Dietary intake of schizophrenic patients in Nithsdale, Scotland: case-control study

McCreadie, Robin G.; Macdonald, Elizabeth; Blacklock, Claire; Tilak-Singh, Deepa; Wiles, D. H.; Halliday, Jennifer; Paterson, John R.

doi:10.1136/bmj.317.7161.784

Cited by 165 publications

(112 citation statements)

References 2 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…A rather scarce (relatively to the scope of the problem) literature on schizophrenic eating habits describes exag-gerated preference for unhealthy predominately fast foodtype (Peet, 2004a, c;Strassnig et al, 2005) palatable nutrition, poor in fiber (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

View full text Add to dashboard Cite

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...

show abstract

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

View full text Add to dashboard Cite

show abstract

“…This increased prevalence results from hereditary and environmental factors, such as less healthy lifestyles. Much of the increased risk can be ascribed to traditional diabetic risk factors such as family history, physical inactivity and poor diet, while there is evidence that SMI itself also increases the risk of diabetes [5][6][7][8]. Any data concerning the link between antipsychotics and diabetes must therefore give due consideration to other potentially confounding factors [2].…”

Section: The Sources Of Evidence Linking Antipsychotic Drugs and Diabmentioning

confidence: 99%

Antipsychotic drugs and diabetes—an application of the Austin Bradford Hill criteria

Holt

Peveler

2006

Diabetologia

View full text Add to dashboard Cite

There is concern that antipsychotic drugs cause diabetes. Although there has been an explosion in the quantity of literature about this subject, it remains confusing and inconsistent. To assess whether the association between antipsychotic drugs and diabetes is causative, we applied the Austin Bradford Hill criteria to the available evidence. In support of a causative relationship, there is temporality for some cases of diabetes, and there is a biologically plausible explanation. The causative link between antipsychotic drugs and diabetes is coherent with our understanding of diabetes and there are other analogies. However the strength of association is weak, there is lack of consistency or specificity, and there is little evidence to support a biological gradient. We should therefore conclude that the evidence surrounding a causative link between antipsychotic drugs and diabetes is inconclusive. Moreover, the risk is probably low and the attributable risk of developing diabetes is greater for traditional risk factors such as family history, ethnicity, obesity and ageing than it is for receiving an antipsychotic drug. Consequently, the majority of patients receiving second-generation antipsychotics will not develop diabetes as a result of their medication.

show abstract

“…A small case-control study in a Scottish population demonstrated that people with schizophrenia made poor dietary choices, characterised by high fat and low fibre intake (McCreadie et al, 1998). The subsequent larger study (McCreadie, 2003) examined in detail the dietary intake of 102 people with schizophrenia in Dumfries and Glasgow.…”

Section: Dietmentioning

confidence: 99%

Lifestyle and physical health in schizophrenia

Connolly¹,

Kelly²

2005

Adv. psychiatr. treat

View full text Add to dashboard Cite

People with schizophrenia have a higher risk of medical illness than does the general population. They also have an increased (by two-to fourfold) relative risk of premature death, dying at least 10 years earlier than age-matched contemporaries (Brown, 1997;Joukamaa et al, 2001). Brown's study of mortality in schizophrenia found that 12% of reported deaths were by suicide, which accounted for 28% of the excess. A further two-thirds of this excess was attributed to 'natural causes' such as cardiovascular disease, respiratory disease and diabetes.Undoubtedly, much of the excess morbidity and mortality of schizophrenia is preventable through lifestyle modification and the recognition and treatment of common diseases. Although there is a clear evidence base acknowledging the poor physical health of people with mental illness, the potential for improving outcomes in this area has been largely neglected in both research and clinical practice.With changing clinical practice, outcome studies have tended to concentrate on psychiatric outcomes -symptomatology, service use, level of function and quality of life. The general lifestyle and physical health of patients with schizophrenia are relatively rarely studied.In this article, we bring together these areas of research and practice to inform the debate on how to improve the physical health of patients with schizophrenia and, ultimately, overall outcomes for the illness. Risk factorsMorbidity can be estimated individually using predictive risk factors and markers, some clearly modifiable and others not (Box 1). Modifiable risk factors are prevalent in people with schizophrenia. They are a consequence of the illness itself, and of associated behaviours, lifestyle and treatment. It is clearly important that services available to people with schizophrenia appreciate the inflated risk and how it contributes to morbidity and premature mortality in these individuals. LifestyleOur lifestyle choices are influenced by a variety of factors such as genes, environment and sociodemographic status. In schizophrenia, the illness itself also plays a part. A drift down the social scale associated with unemployment and poorer financial Lifestyle and physical health in schizophrenia Moira Connolly & Ciara KellyAbstract People with schizophrenia die prematurely. Their illness, its treatment and their lifestyle all contribute to the excess morbidity and mortality. Lifestyle 'choices' (e.g. poor diet, low rates of physical activity and increased likelihood to smoke cigarettes) predispose them to poor physical health and comorbid medical diseases. In addition, weight gain and obesity are a consequence of most antipsychotics, particularly the atypicals. Excessive body weight increases the risk of morbidity and mortality, and is the biggest risk factor for type II diabetes in schizophrenia. Much of the excess mortality of schizophrenia is preventable through lifestyle and risk factor modification and the treatment of common diseases, but the potential for improving outcomes in this area is only s...

show abstract

Dietary intake of schizophrenic patients in Nithsdale, Scotland: case-control study

Cited by 165 publications

References 2 publications

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

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

Antipsychotic drugs and diabetes—an application of the Austin Bradford Hill criteria

Lifestyle and physical health in schizophrenia

Contact Info

Product

Resources

About