Schizophrenia, Obesity, and Antipsychotic Medications: What Can We Do?

Abstract

Obesity is one of the most common physical health problems among patients with severe and persistent mental illnesses, such as schizophrenia. Multifactorial in origin, obesity can be attributed to an unhealthy lifestyle as well as the effects of psychotropic medications such as second-generation antipsychotics. Excess body weight increases the risk for many medical problems, including type 2 diabetes mellitus, coronary heart disease, osteoarthritis, hypertension, and gallbladder disease. A PubMed search revealed 403 English-language citations to the query "schizophrenia" AND "obesity" and 469 citations to the query "obesity" AND "antipsychotics." The evidence is that different antipsychotics have different propensities for weight gain, and that children, adolescents, and fi rst-episode patients are at higher risk for weight gain associated with antipsychotic treatment. Monitoring body weight early in treatment will help predict those at high risk for substantial weight gain. Switching antipsychotic medication may or may not be clinically feasible, but can lead to a reduction in body weight. Lifestyle therapies and other nonpharmacological interventions have been shown to be effective in controlled clinical trials, but the evidence base for adjunctive medication strategies such as with orlistat, sibutramine, amantadine, nizatidine, metformin, topiramate, and others, is conflicting. At the very least, a "small-steps approach" to managing weight should be offered to all patients who are overweight or obese.

SMI Life Goals: Description of a randomized trial of a Collaborative Care Model to improve outcomes for persons with serious mental illness

“…Interventions to date that are designed to reduce CVD risk factors in persons with SMI have typically involved multiple provider teams [43-46], closely supervised diet or exercise regimens [47, 48], or were limited to a single diagnosis, thus precluding their potential generalizability in routine care settings [49, 50]. In contrast, LG-CC includes components that can be potentially taught to existing providers via a manual and training program.…”

Metabolic syndrome with the atypical antipsychotics

“…However, changing antipsychotics may not be as beneficial in patients who have pre-existing obesity or metabolic derangements prior to initiation of their antipsychotics [69]. The decision to switch should be individualized, and the potential benefit of metabolic improvement must be weighed against the risk that long-term efficacy and tolerability may not be maintained by the new antipsychotic drug [70].…”

Treatment of clozapine-associated weight gain: a systematic review

“…Findings such as these therefore highlight the potential for both pharmacological as well as behavioral interventions, such as nutritional counseling, to be implemented as a strategy for decreasing clozapineinduced weight gain. Although the degree of weight gain has been positively associated with improvement in psychopathology during clozapine treatment [25], as noted above, it places the patient at a greater risk of developing cardiometabolic disorders including type 2 DM and coronary heart disease [26], as well as psychosocial issues leading to non-adherence [27]. The leading cause of death in patients with schizophrenia is cardiovascular disease-34 % of deaths in males and 31 % in females [28]-which may be associated with APD treatment.…”