Course of weight gain and metabolic abnormalities in first treated episode of psychosis: the first year is a critical period for development of cardiovascular risk factors

Abstract

Data on the long-term metabolic side-effects associated with antipsychotics are scarce. Prospective longitudinal studies in medication-naive patients with a first episode of psychosis are a valuable source of information as they provide an assessment prior to the antipsychotic exposure and minimize the effect of potential confounding factors. The aim of this study was to assess the course of weight gain and the incidence of metabolic abnormalities during the first 3 yr of antipsychotic treatment. Data were collected from a cohort of 170 first-episode psychosis patients. They were randomly assigned to haloperidol (32%); olanzapine (32%) and risperidone (36%). The dose used was flexible. The initial antipsychotic treatment was changed when required, based on clinical response and tolerability. The results showed that the mean weight gain at 3 yr was 12.1 kg (s.d. = 10.7). It appeared to increase rapidly during the first year (85% of the total mean weight gain) and then stabilized gradually over time. Total cholesterol, LDL-cholesterol and triglyceride levels followed a similar trajectory with a significant increase only during the first year. No significant changes were detected in the mean values of glycaemic parameters. Two patients with a family history of diabetes developed diabetes type II. At short-term the factors positively associated with weight gain were lower body mass index, male gender and olanzapine treatment. At long-term, functional status and clinical response were the main predictors. The results of our study indicate that the first year of antipsychotic treatment is a critical period for weight gain and metabolic changes. Identification of weight gain patterns may help to inform studies that aim to prevent or mitigate the metabolic adverse events associated with antipsychotic therapy.

Weight Gain and its Correlates among Forensic Inpatients

“…1,13 Such medications have been associated with clinically significant weight gain in as few as 10 to 12 weeks. 1,8,[14][15][16][17][18][19][20][21] Among forensic patients, Haw and Rowell 10 reported that obesity was related to the prescription of 1 or more AP, particularly valproate. Ojala et al 22 found that, among Finnish forensic patients (89% male, 92% diagnosed with schizophrenia), metabolic syndrome and obesity were more common among those taking regular doses of atypical APs, controlling for age, sex, and clinical diagnosis, which were not themselves related to BMI.…”

Pharmacovigilance of Neuroleptics and Benzodiazepines in the Psychiatric Teaching Hospital of Benin Republic

“…Weight gaining is a SE due to neuroleptics and can be explained by the improvement of the appetite. 4.65% of the patients experienced an increase of appetite; a number which is smaller than the 78% of Pérez-Iglesias et al' in Spain [29]. This variation is explainable by difference of classes of the neuroleptics prescribed in both settings.…”

Altered reward anticipation: Potential explanation for weight gain in schizophrenia?

“…This Spanish study compared weight gain resulting from treatment with risperidone, haloperidol and olanzapine. In the first three months, olanzapine resulted in faster weight gain than risperidone or haloperidol, but after over 12 months, the amount of weight gain resulting from treatment with these drugs (8-10 kg) was not significantly different (Perez-Iglesias et al, 2008;Pérez-Iglesias et al, 2014). These data suggest that there is a shared general mechanism of weight gain induced by antipsychotics.…”

“…Indeed, weight gain can be excessive (about 12 kg body weight over a course of three years; cf. Pérez-Iglesias et al, 2014) and is typically observed after psychotropic treatment begins, suggesting an interaction between psychiatric disease and medication.…”

“…The weight gain seen with drugs like olanzapine and clozapine can be substantial, although it should be noted that especially clozapine is a drug used for the treatment of treatment-resistant patients (Kane and Correll, 2016), thereby confounding drug-induced weight gain and severity of illness. Weight gain appears to be greatest and most rapid during the first 6 weeks of treatment (Ascher-Svanum et al, 2005;Kemp et al, 2013), with a trend toward a plateau after 12-18 months of treatment (PerezIglesias et al, 2008;Pérez-Iglesias et al, 2014).…”