Predicting antipsychotic-induced weight gain in first episode psychosis – A field-wide systematic review and meta-analysis of non-genetic prognostic factors

Abstract

Background Whether non-genetic prognostic factors significantly influence the variable prognosis of antipsychotic-induced weight gain (AIWG) has not yet been systematically explored. Methods Searches for both randomized and non-randomized studies were undertaken using four electronic databases, two trial registers, and via supplemental searching methods. Unadjusted and adjusted estimates were extracted. Meta-analyses were undertaken using a random-effects generic inverse model. Risk of bias and quality assessments were undertaken using Quality in Prognosis Studies (QUIPS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively. Results Seventy-two prognostic factors were assessed across 27 studies involving 4426 participants. Only age, baseline body mass index (BMI), and sex were suitable for meta-analysis. Age (b=−0.044, 95%CI −0.157–0.069), sex (b=0.236, 95%CI −0.086–0.558), and baseline BMI (b=−0.013 95%CI −0.225–0.200) were associated with nonsignificant effects on AIWG prognosis. The highest quality GRADE rating was moderate in support of age, trend of early BMI increase, antipsychotic treatment response, unemployment, and antipsychotic plasma concentration. Trend of early BMI increase was identified as the most clinically significant prognostic factor influencing long-term AIWG prognosis. Conclusions The strong prognostic information provided by BMI trend change within 12 weeks of antipsychotic initiation should be included within AIWG management guidance to highlight those at highest risk of worse long-term prognosis. Antipsychotic switching and resource-intensive lifestyle interventions should be targeted toward this cohort. Our results challenge previous research that several clinical variables significantly influence AIWG prognosis. We provide the first mapping and statistical synthesis of studies examining non-genetic prognostic factors of AIWG and highlight practice, policy, and research implications.

Shared and unique characteristics of metabolic syndrome in psychotic disorders: a review

“…Indeed, while notable metabolic changes (e.g. triglyceride concentration, waist circumference, and high-density lipoprotein-cholesterol concentration) may be present in FEP individuals, and worsen over the course of the first following year, no conclusive predictors of MetS or of antipsychotic-induced weight gain ( 113 ) have been identified in this population, yet ( 114 ), and polygenetic risk scores-based predictions showed preliminary early promise but remain to be validated ( 115 ). Thus, individualized, longitudinal, and comprehensive surveillance of clinical and biological markers of metabolic and cardiovascular risk is necessary in PSD patients, and in FEP ones, who may be a higher risk of weight-gain and may benefit the most from preventive interventions.…”

Informing the development of antipsychotic-induced weight gain management guidance: patient experiences and preferences – qualitative descriptive study

“…Given its impact on AIWG prognosis, 40 participants described a fundamental aspect of managing AIWG being collaborative decision-making in antipsychotic treatment choices. The decision to change antipsychotic involves consideration of risk by both prescribers and patients.…”

“…Results may be less reflective of male AIWG management experiences and preferences, although we are somewhat reassured by the fact that gender has not been demonstrated to meaningfully impact AIWG risk and trajectory. 40 We did not have the opportunity to include a culturally diverse participant group which may limit result transferability. Five participants were professionally known to the researcher conducting interviews.…”

Are There Biological Correlates of Response to Yoga-Based Interventions in Depression? A Critical Scoping Review

“…However, these increases occur regardless of patient diagnosis, and are not meaningfully connected with contemporary models of the pathogenesis of psychosis. Therefore, they are not biologically plausible biomarkers of antipsychotic response [ 113 ].…”