Impact of antipsychotic treatments on the motivation to eat: preliminary results in 153 schizophrenic patients

Abstract

Many aspects of the motivation to eat are involved in the impairment of adequate food intake and body weight control. The aim of this study was to evaluate, by adopting widely used eating questionnaires, the Three Factors Eating Behaviour Questionnaire (TFEQ) and the Dutch Eating Behavior Questionnaire (DEBQ), the associations of different antipsychotic medications with the food attitudes of 153 schizophrenic patients: we compared 93 individuals treated with atypical antipsychotics, 27 treated with conventional neuroleptics and 33 untreated patients. We did not find any difference according to sex, but the mean body mass index varied significantly among the three groups of patients. The DEBQ external eating factor was higher in patients treated with atypical antipsychotics than in patients who received conventional neuroleptics (P=0.035). The TFEQ disinhibition and DEBQ emotional eating scores tended to change among the three types of treatment. Patients with metabolic syndrome (19%) had lower DEBQ external eating scores (P=0.044) and a tendency of higher TFEQ disinhibition scores. The TFEQ disinhibition and hunger scores increased according to the body mass index (P=0.003; P=0.017). The main outcome of this study is that the patients treated with atypical antipsychotics were more reactive to external eating cues, which could partly explain the higher weight gain often reported in these patients.

Atypical antipsychotics and effects on feeding: from mice to men

“…Interestingly, HAL has been shown to decrease the hedonic value of food (Galistu et al 2011;Hartfield et al 2003) but can also decrease satiety at a lower dosing range (Lee and Clifton 2012;Kaur and Kulkarni 2002). Notably, it has been proposed that obesity and addiction may share a reduction in striatal D 2/3 signaling (Tomasi and Volkow 2013), which may have implications for the observed increases in feeding disinhibition and binge eating observed in the aforementioned human studies (Blouin et al 2008;Kluge et al 2007;Sentissi et al 2009;Theisen et al 2003).…”

“…AAPs have also been associated with perturbations in the secretion and/or action of several hormones (insulin, leptin, ghrelin, adiponectin) and neuropeptides (NPY, AgRP, POMC) involved in the control of satiety and feeding behaviors (Jin et al 2008;Sentissi et al 2009;Song et al 2013). Results are, however, inconsistent; for example, Davoodi et al (2009) demonstrated increased meal size with acute OLA administration in rats was not associated with changes in NPY or POMC mRNA levels.…”

“…An functional magnetic imaging (fMRI) study examining appetite alterations in patients switching to OLA demonstrated increased activity in the limbic brain region (a site implicated in the integration of homeostatic and extrinsic influences associated with eating behaviors) of patients in response to an appetizing stimulus as compared to controls (Stip et al 2012). Finally, a study looked at changes in food attitude with AAP treatment and found that, in general, the AAP group was more susceptible to external food related cues (Sentissi et al 2009). …”

Effects of Antipsychotic Medications on Appetite, Weight, and Insulin Resistance

“…33 The patients treated with atypical APDs were also more reactive to external eating cues. 34 Furthermore, a recent study reported that, consistent with the significant increase of body weight, food consumption and disinhibited eating, one week treatment with olanzapine enhanced both the anticipatory and consummatory reward response to food rewards in the brain reward circuitry, including the inferior frontal cortex, striatum and anterior cingulate cortex, but decreased activation in the brain region (the lateral orbital frontal cortex) thought to inhibit feeding behaviour.…”

“…[32][33][34] On the other hand, there is less understanding of to what extent changes of resting metabolism rate and activity/sedation affect weight gain associated with APD medication, although current evidence suggests that they may play an important role in the development of APD-induced weight gain. 19,35,36 Altered eating behaviours have been reported in a number of clinical studies with treatment involving various APDs.…”