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Sankaranarayanan A, Johnson K, Mammen SJ, Wilding HE, Vasani D, Murali V, Mitchison D, Castle DJ, Hay P. Disordered Eating among People with Schizophrenia Spectrum Disorders: A Systematic Review. Nutrients 2021; 13:nu13113820. [PMID: 34836076 PMCID: PMC8618287 DOI: 10.3390/nu13113820] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
Disordered eating, or abnormal eating behaviours that do not meet the criteria for an independent eating disorder, have been reported among people with schizophrenia. We aimed to systemati-cally review literature on disordered eating among people with schizophrenia spectrum disorder (SSD). Seven databases were systematically searched for studies that described the prevalence and correlates of disordered eating among patients with SSD from January 1984 to 15 February 2021. Qualitative analysis was performed using the National Institutes of Health scales. Of 5504 records identified, 31 studies involving 471,159 subjects were included in the systematic review. The ma-jority of studies (17) rated fair on qualitative analysis and included more men, and participants in their 30s and 40s, on antipsychotics. The commonest limitations include lack of sample size or power calculations, poor sample description, not using valid tools, or not adjusting for con-founders. The reported rates were 4.4% to 45% for binge eating, 16.1% to 64%, for food craving, 27% to 60.6% for food addiction, and 4% to 30% for night eating. Positive associations were re-ported for binge eating with antipsychotic use and female gender, between food craving and weight gain, between food addiction and increased dietary intake, and between disordered eating and female gender, mood and psychotic symptoms. Reported rates for disordered eating among people with SSD are higher than those in the general population. We will discuss the clinical, treatment and research implications of our findings.
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Affiliation(s)
- Anoop Sankaranarayanan
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (D.M.); (P.H.)
- Correspondence:
| | - Karthika Johnson
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
| | - Sanop J. Mammen
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
| | | | - Deepali Vasani
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
| | - Vijaya Murali
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (D.M.); (P.H.)
| | - David J. Castle
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M5S 2E8, Canada;
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (D.M.); (P.H.)
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Sylvia LG, Pegg SL, Dufour SC, Janos JA, Bernstein EE, Chang WC, Hall NE, Ellard KK, Nierenberg AA, Deckersbach T. Pilot study of a lifestyle intervention for bipolar disorder: Nutrition exercise wellness treatment (NEW Tx). J Affect Disord 2019; 250:278-283. [PMID: 30875669 PMCID: PMC7676479 DOI: 10.1016/j.jad.2019.03.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) are more likely than the general population to develop risk factors associated with cardiovascular disease, one of the leading causes of morbidity and mortality in this clinical population. To address this disproportionate medical burden, we developed Nutrition Exercise and Wellness Treatment (NEW Tx), a lifestyle intervention for individuals with BD. METHODS In this study, participants were randomized to NEW Tx (n = 19) or a treatment as usual waitlist (n = 19). We examine the intervention's efficacy to improve the physical and psychological outcomes of individuals with BD. Assessors were blind to participant condition throughout study duration. RESULTS The NEW Tx group reported increased weekly exercise duration and overall functioning, and decreased depression and illness severity over the study duration. However, only improvements in functioning were significantly greater in the NEW Tx group than in the control group. There were no group differences in weight loss or mood symptoms over the study duration. LIMITATIONS Limitations to this study include lack of objective measurement of exercise and a small and relatively homogeneous sample. CONCLUSIONS These data suggest that a manualized lifestyle intervention for BD may not be ideal to improve lifestyle changes in this clinical population. Further research is needed to pilot personalized approaches to creating a healthy lifestyle in BD.
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Affiliation(s)
- Louisa G Sylvia
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Samantha L Pegg
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Steven C Dufour
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Jessica A Janos
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Emily E Bernstein
- Harvard University, Department of Psychology, 33 Kirkland Street, Cambridge, MA 02138, United States
| | - Weilynn C Chang
- McLean Hospital, Gunderson Residence, 115 Mill Street, Belmont, MA 02478, United States
| | - Nathan E Hall
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard University, Department of Biostatistics, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Kristen K Ellard
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Andrew A Nierenberg
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Thilo Deckersbach
- Massachusetts General Hospital, Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
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Evers SS, van Vliet A, van Vugt B, Scheurink AJW, van Dijk G. A low TSH profile predicts olanzapine-induced weight gain and relief by adjunctive topiramate in healthy male volunteers. Psychoneuroendocrinology 2016; 66:101-10. [PMID: 26802597 DOI: 10.1016/j.psyneuen.2015.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
Second generation antipsychotics, like olanzapine (OLZ), have become the first line drug treatment for patients with schizophrenia. However, OLZ treatment is often associated with body weight (BW) gain and metabolic derangements. Therefore, the search for prospective markers for OLZ's negative side effects as well as adjunctive treatments to inhibit these has been of major interest. The aim of this study was to investigate in healthy male volunteers (age: 36 ± 11 years; BW: 84 ± 12 kg; BMI=25.5 ± 2.5) whether adjunctive topiramate (TPM) administration opposes OLZ-induced weight gain over the course of 14 days treatment. In addition, we investigated behavioral, endocrine and metabolic characteristics as underlying and potentially predictive factors for weight regulation and/or metabolic derangements associated with OLZ and TPM treatment. While adjunctive TPM indeed reduced OLZ-induced weight gain (P<0.05, Mann-Whitney U), behavioral/metabolic/endocrine characteristics of OLZ treatment were not affected by TPM. Using multiple regression analysis, BW gain was the key factor explaining metabolic disturbances (e.g., plasma insulin- LDL interaction: P<0.01, R(2)=.320), and cumulative food intake during treatment was the best denominator of BW gain (P<0.01, R(2)=.534). Neither TPM treatment, nor its circulating levels, contributed to variation observed in ΔBW. In a second multiple regression analysis, we observed that a low baseline thyrotropin profile (TSHAUC) before the start of drug treatment was associated with an increase in ΔBW over the course of drug treatment (P<0.05, R(2)=.195). Adding TSHAUC as covariate revealed that adjunctive TPM treatment did attenuate OLZ induced BW gain (P<0.05, ANCOVA). Further exploration of the circulating thyroid hormones revealed that individuals with a low plasma TSH profile were also those that were most sensitive to adjunctive TPM treatment blocking OLZ-induced ΔBW gain. Others have shown that OLZ-induced BW gain is associated with improvement in brief psychiatric rating scores (BPRS); adjunctive TPM treatment may be a solution specifically for those subjects susceptible to OLZ-induced rapid weight gain who-on a therapeutic level-benefit most of OLZ treatment.
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Affiliation(s)
- Simon S Evers
- University of Groningen, Groningen Institute for Evolutionary Life Sciences-Neurobiology, Dept. Behavioral Neurosciences, Groningen, The Netherlands.
| | | | | | - Anton J W Scheurink
- University of Groningen, Groningen Institute for Evolutionary Life Sciences-Neurobiology, Dept. Behavioral Neurosciences, Groningen, The Netherlands
| | - Gertjan van Dijk
- University of Groningen, Groningen Institute for Evolutionary Life Sciences-Neurobiology, Dept. Behavioral Neurosciences, Groningen, The Netherlands; University of Groningen, ESRIG Center for Isotope Analysis, Groningen, The Netherlands.
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Bernstein EE, Nierenberg AA, Deckersbach T, Sylvia LG. Eating behavior and obesity in bipolar disorder. Aust N Z J Psychiatry 2015; 49:566-72. [PMID: 25586751 DOI: 10.1177/0004867414565479] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Individuals with bipolar disorder are more frequently overweight or obese than the general population, but the reasons for this association are unknown. The aim of this study is to further understand the etiology of overweight and obesity in bipolar disorder. METHODS We invited patients in a specialty outpatient bipolar clinic to complete the Eating Inventory. Patients provided self-reported restraint, disinhibition, and perceived hunger as well as general perceptions of dietary intake. RESULTS Sixty-two individuals (37 female) between the ages of 18 and 67 (M = 41.5, SD = 13.38) and with an average body mass index (BMI) of 27.18 (SD = 5.71) completed the survey. Disinhibition and perceived hunger were positively correlated with BMI and self-reported difficulty eating healthy foods. Restraint was positively correlated with healthy eating (ps < .05). Stepwise linear regressions revealed that hunger was the most significant predictor of BMI (F(1) = 8.134, p = .006). Those participants with bipolar I or II disorder reported greater hunger scores (p < .01) and difficulty eating healthily (p < .05) than those without a full diagnosis. CONCLUSIONS These results suggest that disinhibition and perception of hunger may be linked to the disproportionately high rate of obesity in bipolar disorder.
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Affiliation(s)
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Eating disorders in schizophrenia: implications for research and management. SCHIZOPHRENIA RESEARCH AND TREATMENT 2014; 2014:791573. [PMID: 25485152 PMCID: PMC4251071 DOI: 10.1155/2014/791573] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/03/2014] [Indexed: 01/23/2023]
Abstract
Objective. Despite evidence from case series, the comorbidity of eating disorders (EDs) with schizophrenia is poorly understood. This review aimed to assess the epidemiological and clinical characteristics of EDs in schizophrenia patients and to examine whether the management of EDs can be improved. Methods. A qualitative review of the published literature was performed using the following terms: "schizophrenia" in association with "eating disorders," "anorexia nervosa," "bulimia nervosa," "binge eating disorder," or "night eating syndrome." Results. According to our literature review, there is a high prevalence of comorbidity between schizophrenia and EDs. EDs may occur together with or independent of psychotic symptoms in these patients. Binge eating disorders and night eating syndromes are frequently found in patients with schizophrenia, with a prevalence of approximately 10%. Anorexia nervosa seems to affect between 1 and 4% of schizophrenia patients. Psychopathological and neurobiological mechanisms, including effects of antipsychotic drugs, should be more extensively explored. Conclusions. The comorbidity of EDs in schizophrenia remains relatively unexplored. The clearest message of this review is the importance of screening for and assessment of comorbid EDs in schizophrenia patients. The management of EDs in schizophrenia requires a multidisciplinary approach to attain maximized health outcomes. For clinical practice, we propose some recommendations regarding patient-centered care.
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Sylvia LG, Salcedo S, Bernstein EE, Baek JH, Nierenberg AA, Deckersbach T. Nutrition, Exercise, and Wellness Treatment in bipolar disorder: proof of concept for a consolidated intervention. Int J Bipolar Disord 2013; 1:24. [PMID: 24660139 PMCID: PMC3961757 DOI: 10.1186/2194-7511-1-24] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/08/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This pilot study examines the proof of concept of a consolidated Nutrition, Exercise, and Wellness Treatment (NEW Tx) for overweight individuals with bipolar disorder. FINDINGS Five participants completed NEW Tx, a 20-week individual cognitive behavioral therapy-based treatment comprising three modules: Nutrition teaches appropriate serving sizes and balanced diet; Exercise emphasizes increasing weekly physical activity; Wellness focuses on skills for healthy decision-making. Participants attended most sessions and reported high satisfaction with the treatment. Participants' weight, cholesterol and trigyclerides decreased over the study duration as well as number of daily calories and sugar intake. We found that weekly exercise duration more than tripled over the study duration and depressive symptoms and functioning have improved. CONCLUSIONS These results offer proof of concept that consolidated NEW Tx is feasible and acceptable and has the potential to improve nutrition, exercise, wellness, and mood symptoms in bipolar disorder. Future iterations of NEW Tx will reflect the strengths and lessons learned from this study.
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Affiliation(s)
- Louisa G Sylvia
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
- />Harvard Medical School, Boston, MA 02115 USA
| | - Stephanie Salcedo
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
| | - Emily E Bernstein
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
| | - Ji Hyun Baek
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
| | - Andrew A Nierenberg
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
- />Harvard Medical School, Boston, MA 02115 USA
| | - Thilo Deckersbach
- />Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 USA
- />Harvard Medical School, Boston, MA 02115 USA
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Smith RC, Rachakonda S, Dwivedi S, Davis JM. Olanzapine and risperidone effects on appetite and ghrelin in chronic schizophrenic patients. Psychiatry Res 2012; 199:159-63. [PMID: 22475524 DOI: 10.1016/j.psychres.2012.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 12/13/2011] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
Olanzapine and other second generation antipsychotics have been associated with weight gain, which may be related to changes in appetite and food intake. However, it is unclear whether changes in appetite in response to treatment with second generation antipsychotics are persistent in patients treated chronically with these medications and the extent to which changes in appetite are related to any continuing weight gain associated with long-term treatment with these drugs. In a randomized 5-month study of the effects of olanzapine and risperidone on metabolic changes in chronic schizophrenic patients, we assessed appetite changes using two scales and correlated appetite changes with weight gain and metabolic changes. There is evidence that the hormone ghrelin is related to appetite stimulation and falls during satiation after meals, and therefore, may be a physiological concomitant indicating appetite changes. We therefore, also measured ghrelin before and after a fatty meal at baseline and after 2 months of drug treatment. Neither olanzapine nor risperidone increased appetite during the 5 months of study drug treatment, and there was a trend for a decrease in appetite over time. Weight only increased slightly during treatment and changes in appetite scores were not correlated with changes in weight or changes in glucose or lipids. Fasting ghrelin did not increase in olanzapine- or risperidone-treated patients, and there were no significant changes in ghrelin responses to a fatty meal between baseline and 2 months of drug treatment, and no differences in response in olanzapine- vs. risperidone-treated patients. Our findings suggest that in chronic schizophrenic patients treated with multiple antipsychotics in the past, olanzapine or risperidone do not induce increases in appetite and appetite changes are not related to any further small drug-induced weight gain in these chronically treated patients. However, it is possible that different relationships may exist between appetite and weight changes induced by the medications in drug naive patients newly started on olanzapine or risperidone.
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Affiliation(s)
- Robert C Smith
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.
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Praharaj SK, Sharma PSVN. Amantadine for olanzapine-induced weight gain: a systematic review and meta-analysis of randomized placebo-controlled trials. Ther Adv Psychopharmacol 2012; 2:151-6. [PMID: 23983968 PMCID: PMC3736939 DOI: 10.1177/2045125312440441] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to conduct a systematic review and meta-analysis of randomized placebo-controlled trials of amantadine for the treatment of olanzapine-induced weight gain. METHODS Studies were identified using online searches of PUBMED/MEDLINE and Cochrane database (CENTRAL), along with websites recording trial information such as ClinicalTrials.gov, Controlled-trials.com, and Clinicalstudyresults.org. Study eligibility criteria included randomized, double-blind clinical trials comparing amantadine with placebo for olanzapine-induced weight gain with body weight as an outcome measure and study duration of at least 12 weeks. The methodological quality of included trials was assessed using the Jadad Scale. Separate meta-analyses were undertaken for each outcome (body weight and frequency of weight loss >7%) and treatment effects were expressed as weighted mean differences (WMD) and Mantel-Haenszel odds ratio for continuous and categorical outcomes, respectively. RESULTS A systematic review of literature revealed six studies that had assessed amantadine for olanzapine-induced weight gain. Of these, two studies (n = 144) met the review inclusion criteria and were included in the final analysis. Meta-analysis was performed to see the effect size of the treatment on body weight and frequency of body weight loss >7%. For body weight change, WMD was -1.85 (95% confidence interval [CI] -3.31 to -0.39) kg with amantadine as compared with placebo; the overall effect was statistically significant (p = 0.01). For frequency of body weight loss >7%, Mantel-Haenszel odds ratio for weight loss was 3.72 (95% CI 1.19-11.62), favoring amantadine as compared with placebo, and the overall effect was significant (p = 0.02). CONCLUSIONS Existing data is limited to two studies, which support the efficacy of amantadine for olanzapine-induced weight gain and a significant proportion of patients might lose weight with amantadine compared with placebo.
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Affiliation(s)
- Samir Kumar Praharaj
- Assistant Professor, Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka 576104, India
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Vandyk AD, Baker C. Qualitative descriptive study exploring schizophrenia and the everyday effect of medication-induced weight gain. Int J Ment Health Nurs 2012; 21:349-57. [PMID: 22404848 DOI: 10.1111/j.1447-0349.2011.00790.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Weight gain and obesity are serious side effects of the medications used to manage psychotic disorders and successful, long-term weight loss interventions are not yet available. One reason for this may be that current interventions are designed without consideration of the patient's perspective. The purpose of this study was to explore the subjective experience of weight and lifestyle from the perspective of people with schizophrenia. A qualitative, constructivist research design was used and conversational interviews were conducted with 18 purposefully recruited participants from an outpatient clinic at a psychiatric hospital in Eastern Ontario. Data were analysed according to the method of constant comparison and three central themes emerged: a life altering diagnosis, weight management as complex, and today's experiences shape tomorrow's outcomes. Weight management was seen as difficult yet important to the participants. The findings of this study provide insight into the views and opinions of the participants regarding weight and lifestyle and may be used to support the design of tailored heath initiatives for persons with mental illness.
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Teff KL, Kim SF. Atypical antipsychotics and the neural regulation of food intake and peripheral metabolism. Physiol Behav 2011; 104:590-8. [PMID: 21664918 PMCID: PMC3139777 DOI: 10.1016/j.physbeh.2011.05.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/26/2011] [Accepted: 05/31/2011] [Indexed: 12/18/2022]
Abstract
The atypical antipsychotics (AAPs) are associated with weight gain and an increased incidence of metabolic disease including type 2 diabetes mellitus. Epidemiological, cross-sectional and prospective studies suggest that two of the AAPs, olanzapine and clozapine, cause the most dramatic weight gain and metabolic impairments including increased fasting glucose, insulin and triglycerides. Relative to the other AAPs, both olanzapine and clozapine exhibit a particularly high antagonistic affinity for histamine and muscarinic receptors which have been hypothesized as mediators of the reported increase in weight and glucose abnormalities. In this article, we review the current evidence for the AAP associated weight gain and abnormal glucose metabolism. We postulate that the effects of the AAPs on food intake and peripheral metabolism are initially independently regulated but with increasing body adiposity, the early AAP-induced impairments in peripheral metabolism will be exacerbated, thereby establishing a vicious cycle such that the effects of the AAP are magnified by the known pathophysiological consequences of obesity. Furthermore, we examine how inhibition of the histaminergic pathway may mediate increases in food intake and the potential role of the vagus nerve in the reported peripheral metabolic effects.
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Affiliation(s)
- Karen L Teff
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA 19104, USA.
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Correll CU, Lencz T, Malhotra AK. Antipsychotic drugs and obesity. Trends Mol Med 2010; 17:97-107. [PMID: 21185230 DOI: 10.1016/j.molmed.2010.10.010] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 12/15/2022]
Abstract
Mechanisms underlying antipsychotic cardiometabolic adverse effects are incompletely understood. This hampers the identification of high-risk patients, low-risk antipsychotics and preventive/ameliorative treatments. Recent clinical, molecular and genetic data suggest that: (i) antipsychotic-naïve samples provide the greatest power for mechanistic studies; (ii) weight and metabolic effects can be discordant, pointing to overlapping and distinct mechanisms; (iii) antipsychotics affect satiety and energy homeostasis signaling; (iv) the specific peptides mediating these effects are unknown but probably overlap with those involved in idiopathic obesity; and (v) single nucleotide polymorphisms in genes encoding known neurotransmitter receptors and metabolic proteins are promising pharmacogenomic targets for countering adverse affects. However, sophisticated molecular studies and genome-wide association studies, ideally in antipsychotic-naïve/first episode samples, are needed to further advance the field.
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Evers S, Calcagnoli F, van Dijk G, Scheurink A. Olanzapine causes hypothermia, inactivity, a deranged feeding pattern and weight gain in female Wistar rats. Pharmacol Biochem Behav 2010; 97:163-9. [DOI: 10.1016/j.pbb.2010.05.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/29/2010] [Accepted: 05/29/2010] [Indexed: 02/01/2023]
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Maayan L, Correll CU. Management of antipsychotic-related weight gain. Expert Rev Neurother 2010; 10:1175-200. [PMID: 20586697 DOI: 10.1586/ern.10.85] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite variations across individuals and agents, antipsychotics are associated with clearly documented weight gain and adverse metabolic effects. Although increased appetite/caloric intake and various receptors, hormones and peptides have been implicated, biological mechanisms contributing to the increase in weight and glucose and lipid abnormalities with antipsychotics are largely unknown. This has hampered the creation of antipsychotics that are free of cardiometabolic effects, even in antipsychotic-naive/early-phase patients, as well as the development of strategies that can prevent or drastically diminish the adverse cardiometabolic effects. In general, three strategies can reduce the cardiometabolic risk of antipsychotics: switching to a less orexigenic/metabolically adverse antipsychotic; adjunctive behavioral treatments; and adjunctive pharmacologic interventions. However, each of these strategies has only been shown to be modestly effective. Among different behavioral interventions (N = 14, n = 746), group and individual treatment, dietary counseling and cognitive-behavioral therapy seem to be similarly effective. Among 15 different pharmacologic strategies (N = 35, n = 1629), only metformin, fenfluramine, sibutramine, topiramate and reboxetine were more effective than placebo, with the most evidence being available for metformin, and no head-to-head trials comparing individual pharmacologic interventions. However, even in the most successful trials the risk reduction was modest. Weight was not decreased to a pretreatment level, and despite superiority compared with placebo, weight gain still often occurred, particularly in antipsychotic-naive patients and when interventions were 'preventively' coinitiated with antipsychotics. Future research should focus on combining treatment modalities or agents and on exploring novel mechanism-based interventions.
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Affiliation(s)
- Lawrence Maayan
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Case M, Treuer T, Karagianis J, Hoffmann VP. The potential role of appetite in predicting weight changes during treatment with olanzapine. BMC Psychiatry 2010; 10:72. [PMID: 20840778 PMCID: PMC2945973 DOI: 10.1186/1471-244x-10-72] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 09/14/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinically significant weight gain has been reported during treatment with atypical antipsychotics. It has been suggested that weight changes in patients treated with olanzapine may be associated with increased appetite. METHODS Data were used from adult patients for whom both appetite and weight data were available from 4 prospective, 12- to 24-week clinical trials. Patients' appetites were assessed with Eating Behavior Assessment (EBA, Study 1), Platypus Appetite Rating Scale (PARS, Study 2), Eating Inventory (EI, Study 3), Food Craving Inventory (FCI, Study 3), and Eating Attitude Scale (EAS, Study 4). RESULTS In Studies 1 (EBA) and 4 (EAS), patients who reported overall score increases on appetite scales, indicating an increase in appetite, experienced the greatest overall weight gains. However, in Studies 2 (PARS) and 3 (EI, FCI), patients who reported overall score increases on appetite scales did not experience greater weight changes than patients not reporting score increases. Early weight changes (2-4 weeks) were more positively correlated with overall weight changes than early or overall score changes on any utilized appetite assessment scale. No additional information was gained by adding early appetite change to early weight change in correlation to overall weight change. CONCLUSIONS Early weight changes may be a more useful predictor for long-term weight changes than early score changes on appetite assessment scales. CLINICAL TRIALS REGISTRATION This report represents secondary analyses of 4 clinical studies. Studies 1, 2, and 3 were registered at http://clinicaltrials.gov/ct2/home, under NCT00190749, NCT00303602, and NCT00401973, respectively. Study 4 predates the registration requirements for observational studies that are not classified as category 1 observational studies.
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Affiliation(s)
| | | | - Jamie Karagianis
- Eli Lilly Canada Inc., Toronto, Ontario, Canada and Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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