Association between the Weight Gain and Treatment Response to Atypical Antipsychotics in Korean Patients with Schizophrenia

한국인 정신분열병 환자에서 비정형 항정신병 약물의 치료반응과 체중증가의 관련성에 대한 연구

  • Lee, Jae-Byung (Department of Psychiatry, College of Medicine, Korea University) ;
  • Ham, Byung-Joo (Department of Psychiatry, College of Medicine, Korea University) ;
  • Lee, Hwa-Young (Department of Psychiatry, College of Medicine, Soonchunhyang University) ;
  • Lee, Min-Soo (Department of Psychiatry, College of Medicine, Korea University)
  • 이재병 (고려대학교 의과대학 정신과학교실) ;
  • 함병주 (고려대학교 의과대학 정신과학교실) ;
  • 이화영 (순천향대학교 의과대학 정신과학교실) ;
  • 이민수 (고려대학교 의과대학 정신과학교실)
  • Received : 2011.05.26
  • Accepted : 2011.07.25
  • Published : 2011.11.30

Abstract

Objectives Atypical antipsychotics show better treatment efficacy, safety and tolerability than typical antipsychotics. Among the adverse events observed during treatment with antipsychotics, extrapyramidal syndrome (EPS) and negative symptoms has been greatly reduced. But still, weight gain is receiving growing attention. The aim of this study was to investigate the association between therapeutic response to atypical antipsychotics and weight gain in admission status. Methods The study was conducted for Korean inpatients with schizophrenia in a university hospital in Seoul, between Jan 2006 and Dec 2010. Data was collected by reviewing the medical record of 39 consecutively hospitalized patients with Schizophrenia (DSM-IV) at a university hospital. Positive and Negative Symptom Scale (PANSS), Body Mass Index (BMI) and body weights were measured. Results No significant difference was observed for sex, age, illness onset age, family history of schizophrenia, numbers of hospitalization before treatment, educational years, marriage status, occupational status and subtype of schizophrenia between weight gainers and non-weight gainers. Regarding treatment response to atypical antipsychotics, weight gainers show significantly more PANSS decrease than non-weight gainers during admission period. Conclusions Our findings suggest that it appears to be more likely to respond to atypical antipsychotics in weight gainers than non-weight gainers (that weght gainers appear to be more likely to respond to atypical antipsychotics than non-weight gainers). These results show that the antipsychotic-induced body weight gain is associated with therapeutic response of antipsychotics in Korean inpatients with schizophrenia.

Keywords

References

  1. David SR, Taylor CC, Kinon BJ, Breier A. The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia. Clin Ther 2000;22:1085-1096. https://doi.org/10.1016/S0149-2918(00)80086-7
  2. Tollefson GD, Beasley CM Jr, Tran PV, Street JS, Krueger JA, Tamura RN, et al. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry 1997;154:457-465.
  3. Rege S. Antipsychotic induced weight gain in schizophrenia: mechanisms and management. Aust N Z J Psychiatry 2008;42:369-381. https://doi.org/10.1080/00048670801961123
  4. Casey DE. The relationship of pharmacology to side effects. J Clin Psychiatry 1997;58 Suppl 10:55-62.
  5. Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 1999;156:1686-1696.
  6. Ganguli R. Weight gain associated with antipsychotic drugs. J Clin Psychiatry 1999;60 Suppl 21:20-24.
  7. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353:1209-1223. https://doi.org/10.1056/NEJMoa051688
  8. Weiden PJ, Mackell JA, McDonnell DD. Obesity as a risk factor for antipsychotic noncompliance. Schizophr Res 2004;66:51-57. https://doi.org/10.1016/S0920-9964(02)00498-X
  9. Theisen FM, Linden A, Geller F, Schäfer H, Martin M, Remschmidt H, et al. Prevalence of obesity in adolescent and young adult patients with and without schizophrenia and in relationship to antipsychotic medication. J Psychiatr Res 2001;35:339-345. https://doi.org/10.1016/S0022-3956(01)00041-3
  10. Brixner DI, Said Q, Corey-Lisle PK, Tuomari AV, L'italien GJ, Stockdale W, et al. Naturalistic impact of second-generation antipsychotics on weight gain. Ann Pharmacother 2006;40:626-632. https://doi.org/10.1345/aph.1G564
  11. Czobor P, Volavka J, Sheitman B, Lindenmayer JP, Citrome L, McEvoy J, et al. Antipsychotic-induced weight gain and therapeutic response: a differential association. J Clin Psychopharmacol 2002;22: 244-251. https://doi.org/10.1097/00004714-200206000-00003
  12. Ascher-Svanum H, Stensland M, Zhao Z, Kinon BJ. Acute weight gain, gender, and therapeutic response to antipsychotics in the treatment of patients with schizophrenia. BMC Psychiatry 2005;5:3. https://doi.org/10.1186/1471-244X-5-3
  13. Garyfallos G, Dimelis D, Kouniakis P, Sidiropoulos N, Karastergiou A, Lavrentiadis G, et al. Olanzapine versus risperidone: weight gain and elevation of serum triglyceride levels. Eur Psychiatry 2003;18:320-321. https://doi.org/10.1016/j.eurpsy.2003.06.002
  14. 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. https://doi.org/10.2337/diacare.27.2.596
  15. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261-276. https://doi.org/10.1093/schbul/13.2.261
  16. Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003;64:663-667. https://doi.org/10.4088/JCP.v64n0607
  17. Muller MJ, Wetzel H, Eich FX, Rein W, Puech A, Benkert O; Amisulpride Study Group. Dose-related effects of amisulpride on five dimensions of psychopathology in patients with acute exacerbation of schizophrenia. J Clin Psychopharmacol 2002;22:554-560. https://doi.org/10.1097/00004714-200212000-00004
  18. Simpson GM, Josiassen RC, Stanilla JK, de Leon J, Nair C, Abraham G, et al. Double-blind study of clozapine dose response in chronic schizophrenia. Am J Psychiatry 1999;156:1744-1750.
  19. Tzimos A, Samokhvalov V, Kramer M, Ford L, Gassmann-Mayer C, Lim P, et al. Safety and tolerability of oral paliperidone extended- release tablets in elderly patients with schizophrenia: a doubleblind, placebo-controlled study with six-month open-label extension. Am J Geriatr Psychiatry 2008;16:31-43. https://doi.org/10.1097/JGP.0b013e31815a3e7a
  20. Jalenques I, Tauveron I, Albuisson E, Audy V. [Weight gain and clozapine]. Encephale 1996;22 Spec No 3:77-79.
  21. Wetterling T, MÜssigbrodt HE. Weight gain: side effect of atypical neuroleptics? J Clin Psychopharmacol 1999;19:316-321. https://doi.org/10.1097/00004714-199908000-00006
  22. Kalucy RS. Drug-induced weight gain. Drugs 1980;19:268-278. https://doi.org/10.2165/00003495-198019040-00002
  23. Bustillo JR, Buchanan RW, Irish D, Breier A. Differential effect of clozapine on weight: a controlled study. Am J Psychiatry 1996; 153:817-819.
  24. Bai YM, Lin CC, Chen JY, Lin CY. Weight gain among patients on clozapine. Psychiatr Serv 1999;50:704-705.
  25. Shrivastava A, Johnston ME. Weight-gain in psychiatric treatment: risks, implications, and strategies for prevention and management. Mens Sana Monogr 2010;8:53-68. https://doi.org/10.4103/0973-1229.58819
  26. Wetterling T. Bodyweight gain with atypical antipsychotics. A comparative review. Drug Saf 2001;24:59-73. https://doi.org/10.2165/00002018-200124010-00005
  27. Stanton JM. Weight gain associated with neuroleptic medication: a review. Schizophr Bull 1995;21:463-472. https://doi.org/10.1093/schbul/21.3.463
  28. Baptista T. Body weight gain induced by antipsychotic drugs: mechanisms and management. Acta Psychiatr Scand 1999;100:3- 16. https://doi.org/10.1111/j.1600-0447.1999.tb10908.x
  29. Jin H, Meyer JM, Mudaliar S, Jeste DV. Impact of atypical antipsychotic therapy on leptin, ghrelin, and adiponectin. Schizophr Res 2008;100:70-85. https://doi.org/10.1016/j.schres.2007.11.026
  30. Chengappa KN, Sheth S, Brar JS, Parepally H, Marcus S, Gopalani A, et al. Risperidone use at a state hospital: a clinical audit 2 years after the first wave of risperidone prescriptions. J Clin Psychiatry 1999;60:373-378. https://doi.org/10.4088/JCP.v60n0605
  31. Jaffe AB, Levine J. Efficacy and effectiveness of first- and secondgeneration antipsychotics in schizophrenia. J Clin Psychiatry 2003;64 Suppl 17:3-6.
  32. Stroup TS, Lieberman JA, McEvoy JP, Swartz MS, Davis SM, Capuano GA, et al. Effectiveness of olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia after discontinuing perphenazine: a CATIE study. Am J Psychiatry 2007;164:415- 427. https://doi.org/10.1176/appi.ajp.164.3.415
  33. Taylor M, Shajahan P, Lawrie SM. Comparing the use and discontinuation of antipsychotics in clinical practice: an observational study. J Clin Psychiatry 2008;69:240-245. https://doi.org/10.4088/JCP.v69n0210
  34. Essock SM, Hargreaves WA, Covell NH, Goethe J. Clozapine's effectiveness for patients in state hospitals: results from a randomized trial. Psychopharmacol Bull 1996;32:683-697.
  35. Wirshing DA, Wirshing WC, Kysar L, Berisford MA, Goldstein D, Pashdag J, et al. Novel antipsychotics: comparison of weight gain liabilities. J Clin Psychiatry 1999;60:358-363. https://doi.org/10.4088/JCP.v60n0602
  36. Marder SR, Essock SM, Miller AL, Buchanan RW, Davis JM, Kane JM, et al. The Mount Sinai conference on the pharmacotherapy of schizophrenia. Schizophr Bull 2002;28:5-16. https://doi.org/10.1093/oxfordjournals.schbul.a006926