]
Abstract
Antipsychotics frequently cause obesity and related metabolic disorders that current psychopharmacological/endocrinological theories do not explain consistently. An integrative/alternative theory implies metabolic alterations happening at the cellular level. Many observations in vitro and in vivo, and pivotal observations in humans, point towards chemical properties of antipsychotics, independent of receptor binding characteristics. Being amphiphilic weak bases, antipsychotics can disrupt lysosomal function, affecting cholesterol trafficking; moreover, by chemical mimicry, antipsychotics can inhibit cholesterol biosynthesis. These two molecular adverse effects may trigger a cascade of transcriptional and biochemical events, ultimately reducing available cholesterol while increasing cholesterol precursors and fatty acids. The macroscopic manifestation of these molecular alterations includes decreased high-density lipoprotein and increased very low-density lipoprotein and triglycerides that may translate into obesity and related metabolic disorders.
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Affiliation(s)
- Chiara Vantaggiato
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini (LC), 23842, Italy
| | - Elena Panzeri
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini (LC), 23842, Italy
| | - Andrea Citterio
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini (LC), 23842, Italy
| | - Genny Orso
- Department of Pharmacological Sciences, University of Padova (PD), 35131, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini (LC), 23842, Italy.
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21
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Singh R, Bansal Y, Medhi B, Kuhad A. Antipsychotics-induced metabolic alterations: Recounting the mechanistic insights, therapeutic targets and pharmacological alternatives. Eur J Pharmacol 2018; 844:231-240. [PMID: 30529195 DOI: 10.1016/j.ejphar.2018.12.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022]
Abstract
Atypical antipsychotics (AAPs) are the drug of choice in the management of mental illnesses by virtue of their advantage over typical antipsychotics i.e. least tendency of producing extrapyramidal motor symptoms (EPS) or pseudoparkinsonism. Despite the clinical efficacy, AAPs produces troublesome adverse effects, particularly hyperphagia, hyperglycemia, dyslipidemia weight gain, diabetes mellitus, insulin resistance and QT prolongation which further develops metabolic and cardiac complications with subsequent reduction in life expectancy, poor patient compliance, and sudden death. AAPs-induced weight gain and metabolic alterations are increasing at an alarming rate and became an utmost matter of concern for psychopharmacotherapy. Diverse underlying mechanisms have been explored such as the interaction of AAPs with neurotransmitter receptors, alteration in food reward anticipation behavior, altered expressions of hypothalamic orexigenic and anorexigenic neuropeptides, histamine H1 receptor-mediated hypothalamic AMP-activated protein kinase (AMPK) activation, increased blood leptin, ghrelin, pro-inflammatory cytokines. Antipsychotics induced imbalance in energy homeostasis, reduction in energy expenditure which is linked to altered expression of uncoupling proteins (UCP-1) in brown adipose tissue and reduced hypothalamic orexin expressions are emerging insights. In addition, alteration in gut-microbiota and subsequent inflammation, dyslipidemia, obesity, and diabetes after AAPs treatment are also associated with weight gain and metabolic alterations. Oral hypoglycemics and lipid-lowering drugs are mainly prescribed in the clinical management of weight gain associated with AAPs while many other pharmacological and nonpharmacological interventions also have been explored in different clinical and preclinical studies. In this review, we critically discuss the current scenario, mechanistic insights, biomarkers, and therapeutic alternatives for metabolic alterations associated with antipsychotics.
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Affiliation(s)
- Raghunath Singh
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh 160014, India
| | - Yashika Bansal
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh 160014, India
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Anurag Kuhad
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh 160014, India.
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22
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Psychotropic usage by patients presenting to an academic eating disorders program. Eat Weight Disord 2018; 23:769-774. [PMID: 29882037 DOI: 10.1007/s40519-018-0520-3] [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: 04/09/2018] [Accepted: 05/24/2018] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To assess psychotropic use patterns and possible associations with age, eating disorder diagnosis and psychiatric comorbidity in adolescents and young adults with a primary eating disorder. METHODS A retrospective chart review of 86 consecutive patients with a primary eating disorder from August 2012 to December 2014 was conducted. Patients presented for a multidisciplinary evaluation at a United States-based academic program for eating disorders. RESULTS Nearly half (45.3%) of the patients reported being on a psychotropic medication. Antidepressants were the most reported category, prescribed in 38.4% of the patients evaluated. There was a significant association between the type of eating disorder and the number of psychotropics prescribed. Patients with a diagnosis of other specified feeding or eating disorder reported more prescriptions upon presentation than patients with anorexia nervosa. Despite the finding that a significant minority of patients had a psychiatric comorbidity, this did not appear to increase the likelihood of psychotropic usage over those diagnosed with an eating disorder alone. In addition, patients with a longer duration of illness and patients with a history of non-suicidal self-injury were more likely to present to treatment on psychotropic medications. CONCLUSIONS Psychotropic medications appear to be commonly prescribed among individuals evaluated in a tertiary care center for an eating disorder. Given that psychotropics are not recommended as the primary intervention for eating disorders, the frequency may be indicative of practitioners not following research-informed practice guidelines. The differences observed may also reflect complexities related to clinical features or illness history. LEVEL OF EVIDENCE Level V: Descriptive study.
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23
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Leisure time physical activity and incident use of prescription tranquilizers: A longitudinal population-based study. J Affect Disord 2018; 238:327-335. [PMID: 29902737 DOI: 10.1016/j.jad.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/13/2018] [Accepted: 06/04/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Physical inactivity is a major public health problem associated with an increased risk of several psychiatric and physical conditions. This study investigated the association between leisure time physical activity (PA) and incident use of prescription tranquilizers in a regionally representative and prospective cohort. METHODS A total of 4043 men and women (mean age: 61.3 years; 57% women) from the Tromsø Study were followed for six years. Leisure time PA was captured at baseline. Psychiatric morbidity was measured by use of prescription tranquilizers, captured at both baseline and follow-up. Leisure time PA at baseline was used as a predictor of subsequent (incident) use of prescription tranquilizers. We used multinomial regression models and Poisson regression models to estimate relative risk-ratios (RRRs), and relative risks (RRs), respectively, and their corresponding 95% confidence intervals (CIs). RESULTS In the fully-adjusted model, accounting for socio-demographic factors, parental history of psychopathology, years of education, smoking, respondent's psychopathology at baseline, and occupational PA, a lower leisure time PA conferred a 41% increased risk of incident use of prescription tranquilizers at follow-up (RR = 1.41, 95% CI: 1.09, 1.83; p = 0.010). CONCLUSIONS These findings suggest that physical inactivity increases the risk of psychiatric morbidity (albeit, measured via use of prescription tranquilizers). Future regionally representative and longitudinal research is required to confirm/refute our findings and explore underlying mechanisms.
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Jakobsen AS, Speyer H, Nørgaard HCB, Karlsen M, Hjorthøj C, Krogh J, Mors O, Nordentoft M, Toft U. Dietary patterns and physical activity in people with schizophrenia and increased waist circumference. Schizophr Res 2018; 199:109-115. [PMID: 29555213 DOI: 10.1016/j.schres.2018.03.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 03/01/2018] [Accepted: 03/11/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES People with severe mental disorders die 10-25years earlier than people in the Western background population, mainly due to lifestyle related diseases, with cardiovascular disease (CVD) being the most frequent cause of death. Major contributors to this excess morbidity and mortality are unhealthy lifestyle factors including tobacco smoking, unhealthy eating habits and lower levels of physical activity. The aim of this study was to investigate the dietary habits and levels of physical activity in people with schizophrenia spectrum disorders and overweight and to compare the results with the current recommendations and with results from the general Danish population. METHODS We interviewed a sample of 428 people with schizophrenia spectrum disorders and increased waist circumference enrolled in the CHANGE trial using a Food Frequency Questionnaire (FFQ) and a 24h recall interview, a Physical Activity Scale (PAS), scale for assessment of positive and negative symptoms (SAPS and SANS, respectively), Brief Assessment of Cognition in Schizophrenia (BACS) and Global Assessment of Functioning (GAF). We compared with information on dietary intake and physical activity in the general Danish population from the Danish National Survey of Dietary Habits and Physical Activity in 2011-2013 (DANSDA). RESULTS The CHANGE participants reported a very low energy intake and their distribution of nutrients (i.e. fat, protein and carbohydrates) harmonized with the recommendations from the Danish Health Authorities, and were similar to the latest report on the dietary habits in the Danish general population. However, the intake of saturated fat, sugar and alcohol exceed the recommended amounts and the corresponding intake in the general population. The intake of fiber, vegetables and fruit and fish were insufficient and also less than in the general population. The overall estimated quality of the dietary habits was poor, only 10.7% of the participants had healthy dietary patterns, and the quality was poorer than in the general population. Even with a very liberal definition of the term "homecooked", only 62% of the participants had taken any part in the preparation of their food. The level of physical activity was low and only one fifth of the participants complied with the recommendations of min. 30min daily moderate-to-vigorous activity. Half of the CHANGE participants were smokers, compared to 17% in the general population. Negative symptoms were significantly associated with poorer dietary quality and less physical activity, whereas no such significant associations were found for cognition, positive symptoms or antipsychotic medication. CONCLUSIONS Even when accounting for some error from recall - and social desirability bias, the findings point in the direction that the average energy intake in obese people with schizophrenia spectrum disorders is not exceeding that of the general population, and that overweight may to some degree be a result of physical inactivity and metabolic adverse effects of antipsychotic medication. The physical activity level is low and the rate of tobacco smoking is high, and our results suggest that negative symptoms play a significant role. Future research should focus on bringing about lifestyle changes in this fragile population in order to reduce the excess risk of CVD and mortality.
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Affiliation(s)
| | | | | | | | | | | | - Ole Mors
- Aarhus University Hospital, Denmark
| | | | - Ulla Toft
- Research Center for Prevention and Health, Copenhagen, Denmark
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25
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Severi E, Ferrara M, Tedeschini E, Vacca F, Mungai F, Amendolara R, Baccari F, Starace F. Assessment of cardiovascular risk in an Italian psychiatric outpatient sample: A chart review of patients treated with second-generation antipsychotics. Int J Ment Health Nurs 2018; 27:1002-1008. [PMID: 29197134 DOI: 10.1111/inm.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 12/22/2022]
Abstract
Despite the call by the scientific community for a systematic monitoring of physical health in people with psychiatric illnesses, national and international audits have reported poor quality of cardiovascular risk assessments and management in this vulnerable population. Available evidence indicates that in people affected by mental illness, life expectancy is reduced by 10-20 years, mainly due to cardiovascular accidents and metabolic syndrome (MetS)-related diseases. The primary aim of the present study was to evaluate the accuracy of cardiovascular risk monitoring in an outpatient sample of patients taking second-generation antipsychotics. The sample consisted of 200 patients consecutively recruited from two community mental health centres. A clinical chart review was performed on the following laboratory tests: total cholesterol, high- and low-density lipoprotein, serum triglycerides, fasting blood glucose, γ-glutamyl transpeptidase. Blood pressure and waist circumference were measured. A complete cardiovascular risk assessment was available only in 60 patients out of 200 (33.3%). The only variable associated with laboratory tests for MetS was receiving three or more psychotropic medications, which increased fourfold the probability of metabolic screening. In the subsample of patients with full screening, the prevalence of MetS was 33.3%. Our findings suggest that mental health professionals working in community mental health services should incorporate a more systematic assessment of physical health in their practice, and intervene proactively to reduce the significant cardiovascular burden carried by people with several mental illness.
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Affiliation(s)
- Elena Severi
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Maria Ferrara
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Enrico Tedeschini
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Francesca Vacca
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Francesco Mungai
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Rocco Amendolara
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Flavia Baccari
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Fabrizio Starace
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
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26
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Huang XF, Weston-Green K, Yu Y. Decreased 5-HT2cR and GHSR1a interaction in antipsychotic drug-induced obesity. Obes Rev 2018; 19:396-405. [PMID: 29119689 DOI: 10.1111/obr.12638] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/20/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022]
Abstract
Second generation antipsychotics (SGAs), notably atypical antipsychotics including olanzapine, clozapine and risperidone, can cause weight gain and obesity side effects. Antagonism of serotonin 2c receptors (5-HT2cR) and activation of ghrelin receptor type 1a (GHSR1a) signalling have been identified as a main cause of SGA induced obesity. Here we review the pivotal regulatory role of the 5-HT2cR in ghrelin-mediated appetite signalling. The 5-HT2cR dimerizes with GHSR1a to inhibit orexigenic signalling, while 5-HT2cR antagonism reduces dimerization and increases GHSR1a-induced food intake. Dimerization is specific to the unedited 5-HT2cR isoform. 5-HT2cR antagonism by SGAs may disrupt the normal inhibitory tone on the GHSR1a, increasing orexigenic signalling. The 5-HT2cR and its interaction with the GHSR1a could serve as the basis for discovering novel approaches to preventing and treating SGA-induced obesity.
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Affiliation(s)
- X-F Huang
- School of Medicine, University of Wollongong and Illawarra Health and Medical Research Institute, NSW, Australia.,Jiangsu Key Laboratory for Immunity and Metabolism, Xuzhou Medical University, Jiangsu, China.,Centre for Medical and Molecular Biosciences, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - K Weston-Green
- School of Medicine, University of Wollongong and Illawarra Health and Medical Research Institute, NSW, Australia.,Centre for Medical and Molecular Biosciences, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Y Yu
- School of Medicine, University of Wollongong and Illawarra Health and Medical Research Institute, NSW, Australia.,Jiangsu Key Laboratory for Immunity and Metabolism, Xuzhou Medical University, Jiangsu, China
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Raben AT, Marshe VS, Chintoh A, Gorbovskaya I, Müller DJ, Hahn MK. The Complex Relationship between Antipsychotic-Induced Weight Gain and Therapeutic Benefits: A Systematic Review and Implications for Treatment. Front Neurosci 2018; 11:741. [PMID: 29403343 PMCID: PMC5786866 DOI: 10.3389/fnins.2017.00741] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Antipsychotic-induced weight gain (AIWG) and other adverse metabolic effects represent serious side effects faced by many patients with psychosis that can lead to numerous comorbidities and which reduce the lifespan. While the pathophysiology of AIWG remains poorly understood, numerous studies have reported a positive association between AIWG and the therapeutic benefit of antipsychotic medications. Objectives: To review the literature to (1) determine if AIWG is consistently associated with therapeutic benefit and (2) investigate which variables may mediate such an association. Data Sources: MEDLINE, Google Scholar, Cochrane Database and PsycINFO databases were searched for articles containing all the following exploded MESH terms: schizophrenia [AND] antipsychotic agents/neuroleptics [AND] (weight gain [OR] lipids [OR] insulin [OR] leptin) [AND] treatment outcome. Results were limited to full-text, English journal articles. Results: Our literature search uncovered 31 independent studies which investigated an AIWG-therapeutic benefit association with a total of 6063 enrolled individuals diagnosed with schizophrenia or another serious mental illness receiving antipsychotic medications. Twenty-two studies found a positive association while, 10 studies found no association and one study reported a negative association. Study variables including medication compliance, sex, ethnicity, or prior antipsychotic exposure did not appear to consistently affect the AIWG-therapeutic benefit relationship. In contrast, there was some evidence that controlling for baseline BMI/psychopathology, duration of treatment and specific agent studied [i.e., olanzapine (OLZ) or clozapine (CLZ)] strengthened the relationship between AIWG and therapeutic benefit. Limitations: There were limitations of the reviewed studies in that many had small sample sizes, and/or were retrospective. The heterogeneity of the studies also made comparisons difficult and publication bias was not controlled for. Conclusions: An AIWG-therapeutic benefit association may exist and is most likely to be observed in OLZ and CLZ-treated patients. The clinical meaningfulness of this association remains unclear and weight gain and other metabolic comorbidities should be identified and treated to the same targets as the general population. Further research should continue to explore the links between therapeutic benefit and metabolic health with emphasis on both pre-clinical work and well-designed prospective clinical trials examining metabolic parameters associated, but also occurring independently to AIWG.
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Affiliation(s)
- Alex T Raben
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victoria S Marshe
- Pharmacogenetic Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Araba Chintoh
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ilona Gorbovskaya
- Pharmacogenetic Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Pharmacogenetic Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Margaret K Hahn
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Pawełczyk T, Trafalska E, Pawełczyk A, Kotlicka-Antczak M. Differences in omega-3 and omega-6 polyunsaturated fatty acid consumption in people at ultra-high risk of psychosis, first-episode schizophrenia, and in healthy controls. Early Interv Psychiatry 2017; 11:498-508. [PMID: 26279283 DOI: 10.1111/eip.12267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 07/12/2015] [Indexed: 01/18/2023]
Abstract
AIM Supplementation with omega-3 PUFA showed efficacy in reducing the risk of transition into psychosis in UHR individuals. It is uncertain whether dietary patterns can be partly responsible for n-3 deficiencies observed in susceptible participants before the diagnosis of schizophrenia. The study was designed to assess differences in omega-3 and omega-6 PUFA consumption in healthy controls (HC), UHR participants and FES patients as well as to verify the hypothesis that dietary changes in PUFA consumption are present before active psychosis develops, that is, in UHR individuals. METHODS Dietary habits during the previous year were assessed in 34 patients at UHR of psychosis, 33 patients diagnosed with FES and 33 HC participants using a validated Food-Frequency Questionnaire and the Polish Food Composition Tables. RESULTS Significant differences in omega-3 and omega-6 PUFA intake were observed between study groups. UHR and FES groups reported significantly higher consumption of omega-6 PUFA in comparison with HC. FES patients also reported a higher consumption of alpha-linolenic acid (omega-3) in comparison with HC. No significant differences were seen in consumption of long-chain marine PUFA. CONCLUSIONS Differences in omega-6 and omega-3 PUFA consumption exist before development of psychotic symptoms, fulfilling the criteria of schizophrenia.
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Affiliation(s)
- Tomasz Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Elżbieta Trafalska
- Nutrition Hygiene and Epidemiology, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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Abstract
Years of research and clinical practice have demonstrated that individuals with certain mental health conditions are at an increased risk of obesity. However, no identified research has examined associations between multiple comorbid psychiatric disorders and body mass index (BMI). This study uses a secondary analysis to examine associations between a large number of combinations of various mental health conditions and BMI. Surprisingly, the results of this study indicate that the most comorbid psychiatric disorders are not associated with an increased risk of elevated BMI. However, bipolar disorder, agoraphobia, attention-deficit hyperactivity disorder, and panic disorder had the greatest number of comorbid disorder associations linked with elevated BMI. The effect sizes ranged from a significant but relatively small Cohen's d of 0.3 to a more notable effect size of 0.7. The results of this study indicate that practitioners should be especially vigilant in helping their patients to avoid weight gain when they have one of the four identified disorders in combination with at least one other disorder. Future research is needed to understand the mechanisms underlying this increased risk and evaluate targeted interventions that would be the most effective for people with these diagnoses.
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Affiliation(s)
- Nicholas Guenzel
- a University of Nebraska Medical Center , College of Nursing , Omaha , Nebraska , USA
| | - Daniel J Schober
- a University of Nebraska Medical Center , College of Nursing , Omaha , Nebraska , USA
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30
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Skrede S, González-García I, Martins L, Berge RK, Nogueiras R, Tena-Sempere M, Mellgren G, Steen VM, López M, Fernø J. Lack of Ovarian Secretions Reverts the Anabolic Action of Olanzapine in Female Rats. Int J Neuropsychopharmacol 2017; 20:1005-1012. [PMID: 29020342 PMCID: PMC5716078 DOI: 10.1093/ijnp/pyx073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/08/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Olanzapine is an orexigenic antipsychotic drug associated with serious metabolic adverse effects in humans. Development of valid rodent models for antipsychotic-induced metabolic adverse effects is hampered by the fact that such effects occur in females only. Estradiol is a predominant female hormone that regulates energy balance. We hypothesized that the female-specific hyperphagia and weight gain induced by olanzapine in the rat are dependent on the presence of estrogens. METHODS Female sham-operated or ovariectomized rats were treated with a single injection of olanzapine depot formulation. Food intake, body weight, plasma lipids, lipogenic gene expression, energy expenditure, and thermogenic markers including brown adipose tissue uncoupling protein 1 protein levels were measured. Olanzapine was also administered to ovariectomized rats receiving estradiol replacement via the subcutaneous (peripheral) or intracerebroventricular route. RESULTS Orexigenic effects of olanzapine were lost in ovariectomized female rats. Ovariectomized rats treated with olanzapine had less pronounced weight gain than expected from their food intake. Accordingly, brown adipose tissue temperature and protein levels of uncoupling protein 1 were elevated. Replacement in ovariectomized rats with either peripherally or centrally administered estradiol reduced food intake and body weight. Cotreatment with olanzapine blocked the anorexigenic effect of peripheral, but not central estradiol. CONCLUSIONS Our results indicate that the ovarian hormone estradiol plays an important role in olanzapine-induced hyperphagia in female rats and pinpoint the complex effects of olanzapine on the balance between energy intake and thermogenesis.
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Affiliation(s)
- Silje Skrede
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede)
| | - Ismael González-García
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede)
| | - Luís Martins
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede)
| | - Rolf Kristian Berge
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede)
| | - Ruben Nogueiras
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede)
| | - Manuel Tena-Sempere
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede)
| | - Gunnar Mellgren
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede)
| | - Vidar Martin Steen
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede)
| | - Miguel López
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede),Correspondence: Miguel López, PhD, Department of Physiology, CIMUS, University of Santiago de Compostela, Avda. Barcelona, S/N, 15782, Santiago de Compostela, Spain. (); and Johan Fernø, Department of Clinical Science, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway. ()
| | - Johan Fernø
- The Norwegian Centre for Mental Disorders Research and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Skrede, Steen, and Fernø); Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway (Drs Skrede, Steen, and Fernø); Department of Physiology, Research Center of Molecular Medicine and Chronic Diseases, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); CIBER Fisiopatología de la Obesidad y Nutrición, Santiago de Compostela, Spain (Drs González-García, Martins, Nogueiras, and López); The Lipid Research Group, Section for Medical Biochemistry, Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Berge); Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica/Hospital Reina Sofía, Córdoba, Spain (Dr Tena-Sempere); KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway (Drs Mellgren and Fernø); Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (Dr Mellgren); Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway (Dr Skrede),Correspondence: Miguel López, PhD, Department of Physiology, CIMUS, University of Santiago de Compostela, Avda. Barcelona, S/N, 15782, Santiago de Compostela, Spain. (); and Johan Fernø, Department of Clinical Science, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway. ()
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Teasdale SB, Samaras K, Wade T, Jarman R, Ward PB. A review of the nutritional challenges experienced by people living with severe mental illness: a role for dietitians in addressing physical health gaps. J Hum Nutr Diet 2017; 30:545-553. [PMID: 28419586 DOI: 10.1111/jhn.12473] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
People experiencing a severe mental illness (SMI), such as schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psychotic features, have a 20-year mortality gap compared to the general population. This 'scandal of premature mortality' is primarily driven by preventable cardiometabolic disease, and recent research suggests that the mortality gap is widening. Multidisciplinary mental health teams often include psychiatrists, clinical psychologists, specialist mental health nurses, social workers and occupational therapists, offering a range of pharmacological and nonpharmacological treatments to enhance the recovery of clients who have experienced, or are experiencing a SMI. Until recently, lifestyle and life skills interventions targeting the poor physical health experienced by people living with SMI have not been offered in most routine clinical settings. Furthermore, there are calls to include dietary intervention as mainstream in psychiatry to enhance mental health recovery. With the integration of dietitians being a relatively new approach, it is important to review and assess the literature to inform practice. This review assesses the dietary challenges experienced by people with a SMI and discusses potential strategies for improving mental and physical health.
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Affiliation(s)
- S B Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, Australia.,School of Psychiatry, University of New South Wales, Kensington, Australia
| | - K Samaras
- Department of Endocrinology, St Vincent's Hospital, Darlinghurst, Australia.,Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - T Wade
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, Australia
| | - R Jarman
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, Australia
| | - P B Ward
- School of Psychiatry, University of New South Wales, Kensington, Australia.,Schizophrenia Research Unit, South Eastern Sydney Local Health District & Ingham Institute for Applied Medical Research, Liverpool, Australia
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Baeza I, Vigo L, de la Serna E, Calvo-Escalona R, Merchán-Naranjo J, Rodríguez-Latorre P, Arango C, Castro-Fornieles J. The effects of antipsychotics on weight gain, weight-related hormones and homocysteine in children and adolescents: a 1-year follow-up study. Eur Child Adolesc Psychiatry 2017; 26:35-46. [PMID: 27209421 DOI: 10.1007/s00787-016-0866-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/10/2016] [Indexed: 12/21/2022]
Abstract
To analyze weight gain, metabolic hormones, and homocysteine (Hcys) levels in children and adolescents on antipsychotics (AP) during a year-long follow-up. 117 patients, AP-naïve or quasi-naïve (less than 30 days on AP), were included. Weight, body mass index (BMI), BMI z-score (z-BMI), and levels of leptin, insulin, insulin resistance (HOMA-IR), adiponectin, ghrelin, thyroid stimulating hormone (TSH), free thyroxine (FT4), and Hcys were measured at baseline, and at 3, 6, and 12 months, while patients remained on the same AP. Patients (mean age: 14.4 ± 3 years; 64.1 % male) were on risperidone (N = 84), olanzapine (N = 20) or quetiapine (N = 13) from baseline up to 1-year follow-up and significantly increased weight (5.8 ± 4.3 kg at 3-month, 8.1 ± 6.1 kg at 6-month, and 11.6 ± 7.0 kg at 1 year), BMI, and z-BMI. Leptin levels significantly increased from baseline to 3 and 6 months, as did TSH levels from baseline to 3 months, while FT4 levels decreased from baseline to 3 and 6 months. Patients with BMI >85th percentile at baseline (N = 16) significantly increased weight, BMI, and z-BMI, more than patients with normal BMI over time. Higher baseline levels of insulin, HOMA-IR, and leptin were associated with increased weight/BMI during follow-up, while higher baseline levels of FT4, adiponectin, and ghrelin were associated with lower weight/BMI during follow-up. All AP were associated with increased weight and BMI/z-BMI in all of the assessments; however, at 1-year assessment, this increase was significantly higher for patients on quetiapine. Both higher baseline levels of insulin, HOMA-IR, and leptin, as well as being overweight/obese at baseline were associated with increased weight/BMI during 1-year follow-up in children and adolescents on AP. Awareness of weight-related parameters in this population may help inform decisions regarding AP prescriptions.
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Affiliation(s)
- Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Institut Clinic of Neurosciences, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona, 08036, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Laura Vigo
- Adolescent Service, Mapther house, Maudsley Hospital, London, UK
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Institut Clinic of Neurosciences, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona, 08036, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rosa Calvo-Escalona
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Institut Clinic of Neurosciences, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona, 08036, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jessica Merchán-Naranjo
- Child and adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Pamela Rodríguez-Latorre
- Child and adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Institut Clinic of Neurosciences, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona, 08036, Spain.,Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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The Relationship between Body Weight Change and Body Constitutions of Traditional Chinese Medicine in Patients with Schizophrenia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:9585968. [PMID: 27818703 PMCID: PMC5081436 DOI: 10.1155/2016/9585968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/16/2016] [Accepted: 09/21/2016] [Indexed: 01/09/2023]
Abstract
Objective. To explore the relationship between body constitution (BC) types and weight change in patients with schizophrenia and who underwent second-generation antipsychotics (SGAs) treatment. Method. Body weight and waist circumference of eighty-five participants were measured for 6 consecutive weeks. Constitutions of Yin-Xu, Yang-Xu, and Stasis were assessed using the Body Constitution Questionnaire (BCQ). Results. Participants with body constitutions Yin-Xu (50.6%), Yang-Xu (49.4%), or Stasis (38.8%) exhibited worse physical condition and unhealthy daily habits, particularly in Stasis constitution. Moreover, Stasis constitution was significantly associated with several factors, including BMI, body weight, waist circumference, perception of stress, perception of health, staying up late, and less physical exercise. However, perception of stress showed significant difference in Yin-Xu, Yang-Xu, and Stasis. Generalized estimating equation (GEE) analysis revealed that significant time effects in body weight increase in the imbalanced BC types and gentleness BC type. SGAs induced weight gain in imbalanced BC type as well as gentleness BC type, especially treated with olanzapine. Conclusions. This is the first study to explore the longitudinal relationship between BC and weight gain in schizophrenia patients undergoing SGAs treatment. Health care providers should focus on weight gain problems in schizophrenia patients who underwent SGAs treatment.
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Guenzel N, Houfek J, Watanabe-Galloway S. Adverse Events in Childhood as a Risk Factor for Elevated BMI among People with Schizophrenia and Bipolar Disorder. Issues Ment Health Nurs 2016; 37:829-838. [PMID: 27681707 DOI: 10.1080/01612840.2016.1224281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Diseases of obesity have become a major cause of morbidity and mortality among people with schizophrenia and bipolar disorder. Childhood adversity has been associated with adult obesity in the general public, but has not been examined among people with mental illness. This study used a secondary analysis to examine childhood adversity and body mass index in people with schizophrenia and bipolar disorder. Among females, a history of physical abuse from parents or paternal emotional neglect was associated with an increased risk for obesity (OR = 3.34 and 2.44, respectively).
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Affiliation(s)
- Nicholas Guenzel
- a University of Nebraska Medical Center , College of Nursing , Lincoln , Nebraska , USA
| | - Julia Houfek
- b University of Nebraska Medical Center , College of Nursing , Nebraska Medical Center, Omaha , Nebraska , USA
| | - Shinobu Watanabe-Galloway
- c University of Nebraska Medical Center, College of Public Health , Nebraska Medical Center, Omaha , Nebraska , USA
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Salcedo S, Gold AK, Sheikh S, Marcus PH, Nierenberg AA, Deckersbach T, Sylvia LG. Empirically supported psychosocial interventions for bipolar disorder: Current state of the research. J Affect Disord 2016; 201:203-14. [PMID: 27243619 DOI: 10.1016/j.jad.2016.05.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/29/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Bipolar disorder requires psychiatric medications, but even guideline-concordant treatment fails to bring many patients to remission or keep them euthymic. To address this gap, researchers have developed adjunctive psychotherapies. The purpose of this paper is to critically review the evidence for the efficacy of manualized psychosocial interventions for bipolar disorder. METHODS We conducted a search of the literature to examine recent (2007-present), randomized controlled studies of the following psychotherapy interventions for bipolar disorder: psychoeducation (PE), cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), and family therapies such as family focused therapy (FFT). RESULTS All of the psychotherapy interventions appear to be effective in reducing depressive symptoms. Psychoeducation and CBT are associated with increased time to mood episode relapse or recurrence. MBCT has demonstrated a particular effectiveness in improving depressive and anxiety symptoms. Online psychotherapy interventions, programs combining one or more psychotherapy interventions, and targeted interventions centering on particular symptoms have been the focus of recent, randomized controlled studies in bipolar disorder. CONCLUSIONS Psychotherapy interventions for the treatment of bipolar disorder have substantial evidence for efficacy. The next challenge will to disseminate these psychotherapies into the community.
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Affiliation(s)
- Stephanie Salcedo
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
| | - Alexandra K Gold
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sana Sheikh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychology, Suffolk University, Boston, MA, USA
| | - Peter H Marcus
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Martin K, Woo J, Timmins V, Collins J, Islam A, Newton D, Goldstein BI. Binge eating and emotional eating behaviors among adolescents and young adults with bipolar disorder. J Affect Disord 2016; 195:88-95. [PMID: 26890288 DOI: 10.1016/j.jad.2016.02.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/24/2016] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study investigates nutritional behavior among adolescents and young adults with bipolar disorder (BP) in comparison to those without history of major psychiatric disorder. METHODS 131 participants (82 BP, 49 controls) with a mean age of 16.11 ± 1.61 years were included. The self-reported Quick Weight, Activity, Variety & Excess (WAVE) Screener was used to assess dietary habits, yielding a total nutritional score as well as Excess, Variety, and Household Food Insecurity subscale scores. Specifically, the Variety subscale was used to measure daily consumption of essential nutrients; the Excess subscale measured unhealthy eating behaviors such as binge eating and excessive intake of fat and sugar; and the Household Food Insecurity subscale was used to detect food insecurity. Within-group analysis was conducted on participants with BP to identify correlates of unhealthy diet. RESULTS BP participants scored significantly lower than controls on the WAVE (t=2.62, p=0.010), specifically the Excess subscale (t=3.26, p=0.001). This was related to higher prevalence of binge eating and emotional eating behaviors among participants with BP compared to controls. Within-group analyses showed that self-reported emotional dysregulation/impulsivity was associated with maladaptive nutritional behaviors (t=3.38, p=0.035). LIMITATIONS Cross-sectional design. Within-group analyses were underpowered. Diet quality was measured using a brief self-report screener. CONCLUSION Adolescents and young adults with BP have poorer nutritional behaviors compared to controls, and this difference is related to stress-induced eating. This demonstrates the need to screen for stress-induced eating and to intervene when needed in order to optimize nutritional behaviors among adolescents and young adults with BP.
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Affiliation(s)
- Katharine Martin
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5
| | - Julia Woo
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5
| | - Vanessa Timmins
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5
| | - Jordan Collins
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5
| | - Alvi Islam
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5
| | - Dwight Newton
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5.
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A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis. Br J Nutr 2016; 115:1987-93. [DOI: 10.1017/s0007114516001033] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractSevere mental illness is characterised by a 20-year mortality gap due to cardiometabolic disease. Poor diet in those with severe mental illness is an important and modifiable risk factor. The present study aimed to (i) examine baseline nutritional intake in youth with first-episode psychosis (FEP), (ii) evaluate the feasibility and acceptability of nutritional intervention early in FEP and (iii) to evaluate the effectiveness of early dietary intervention on key nutritional end points. Participants were recruited over a 12-month period from a community-based programme specifically targeting young people aged 15–25 years with newly diagnosed FEP. Individual dietetic consultations and practical group sessions were offered as part of a broader lifestyle programme. Dietary assessments were conducted before and at the end of the 12-week intervention. Participants exceeded recommended energy and Na intakes at baseline. Retention within the nutrition intervention was 67 %, consistent with other interventions offered to FEP clients. There was a 47 % reduction in discretionary food intake (−94 g/d,P<0·001) and reductions in daily energy (−24 %,P<0·001) and Na (−26 %,P<0·001) intakes. Diet quality significantly improved, and the mean change was 3·6 (95 % CI 0·2, 6·9,P<0·05), although this finding was not significant after Bonferroni’s correction. Increased vegetable intake was the main factor contributing to improved diet quality. Nutrition intervention delivered shortly after initiation of antipsychotic medication is feasible, acceptable and effective in youth with FEP. Strategies to prevent weight gain and metabolic decline will contribute to prevent premature cardiometabolic disease in this vulnerable population.
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Ameliorating antipsychotic-induced weight gain by betahistine: Mechanisms and clinical implications. Pharmacol Res 2016; 106:51-63. [DOI: 10.1016/j.phrs.2016.02.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 01/08/2023]
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Woldeyohannes HO, Soczynska JK, Maruschak NA, Syeda K, Wium-Andersen IK, Lee Y, Cha DS, Xiao HX, Gallaugher LA, Dale RM, Alsuwaidan MT, Mansur RB, Muzina DJ, Carvalho AF, Jerrell J, Kennedy S, McIntyre RS. Binge eating in adults with mood disorders: Results from the International Mood Disorders Collaborative Project. Obes Res Clin Pract 2015; 10:531-543. [PMID: 26508286 DOI: 10.1016/j.orcp.2015.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/09/2015] [Accepted: 10/04/2015] [Indexed: 01/31/2023]
Abstract
A post hoc analysis was conducted using data from participants (N=631) with a DSM-IV-TR defined diagnosis of major depressive disorder (MDD) or bipolar disorder (BD) who were enrolled in the International Mood Disorders Collaborative Project (IMDCP) between January 2008 and July 2013. It was determined that 20.6% of adults with mood disorders as part of the IMDCP fulfilled criteria for binge eating behaviour (BE). A higher percentage of individuals with BD met criteria for BE when compared to MDD (25.4% vs. 16%; p=0.004) Univariate analyses indicated that individuals with a mood disorder (i.e., MDD or BD) and BE had greater scores on measures of anxiety severity (p=0.013) and higher rates of lifetime and current substance dependence, lifetime alcohol abuse (p=0.007, p=0.006, and p=0.015, respectively), Attention Deficit Hyperactivity Disorder (ADHD) (p=0.018) and measures of neuroticism (p=0.019). Individuals with a mood disorder and concurrent BE had lower scores on measures of conscientiousness (p=0.019). Individuals meeting criteria for BE were also significantly more likely to be obese (i.e., BMI≥30kg/m2) (50% vs. 25.5%; p<0.001). Binge eating is common amongst adults utilising tertiary care services principally for a mood disorder. The presence of BE identifies a subset of adults with mood disorders who have greater illness complexity as evidenced by course of illness variables and comorbidity. Screening for BE amongst individuals with mood disorders is warranted; parsing neurobiological substrates subserving non-homeostatic eating behaviour amongst individuals with mood disorders is a future research vista.
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Affiliation(s)
- Hanna O Woldeyohannes
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Joanna K Soczynska
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nadia A Maruschak
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Kahlood Syeda
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Ida K Wium-Andersen
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Holly X Xiao
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Laura A Gallaugher
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | | | - Mohammad T Alsuwaidan
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | | | - Andre F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Jeanette Jerrell
- Department of Neuropsychiatry, University of South Carolina School of Medicine, USA
| | - Sidney Kennedy
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
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Motyl KJ, DeMambro VE, Barlow D, Olshan D, Nagano K, Baron R, Rosen CJ, Houseknecht KL. Propranolol Attenuates Risperidone-Induced Trabecular Bone Loss in Female Mice. Endocrinology 2015; 156:2374-83. [PMID: 25853667 PMCID: PMC4475716 DOI: 10.1210/en.2015-1099] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Atypical antipsychotic (AA) drugs cause significant metabolic side effects, and clinical data are emerging that demonstrate increased fracture risk and bone loss after treatment with the AA, risperidone (RIS). The pharmacology underlying the adverse effects on bone is unknown. However, RIS action in the central nervous system could be responsible because the sympathetic nervous system (SNS) is known to uncouple bone remodeling. RIS treatment in mice significantly lowered trabecular bone volume fraction (bone volume/total volume), owing to increased osteoclast-mediated erosion and reduced osteoblast-mediated bone formation. Daytime energy expenditure was also increased and was temporally associated with the plasma concentration of RIS. Even a single dose of RIS transiently elevated expression of brown adipose tissue markers of SNS activity and thermogenesis, Pgc1a and Ucp1. Rankl, an osteoclast recruitment factor regulated by the SNS, was also increased 1 hour after a single dose of RIS. Thus, we inferred that bone loss from RIS was regulated, at least in part, by the SNS. To test this, we administered RIS or vehicle to mice that were also receiving the nonselective β-blocker propranolol. Strikingly, RIS did not cause any changes in trabecular bone volume/total volume, erosion, or formation while propranolol was present. Furthermore, β2-adrenergic receptor null (Adrb2(-/-)) mice were also protected from RIS-induced bone loss. This is the first report to demonstrate SNS-mediated bone loss from any AA. Because AA medications are widely prescribed, especially to young adults, clinical studies are needed to assess whether β-blockers will prevent bone loss in this vulnerable population.
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Affiliation(s)
- Katherine J Motyl
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Victoria E DeMambro
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Deborah Barlow
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - David Olshan
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Kenichi Nagano
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Roland Baron
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Clifford J Rosen
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Karen L Houseknecht
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
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Lian J, De Santis M, He M, Deng C. Risperidone-induced weight gain and reduced locomotor activity in juvenile female rats: The role of histaminergic and NPY pathways. Pharmacol Res 2015; 95-96:20-6. [DOI: 10.1016/j.phrs.2015.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/07/2015] [Accepted: 03/07/2015] [Indexed: 01/05/2023]
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Hsieh K, Heller T, Bershadsky J, Taub S. Impact of adulthood stage and social-environmental context on body mass index and physical activity of individuals with intellectual disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015; 53:100-113. [PMID: 25860448 DOI: 10.1352/1934-9556-53.2.100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Individuals with intellectual disability (ID) are at risk for obesity and physical inactivity. We analyzed a subset of 2009-2010 National Core Indicators (NCI) database to examine (1) the impact of three adulthood stages- younger (20-39 years), middle (40-59 years), and older (60 years and older) on Body Mass Index (BMI) and physical activity (PA); and (2) the relationship between social-environmental context (i.e., residence type, everyday choices, and community participation) and BMI and PA, with adjustment for individual characteristics of the adults with ID. Findings highlight the need to pay more attention to obesity by providing health education and emphasizing healthy choices. Results also suggest the importance of community participation as a way of promoting more physical activity.
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Wang Y, Lin HQ, Law WK, Liang WC, Zhang JF, Hu JS, Ip TM, Waye MMY, Wan DCC. Pimozide, a novel fatty acid binding protein 4 inhibitor, promotes adipogenesis of 3T3-L1 cells by activating PPARγ. ACS Chem Neurosci 2015; 6:211-8. [PMID: 25437245 DOI: 10.1021/cn5002107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pimozide is a conventional antipsychotic of the diphenylbutylpiperidine class that has been clinically used for over 30 years. The obvious side effect of this drug is weight gain. However, the mechanism of pimozide-induced weight gain is still unknown. In the present study, we identified pimozide as a novel fatty acid binding protein 4 (FABP4) inhibitor using molecular docking simulation as well as biochemical characterizations. BMS309403, a well-known FABP4 inhibitor, elevated the basal protein levels of PPARγ, therefore stimulating adipogenesis in adipocytes. The present study showed that the inhibitory effect of pimozide on FABP4 promoted adipocyte differentiation with the potency proportional to their propensities for weight gain. These effects in adipogenesis by pimozide may help to explain the weight gain that is frequently observed in patients treated with pimozide.
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Affiliation(s)
- Yan Wang
- School
of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Huang-Quan Lin
- Division
of Life Science and Center for Chinese Medicine, The Hong Kong University of Science and Technology, Clear Water Bay Road, Hong
Kong SAR, China
| | - Wai-Kit Law
- School
of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wei-Cheng Liang
- School
of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department
of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jin-Fang Zhang
- School
of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department
of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jian-Shu Hu
- School
of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Tsz-Ming Ip
- School
of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Mary Miu-Yee Waye
- School
of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - David Chi-Cheong Wan
- School
of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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44
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Chi LW, Lin SC, Chang SH, Wu HS. Factors Associated With Hyperphagic Behavior in Patients With Dementia Living at Home. Biol Res Nurs 2014; 17:567-73. [PMID: 25510250 DOI: 10.1177/1099800414562025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the prevalence and patterns of and factors associated with hyperphagic behavior in Taiwanese patients with dementia living at home. METHODS A cross-sectional and correlational design was used. A total of 104 patients with dementia and their primary caregivers were recruited from the geriatric, neurology, and memory clinics of a regional hospital, a medical center and two day-care centers in central Taiwan. The data related to hyperphagic behavior, functional abilities, medical conditions, body weight, and demographic characteristics of patients as well as the demographic characteristics of their primary caregivers were collected between January and May 2013. RESULTS Based on a strict criterion (a median score of 3 for the hyperphagic subscale), the prevalence of hyperphagia in patients with dementia was 53.8%. Specific hyperphagic patterns exhibited included increased food intake (49% of patients with dementia), hoarding (8.7%), oral exploration (6.8%), and pica (3.9%). Years of education of the patient, the use of antipsychotics in patients, and the age of primary caregivers explained 16.3% of the variance in hyperphagic behavior subscale scores (F = 6.47, p < .001). CONCLUSIONS For the early identification and treatment of hyperphagic behavior in patients with dementia in home care or in clinic services provided by health professionals, specific attention should be paid to the usual eating behaviors of patients with lower levels of education or who are taking antipsychotic medication or those who have a female primary caregiver.
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Affiliation(s)
- Lu-Wen Chi
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shu-Chin Lin
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shu-Hua Chang
- Department of Nursing, Lin-Shin Medical Corporation Lin-Shin Hospital, Taichung, Taiwan
| | - Hua-Shan Wu
- Department of Nursing, Asia University, Taichung, Taiwan
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45
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García-Ptacek S, Faxén-Irving G, Cermáková P, Eriksdotter M, Religa D. Body mass index in dementia. Eur J Clin Nutr 2014; 68:1204-9. [PMID: 25271014 DOI: 10.1038/ejcn.2014.199] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/12/2014] [Indexed: 02/03/2023]
Abstract
This review comprehensively examines the current knowledge on the relationship between body mass index (BMI) and dementia. The association between BMI and cognition is complex: in younger adults, higher BMIs are associated with impaired cognition. Overweight and obesity in middle age are linked to increased future dementia risk in old age. However, when examined in old age, higher BMIs are associated with better cognition and decreased mortality. Little is known about the optimal BMI for well-being and survival in populations already suffering from dementia. Lifetime trends in weight, rather than single measures, might predict prognosis better and help untangle these apparent contradictions. Thus, the need arises to properly monitor BMI trends in affected dementia patients. Registries can include BMI, improving the management of dementia patients throughout the whole course of the disease. The role of central obesity and systemic inflammation on brain pathology and cognitive decline are discussed in this review. Understanding the life-course changes in BMI and their influence on dementia risk, cognitive prognosis and mortality after diagnosis may provide new insights into the underlying pathophysiology of dementia and shape possible intervention and treatment strategies.
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Affiliation(s)
- S García-Ptacek
- 1] Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden [2] Department of Medicine, Universidad Complutense, Madrid, Spain
| | - G Faxén-Irving
- 1] Clinical Nutrition, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden [2] Department of Clinical Nutrition and Dietetics, Karolinska University Hospital, Stockholm, Sweden
| | - P Cermáková
- 1] KI-Alzheimer Disease Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden [2] International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic
| | - M Eriksdotter
- 1] Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden [2] Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - D Religa
- 1] KI-Alzheimer Disease Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden [2] Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden [3] Department of Neurodegenerative Diseases, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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