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Changes in Body Mass and Metabolic Profiles in Patients with First-Episode Schizophrenia Treated for 12 Months with A First-Generation Antipsychotic

Published online by Cambridge University Press:  15 April 2020

B. Chiliza ,
L. Asmal ,
P. Oosthuizen ,
E. van Niekerk ,
R. Erasmus ,
M. Kidd ,
A. Malhotra  and
R. Emsley
B. Chiliza*
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
L. Asmal
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
P. Oosthuizen
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
E. van Niekerk
Affiliation:
Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
R. Erasmus
Affiliation:
Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
M. Kidd
Affiliation:
Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
A. Malhotra
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA
R. Emsley
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
*
*Corresponding author. Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, Cape Town, South Africa Tel.: +27 21 938 9227; fax: +27 21 938 9738. E-mail address:bonga@sun.ac.za (B. Chiliza).
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Abstract

Objectives:

To assess changes in body mass and metabolic profiles in patients with first-episode schizophrenia receiving standardised, assured treatment and to identify predictors and moderators of the effects.

Methods:

We investigated the changes in body mass, fasting blood glucose and lipids in 107 largely antipsychotic naïve, first-episode schizophrenia patients who were treated according to a standard algorithm with long-acting injectable flupenthixol decanoate over 12 months.

Results:

Eighty-three (78%) participants completed the 12 months of treatment, and 104 (97%) received 100% of the prescribed injections during their participation. There were significant increases in BMI (P < .0001), waist circumference (P = 0.0006) and triglycerides (P = 0.03) and decrease in HDL (P = 0.005), while systolic (P = 0.7) and diastolic blood pressure (P = 0.8), LDL (P = 0.1), cholesterol (P = 0.3), and glucose (P = 0.9) values did not change over time. The triglyceride: HDL ratio increased by 91%. Change in BMI was only correlated with change in triglycerides (P = .008). The only significant predictor of BMI increase was non-substance abuse (P = .002).

Conclusions:

The risks of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics. This is a global problem, and developing communities may be particularly susceptible.

Keywords

First-episode schizophreniaFlupenthixolWeight gainMetabolic syndromeDeveloping countries

Information

Type
Original article
Information
European Psychiatry , Volume 30 , Issue 2 , February 2015 , pp. 277 - 283
Copyright
Copyright © Elsevier Masson SAS 2014

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References

Addington, D., Addington, J., Maticka-Tyndale, E.. Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry Suppl 1993;22 (22):39–44.CrossRefGoogle Scholar
Alberti, K.G., Eckel, R.H., Grundy, S.M., Zimmet, P.Z., Cleeman, J.I., Donato, K.A., et al.Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120 (16):1640–1645.CrossRefGoogle Scholar
Allison, D.B., Loebel, A.D., Lombardo, I., Romano, S.J., Siu, C.O.. Understanding the relationship between baseline BMI and subsequent weight change in antipsychotic trials: effect modification or regression to the mean?. Psychiatry Res 2009 170 (2–3):172–176.CrossRefGoogle ScholarPubMed
Alvarez-Jimenez, M., Gonzalez-Blanch, C., Crespo-Facorro, B., Hetrick, S., Rodriguez-Sanchez, J.M., Perez-Iglesias, R., et al.Antipsychotic-induced weight gain in chronic and first-episode psychotic disorders: a systematic critical reappraisal. CNS Drugs 2008;22 (7):547–562.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders IV-TR. Washington, DC: American Psychiatric Association; 2000.Google Scholar
Brown, S., Birtwistle, J., Roe, L., Thompson, C.. The unhealthy lifestyle of people with schizophrenia. Psychol Med 1999;29 (3):697–701.CrossRefGoogle ScholarPubMed
Coldham, E.L., Addington, J., Addington, D.. Medication adherence of individuals with a first episode of psychosis. Acta Psychiatr Scand 2002;106 (4):286–290.CrossRefGoogle ScholarPubMed
Correll, C.U., Lencz, T., Malhotra, A.K.. Antipsychotic drugs and obesity. Trends Mol Med 2011;17 (2):97–107.CrossRefGoogle ScholarPubMed
Correll, C.U., Manu, P., Olshanskiy, V., Napolitano, B., Kane, J.M., Malhotra, A.K.. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA 2009;302 (16):1765–1773.CrossRefGoogle ScholarPubMed
De Hert, M., Dekker, J.M., Wood, D., Kahl, K.G., Holt, R.I., Moller, H.J.. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 2009;24 (6):412–424.CrossRefGoogle Scholar
de Wit, E., Delport, W., Rugamika, C.E., Meintjes, A., Möller, M., van Helden, P.D., et al.Genome-wide analysis of the structure of the South African Coloured Population in the Western Cape. Hum Genet 2010; 128 2: 145–153.CrossRefGoogle ScholarPubMed
de Wit, H.Flupenthixol. In Stolerman, I.P., Encyclopedia of psychopharmacology: Springer; 2010.Google Scholar
Dobiasova, M., Frohlich, J.. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem 2001;34 (7):583–588.CrossRefGoogle Scholar
Erasmus, R.T., Soita, D.J., Hassan, M.S., Blanco-Blanco, E., Vergotine, Z., Kegne, A.P., et al.High prevalence of diabetes mellitus and metabolic syndrome in a South African coloured population: baseline data of a study in Bellville, Cape Town. S Afr Med J 2012;102 (11 Pt 1):841–844.CrossRefGoogle Scholar
Falissard, B., Mauri, M., Shaw, K., Wetterling, T., Doble, A., Giudicelli, A., et al.The METEOR study: frequency of metabolic disorders in patients with schizophrenia. Focus on first and second generation and level of risk of antipsychotic drugs. Int Clin Psychopharmacol 2011;26 (6):291–302.CrossRefGoogle ScholarPubMed
First, M.B.Structured clinical interview for DSM-IV axis I disorders, SCID-I: clinician version. Washington, D.C: American Psychiatric Press; 1997.Google Scholar
Fleischhacker, W.W., Siu, C.O., Boden, R., Pappadopulos, E., Karayal, O.N., Kahn, R.S., et al.Metabolic risk factors in first-episode schizophrenia: baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial. Int J Neuropsychopharmacol 2013;16 (5):987–995.CrossRefGoogle ScholarPubMed
Foley, D.L., Morley, K.I.. Systematic review of early cardiometabolic outcomes of the first treated episode of psychosis. Arch Gen Psychiatry 2011;68 (6):609–616.CrossRefGoogle Scholar
Frohlich, J., Dobiasova, M.. Fractional esterification rate of cholesterol and ratio of triglycerides to HDL-cholesterol are powerful predictors of positive findings on coronary angiography. Clin Chem 2003;49 (11):1873–1880.CrossRefGoogle ScholarPubMed
Gebhardt, S., Haberhausen, M., Heinzel-Gutenbrunner, M., Gebhardt, N., Remschmidt, H., Krieg, J.C., et al.Antipsychotic-induced body weight gain: predictors and a systematic categorization of the long-term weight course. J Psychiatr Res 2009;43 (6):620–626.CrossRefGoogle Scholar
Gohlke, J.M., Dhurandhar, E.J., Correll, C.U., Morrato, E.H., Newcomer, J.W., Remington, G., et al.Recent advances in understanding and mitigating adipogenic and metabolic effects of antipsychotic drugs. Front Psychiatry 2012;28 (3):62.Google Scholar
Gupta, N., Shah, P., Nayyar, S., Misra, A.. Childhood obesity and the metabolic syndrome in developing countries. Indian J Pediatr 2013;80 (Suppl. 1):S28–S37.CrossRefGoogle ScholarPubMed
International Conference on Harmonization. ICH Harmoniesed Tripartite Guidelines for Good Clinical Practice. Surrey: Brookwood Medical Publications Ltd; 1996.Google Scholar
Kay, S.R., Fiszbein, A., Opler, L.A.. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13 (2):261–276.CrossRefGoogle Scholar
Kahn, R.S., Fleischhacker, W.W., Boter, H., Davidson, M., Vergouwe, Y., Keet, I.P., et al.Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008;371 (9618):1085–1097.CrossRefGoogle ScholarPubMed
Leucht, S., Corves, C., Arbter, D., Engel, R.R., Li, C., Davis, J.M.. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 2009;373 (9657):31–41.CrossRefGoogle ScholarPubMed
Malhotra, A.K., Correll, C.U., Chowdhury, N.I., Muller, D.J., Gregersen, P.K., Lee, A.T., et al.Association between common variants near the melanocortin 4 receptor gene and severe antipsychotic drug-induced weight gain. Arch Gen Psychiatry 2012;69 (9):904–912.CrossRefGoogle ScholarPubMed
Matsha, T.E., Hassan, M.S., Hon, G.M., Soita, D.J., Kengne, A.P., Erasmus, R.T.. Derivation and validation of a waist circumference optimal cutoff for diagnosing metabolic syndrome in a South African mixed ancestry population. Int J Cardiol 2013;168 (3):2954–2955.CrossRefGoogle Scholar
McEvoy, J.P., Meyer, J.M., Goff, D.C., Nasrallah, H.A., Davis, S.M., Sullivan, L., 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 from NHANES III. Schizophr Res 2005;80 (1):19–32.CrossRefGoogle ScholarPubMed
Messer, T., Glaser, T., Landen, H., Schmauss, M.. Long-term treatment with flupentixol results of a post-marketing surveillance study. J Psychopharmacol 2009;23 (7):805–813.CrossRefGoogle ScholarPubMed
Mitchell, A.J., Delaffon, V., Vancampfort, D., Correll, C.U., De Hert, M.. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med 2012;42 (1):125–147.CrossRefGoogle ScholarPubMed
Mitchell, A.J., Vancampfort, D., De Herdt, A., Yu, W., De Hert, M.. Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Schizophr Bull 2013;39 (2):295–305.CrossRefGoogle ScholarPubMed
Ochoa, S., Usall, J., Cobo, J., Labad, X., Kulkarni, J.. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treat 2012;2012 :916198.Google ScholarPubMed
Osby, U., Correia, N., Brandt, L., Ekbom, A., Sparen, P.. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000;45 (1–2):21–28.CrossRefGoogle ScholarPubMed
Patel, J.K., Buckley, P.F., Woolson, S., Hamer, R.M., McEvoy, J.P., Perkins, D.O., et al.Metabolic profiles of second-generation antipsychotics in early psychosis: findings from the CAFE study. Schizophr Res 2009;111 (1–3):9–16.CrossRefGoogle ScholarPubMed
Raedler, T.J.. Cardiovascular aspects of antipsychotics. Curr Opin Psychiatry 2010;23 (6):574–581.CrossRefGoogle ScholarPubMed
Ratzoni, G., Gothelf, D., Brand-Gothelf, A., Reidman, J., Kikinzon, L., Gal, G., et al.Weight gain associated with olanzapine and risperidone in adolescent patients: a comparative prospective study. J Am Acad Child Adolesc Psychiatry 2002;41 (3):337–343.CrossRefGoogle ScholarPubMed
Schulz, K.F., Altman, D.G., Moher, D. CONSORT Group CONSORT 2010 Statement: updated Guidelines for Reporting Parallel Group Randomised Trials. PLoS Med 2010;7 (3):e1000251. http://dx.doi.org/10.1371/journal.pmed.1000251CrossRefGoogle ScholarPubMed
Shisana, O., Labadarios, D., Rehle, T., Simbayi, L., Zuma, K., Dhansay, A., et al.South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press; 2014.Google Scholar
Shen, X., Xia, J., Adams, C.E.Flupenthixol versus placebo for schizophrenia. Cochrane Database Syst Rev 2012;11 2CD009777.Google Scholar
Strassnig, M., Brar, J.S., Ganguli, R.Nutritional assessment of patients with schizophrenia: a preliminary study. Schizophr Bull 2003;29 (2):393–397.CrossRefGoogle ScholarPubMed
Strassnig, M., Miewald, J., Keshavan, M., Ganguli, R.Weight gain in newly diagnosed first-episode psychosis patients and healthy comparisons: one-year analysis. Schizophr Res 2007;93 (1–3):90–98.CrossRefGoogle ScholarPubMed
Stauffer, V.L., Sniadecki, J.L., Piezer, K.W., Gatz, J., Kollack-Walker, S., Hoffmann, V.P., Conley, R., Durell, T.Impact of race on efficacy and safety during treatment with olanzapine in schizophrenia, schizophreniform or schizoaffective disorder. BMC Psychiatry 2010;10 289.http://dx.doi.org/10.1186/1471-244X-10-89.CrossRefGoogle ScholarPubMed
Tarricone, I., Ferrari Gozzi, B., Serretti, A., Grieco, D., Berardi, D.Weight gain in antipsychotic-naive patients: a review and meta-analysis. Psychol Med 2010;40 (2):187–200.CrossRefGoogle ScholarPubMed
Tiihonen, J., Haukka, J., Taylor, M., Haddad, P.M., Patel, M.X., Korhonen, P.A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry 2011;168 (6):603–609.CrossRefGoogle Scholar
Velligan, D.I., Weiden, P.J., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., et al.Assessment of adherence problems in patients with serious and persistent mental illness: recommendations from the Expert Consensus Guidelines. J Psychiatr Pract 2010;16 (1):34–45.CrossRefGoogle ScholarPubMed
von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., Gøtzsche, P.C., Vandenbroucke, J.P.STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370 (9596):1453–1457.CrossRefGoogle ScholarPubMed
Zipursky, R.B., Gu, H., Green, A.I., Perkins, D.O., Tohen, M.F., McEvoy, J.P., et al.Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol. Br J Psychiatry 2005;187 :537–543.CrossRefGoogle ScholarPubMed
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