Hostname: page-component-848d4c4894-5nwft Total loading time: 0 Render date: 2024-05-19T03:39:43.959Z Has data issue: false hasContentIssue false
  • English
  • Français

Targeted Care Plans for Schizophrenia

Published online by Cambridge University Press:  07 November 2014

Oliver Freudenreich
Get access Rights & Permissions [Opens in a new window]

Extract

Thomas was a 40-year-old, white male, with a 16-year history of schizoaffective disorder (Slide 1). He first became ill at 24 years of age and had an unstable course for ∼10 years, characterized by frequent hospitalizations and partial adherence. Unfortunately, during episodes of psychosis, he was also extremely violent. During his first hospitalization, risperidone was initiated, which he used intermittently for ∼10 years. There are no records documenting his weight and metabolic parameters at 24 years of age prior to receiving psychiatric medications. During his last psychiatric hospitalization at 34 years of age, olanzapine was prescribed and he stabilized. He entered a period of stable outpatient treatment and had not had a psychiatric hospitalization for 6 years.

When Thomas began taking olanzapine, his weight was 200 lbs, which, given his height, corresponds to a body mass index (BMI) of 28, putting him in the overweight category. However, he had no metabolic monitoring for 3 years. After 3 years of treatment with olanzapine, he had gained substantial weight, increasing to 258 lbs, which corresponds to a BMI of 36 and class 2 obesity.

Type
Research Article
Information
CNS Spectrums , Volume 15 , supplement S8: Real World Management of Schizophrenia in the Comorbid Patient , July 2010 , pp. 6 - 9
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Volavka, J, Citrome, L. Oral antipsychotics for the treatment of schizophrenia: heterogeneity in efficacy and tolerability should drive decision-making. Expert Opin Pharmacother. 2009;10(12):1917–1928.CrossRefGoogle ScholarPubMed
2.Leucht, S, Corves, C, Arbter, D, Engel, RR, Li, C, Davis, JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009;373(9657):31–41.CrossRefGoogle ScholarPubMed
3.Leucht, S, Komossa, K, Rummel-Kluge, C et al. , A meta-analysis of head-to-head comparisons of second-generation antipsy-chotics in the treatment of schizophrenia. Am J Psychiatry. 2009;166(2):152–163.CrossRefGoogle Scholar
4.Lieberman, JA, Stroup, TS, McEvoy, JP et al. , Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209–1223.CrossRefGoogle ScholarPubMed
5.Kahn, RS, Fleischhacker, WW, Boter, H et al. , Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizo-phreniform disorder: an open randomised clinical trial. Lancet. 2008;29:1085–1097.CrossRefGoogle Scholar
6.Buchanan, RW, Kreyenbuhl, J, Kelly, DL et al. , The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull. 2010;36:71–93.CrossRefGoogle ScholarPubMed
7.McEvoy, JP, Lieberman, JA, Perkins, DO et al. , Efficacy and tolerability of olanzapine, quetiapine, and risperidone in the treatment of early psychosis: a randomized, double-blind, 52-week comparison. Am J Psychiatry. 2007;164:1050–1060.CrossRefGoogle ScholarPubMed
8.Davis, JM. The choice of drugs for schizophrenia. N Engl J Med. 2006;354(5):518–520.CrossRefGoogle ScholarPubMed
9.Miller, DD. Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):3–7.Google ScholarPubMed
10.Correll, CU, Manu, P, Olshanskiy, V, Napolitano, B, Kane, JM, Malhotra, AK. Cardiometabolic risk of second-generation antipsy-chotic medications during first-time use in children and adolescents. JAMA. 2009;302(16):1765–1773.CrossRefGoogle Scholar
11.Sikich, L, Frazier, JA, McClellan, J et al. , Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. Am J Psychiatry. 2008;165(11):1420–1431.CrossRefGoogle ScholarPubMed
12.McEvoy, JP, Meyer, JM, Goff, DC et al. , Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates esting rates in 3 state Medicaid programs after FDA warnings and ADA/APA recommendations for second-generation antipsychotic drugs. Arch Gen Psychiatry. 2010;67(1):17–24.Google Scholar
13.Weiden, PJ, Newcomer, JW, Loebel, AD, Lebovitz, HE. Long-term changes in weight and plasma lipids during maintenance treatment with ziprasidone. Neuropsychopharmacology. 2008;33(5):985–994.CrossRefGoogle ScholarPubMed
14.Morrato, EH, Druss, B, Hartung, DM et al. , Metabolic from NHANES III. Schizophr Res. 2005;80:19–32.Google Scholar
15.Stroup, TS, McEvoy, JP, Swartz, MS et al. , Comparison of antipsychotics for metabolic problems (CAMP): a NIMH schizophrenia trials network study. Clin Schizophr Related Psychoses. 2007;1:69–72.CrossRefGoogle Scholar
16.De Hert, M, Kalnicka, D, van Winkel, R et al. , Treatment with rosuvastatin for severe dyslipidemia in patients with schizophrenia and schizoaffective disorder. J Clin Psychiatry. 2006;67(12):1889–1896.CrossRefGoogle ScholarPubMed
17.Wu, RR, Zhao, JP, Jin, H et al. , Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain: a randomized controlled trial. JAMA. 2008;299(2):185–193.CrossRefGoogle ScholarPubMed
18.Henderson, DC, Copeland, PM, Daley, TB et al. , A double-blind, placebo-controlled trial of sibutramine for olanzapine-associated weight gain. Am J Psychiatry. 2005;162(5):954–962.CrossRefGoogle ScholarPubMed
19.Dixon, LB, Dickerson, F, Bellack, AS et al. , The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull. 2010;36(1):48–70.CrossRefGoogle ScholarPubMed
20.Newcomer, JW, Campos, JA, Marcus, RN et al. , A multicenter, randomized, double-blind study of the effects of aripiprazole in overweight subjects with schizophrenia or schizoaffective disorder switched from olanzapine. J Clin Psychiatry. 2008;69:1046–1056.CrossRefGoogle ScholarPubMed
21.Kim, SH, Ivanova, O, Abbasi, FA et al. , Metabolic impact of switching antipsychotic therapy to aripiprazole after weight gain: a pilot study. J Clin Psychopharmacol. 2007;27:365–368.CrossRefGoogle ScholarPubMed
22.Kumra, S, Oberstar, JV, Sikich, L et al. , Efficacy and tolerability of second-generation antipsychotics in children and adolescents with schizophrenia. Schizophr Bull. 2008;34:60–71.CrossRefGoogle ScholarPubMed
23.Perez-Iglesias, R, Crespo-Facorro, B, Martinez-Garcia, O et al. , Weight gain induced by haloperidol, risperidone and olanzapine after 1 year: findings of a randomized clinical trial in a drug-naïve population. Schizophr Res. 2008;99(1–3):13–22.CrossRefGoogle Scholar
24.Wu, RR, Zhao, JP, Guo, XF et al. , Metformin addition attenuates olanzapine-induced weight gain in drug-naive first-episode schizophrenia patients: a double-blind, placebo-controlled study. Am J Psychiatry. 2008;165(3):352–358.CrossRefGoogle ScholarPubMed
25.Alvarez-Jiménez, M, González-Blanch, C, Vázquez-Barquero, JL et al. , Attenuation of antipsychotic-induced weight gain with early behavioral intervention in drug-naive first-episode psychosis patients: A randomized controlled trial. J Clin Psychiatry. 2006;67(8):1253–1260.CrossRefGoogle ScholarPubMed
26.Alvarez-Jiménez, M, Martínez-García, O, Pérez-Iglesias, R et al. , Prevention of antipsychotic-induced weight gain with early behavioural intervention in first-episode psychosis: 2-year results of a randomized controlled trial. Schizophr Res. 2010;116(1):16–19.CrossRefGoogle ScholarPubMed
27.American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27:596–601.CrossRefGoogle Scholar