Dietary improvement in people with schizophrenia

McCreadie, Robin G.; Kelly, Ciara; Connolly, Moira; Williams, Sue; Baxter, Gwen; Lean, Michael E. J.; Paterson, John R.

doi:10.1192/bjp.187.4.346

Cited by 78 publications

(81 citation statements)

References 13 publications

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“…That this is difficult was illustrated by Ussher [27], who described an ambivalent attitude in psychiatric patients towards physical exercise. In addition, the effect, size and duration of lifestyle interventions are often limited [28]. Therefore, we favor research into more effective ways to prevent and treat obesity in psychiatric patients.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Overweight and Diabetes mellitus in Residential Psychiatric Patients

Mookhoek¹,

Vries²,

Hovens³

et al. 2011

Obes Facts

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Objective: To investigate the prevalence of and risk factors for overweight and diabetes mellitus in long-stay psychiatric inpatients. Method: Statistical analysis of data collected from medical, laboratory, and pharmacy files. Results: 80% of the 256 patients were suffering from schizophrenia or other psychotic disorders. The prevalence of diabetes mellitus was 15%. The prevalence of a disturbed glucose tolerance was 14%. Severe overweight (BMI > 30) was positively associated with the use of clozapine (odds ratio (OR) = 2.7; 95% confidence interval (CI): 1.31–5.75), but negatively with the diagnosis schizophrenia (OR = 0.4; 95% CI: 0.22–0.88). Diabetes mellitus was associated with severe overweight (OR = 3.5; 95% CI: 1.57–7.69). Caucasian patients were at a lower risk for diabetes mellitus (OR = 0.2; 95% CI: 0.08–0.54). Conclusions: In residential psychiatric patients, diabetes mellitus is especially associated with overweight and non-Caucasian origin. In this survey, the use of clozapine was associated with overweight, but not directly with diabetes mellitus. Diabetes mellitus is highly prevalent, which calls for screening for diabetes mellitus at regular intervals.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Overweight and Diabetes mellitus in Residential Psychiatric Patients

Mookhoek¹,

Vries²,

Hovens³

et al. 2011

Obes Facts

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“…A rather scarce (relatively to the scope of the problem) literature on schizophrenic eating habits describes exag- (Brown et al, 1999;McCreadie et al, 1998), in fruits and in vegetables (McCreadie et al, 1998(McCreadie et al, , 2005McCreadie, 2003), but excessive in saturated fat (Brown et al, 1999;Strassnig et al, 2003aStrassnig et al, , 2005Ryan et al, 2003Ryan et al, , 2004, in carbohydrates (Strassnig et al, 2003b), and in high glycemic index (Foster-Powell et al, 2002) foodstuffs such as cereal (McCreadie, 2003). These patterns may be further worsened by treatment with SGAs such as clozapine, olanzapine, and to lesser degree quetiapine and risperidone, but not ziprasidone or aripiprazole (Allison et al, 1999b; American Diabetes Association, 2004;Kane et al, 2004;Newcomer 2005).…”

Section: Dietary Habits Of Schizophrenic Patientsmentioning

confidence: 99%

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Elman

Borsook

Lukas

2006

Neuropsychopharmacol

138

142

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Obesity is highly prevalent among patients with schizophrenia and is associated with detrimental health consequences. Although excessive consumption of fast food and pharmacotherapy with such second-generation antipsychotic agents (SGAs) as clozapine and olanzapine has been implicated in the schizophrenia/obesity comorbidity, the pathophysiology of this link remains unclear. Here, we propose a mechanism based on brain reward function, a relevant etiologic factor in both schizophrenia and overeating. A comprehensive literature search on neurobiology of schizophrenia and of eating behavior was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) energy homeostasis, (2) food reward and hedonics, (3) reward function in schizophrenia, and (4) metabolic effects of the SGAs. A mesolimbic hyperdopaminergic state may render motivational/incentive reward system insensitive to low salience/palatability food. This, together with poor cognitive control from hypofunctional prefrontal cortex and enhanced hedonic impact of food, owing to exaggerated opioidergic drive (clinically manifested as pain insensitivity), may underlie unhealthy eating habits in patients with schizophrenia. Treatment with SGAs purportedly improves dopamine-mediated reward aspects, but at the cost of increased appetite and worsened or at least not improved opiodergic capacity. These effects can further deteriorate eating patterns. Pathophysiological and therapeutic implications of these insights need further validation via prospective clinical trials and neuroimaging studies. INTRODUCTIONObesity has reached pandemic proportions and it is rapidly surpassing smoking as a number one killer in the industrialized world (Sturm, 2002;Skidmore and Yarnell, 2004). Its annual cost to the American society is staggering, and is estimated to be around $117 billion owing to related illnesses and loss of productivity (National Institute of Diabetes and Digestive and Kidney Diseases, 2005).In schizophrenia, obesity is twice as prevalent as in the general public, afflicting over half this patient population (Allison et al, 1999a;Dixon et al, 2000; American Diabetes Association, 2004;Marder et al, 2004;Wirshing, 2004). Besides negative psychosocial impacts (distorted selfesteem and societal stigmatization) and medications noncompliance, schizophrenics appear to be particularly susceptible to the detrimental medical sequelae of obesity such as the 'Metabolic Syndrome', which is a cluster of cardiovascular risk factors, including abdominal adiposity, insulin resistance, impaired, glucose tolerance, dyslipidemia, and hypertension (McKee et al, 1986;Mukherjee et al, 1996;Brown et al, 2000;Haupt and Newcomer, 2002;Ryan and Thakore, 2002;Ryan et al, 2003;Holt et al, 2004;Kohen, 2004;Marder et al, 2004;Lieberman et al, 2005).Excessive body weight gain (BWG) could be attributed to a constellation of endocrine, molecular, genetic, demographic, and lifestyle-related factors. Provided that a common tra...

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“…For example, ongoing disrupted food choice learning following nutrition training has been reported [58], and without specific interventions, low salience immediate hedonic experiences (i.e., vegetable intake, exercise) may never translate into long-term habits. That is, the more the reward is delayed temporally, the less subjective value it holds, particularly in schizophrenia [59,60].…”

Section: Introductionmentioning

confidence: 99%

Cognitive deficits, obesity and disability in schizophrenia

Strassnig

Cáceda

Newcomer

et al. 2012

Translational Neuroscience

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Despite 50 years of pharmacological and psychosocial interventions schizophrenia remains one of the leading causes of disability. The inability to function in everyday settings includes deficits in performance of social, occupational, and independent living activities. Schizophrenia is also a life-shortening illness, caused mainly by poor physical health and its complications. Dysfunctional lifestyles including sedentary behavior and lack of physical activity prevail, while treatment with adipogenic antipsychotic medication interacts with poor performance in screening, monitoring, and intervention that result in shortening of life expectancies by 25-30 years. Disability interferes with self-care and medical care, further worsening physical health to produce a vicious cycle of disability. Further, the neurobiological impact of obesity on brain functioning is substantial and relevant to schizophrenia. Decision making deficits that lead to choices resulting in obesity themselves have neurobiological determinants. Simultaneous treatment of cognitive deficits and related deficits in functional skills, ubiquitous determinants of everyday functioning in schizophrenia, and targeted interventions aimed at poor physical health, especially obesity and associated comorbidities, may lead to additive or even interactive gains in everyday functioning in patients with schizophrenia not previously realized with other interventions.

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Dietary improvement in people with schizophrenia

Abstract: The diet of people with schizophrenia improved when they were given free fruit and vegetables but this was given free fruit and vegetables but this was not sustained after withdrawal of the intervention. A support programme added no benefit.

Cited by 78 publications

References 13 publications

Risk Factors for Overweight and Diabetes mellitus in Residential Psychiatric Patients

Risk Factors for Overweight and Diabetes mellitus in Residential Psychiatric Patients

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Cognitive deficits, obesity and disability in schizophrenia

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