Lifestyle Intervention and Metformin for Treatment of Antipsychotic-Induced Weight Gain

Wu, Renhua; Zhao, Jingping; Jin, Hua; Shao, Ping; Fang, Maosheng; Guo, Xiaofeng; He, Yanling; Liu, Yijun; Chen, Jindong; Li, Lehua

doi:10.1001/jama.2007.56-b

Cited by 311 publications

(326 citation statements)

References 36 publications

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“…Lifestyle changes are considered the first line of treatment to decrease cardiovascular risks in people with metabolic syndrome, 30 being more effective than pharmacological interventions. 3,8,15,20,[31][32][33][34][35][36][37][38][39][40] Forensic psychiatrists try to treat obesity on a case-by-case basis by imposing limits on junk food, 41 but systematic control over diet and behavioural contingencies is quite feasible in psychiatric hospitals. 33 A simple measure already taken in the study hospital is to reduce the regular diet to no more than 2400 kcal/day, and therapy for forensic inpatients with metabolic syndrome that supports dietary and activity changes is proposed.…”

Section: Discussionmentioning

confidence: 99%

Weight Gain and its Correlates among Forensic Inpatients

et al. 2015

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Objective: We investigated changes in weight, body mass index (BMI), and other indices of the metabolic syndrome in forensic inpatients. Weight gain associated with newer antipsychotics (APs) is well established in the general psychiatric population. Methods:We examined the medical records of 291 men admitted to a forensic hospital at admission and again at discharge or 365 days later if still in hospital. We also recorded diagnosis and smoker status on admission and quantified psychotropic treatment and adherence, physical activity, and daytime occupation during the hospitalization.Results: On admission, 33% were obese and 22% of the 106 patients for whom sufficient data were available met criteria for metabolic syndrome. Among patients staying at least 30 days, 60% were weighed again before discharge but repeated blood pressure and waist circumference measures were uncommon, even among those at greatest risk. The 122 forensic inpatients with sufficient information gained an average of 12% of their body weight and 40% increased by at least 1 BMI category, gaining an average of 3.67 kg per month. Weight gain was associated with duration of time and was not attributable to being underweight on admission, diagnosis of schizophrenia, atypical AP treatment, medication adherence, or having been a smoker. Conclusions:Patients gained weight during forensic hospitalization independent of medication use. We recommend further research using consistent measurement and wider sampling of both metabolic syndrome indicators and its individual and systemic causes in forensic populations.

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Section: Discussionmentioning

confidence: 99%

Weight Gain and its Correlates among Forensic Inpatients

et al. 2015

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“…Klein and colleagues, in their randomized, double-blind, placebo-controlled trial of metformin in children and adolescents taking atypical antipsychotics, found arrested weight gain, as well as improved insulin resistance (Klein et al 2006). Whereas Baptista and associates found that metformin did not prevent olanzapineinduced weight gain in a group of adult patients with schizophrenia (Baptista et al 2006), Wu and colleagues published two studies indicating that metformin, administered to a group of adult patients with schizophrenia on antipsychotics, including olanzapine, was effective in attenuating weight gain and improving insulin sensitivity (Wu et al 2008a;Wu et al 2008b). …”

Section: Introductionmentioning

confidence: 99%

Metformin for Weight Control in Pediatric Patients on Atypical Antipsychotic Medication

Shin

Bregman

Breeze

et al. 2009

Journal of Child and Adolescent Psychopharmacology

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Objective: Metformin was assessed as an interventional medication for weight gain in children and adolescents taking atypical antipsychotic agents. Method: A 12-week open-label trial was conducted to evaluate metformin's effectiveness and safety for weight management. Eleven subjects, ages 10-18 years, participated in the study. Each subject received metformin orally up to 2000 mg=day. Primary outcome measures included weight, body mass index (BMI), and waist circumference. Secondary outcome measures included serum glucose, insulin, and fasting lipid profile. Changes in weight, BMI, waist, and metabolic profile were obtained by using repeated measures of covariance. Results: The mean reduction in weight, waist, BMI, serum glucose, and serum insulin was not statistically significant. However, 5 out of 11 patients lost weight (mean, À2.82 kg AE 7.25), and overall the sample did not continue to gain weight. There was a significant decrease in triglyceride levels. Metformin was fairly well tolerated. Conclusion: Preliminary data suggests that metformin may safely and effectively improve the triglyceride profile. However, contrary to study hypotheses, weight, waist, and BMI reduction were not statistically significant. Future double-blind studies with larger sample sizes and of longer duration are warranted to assess more fully the safety and efficacy of this intervention.

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“…One way to explore this might be a randomized controlled trial of risperidone alone versus risperidone plus diet and exercise or versus risperidone plus metformin to prevent weight gain. Metformin, an antidiabetic drug, has been reported to be safe and effective to combat weight gain of antipsychotics in adults (Wu et al 2008) and children (Klein et al 2006). If the treatment including weight gain prevention produced better symptom outcomes than risperidone alone, then weight gain would be a negative mediator of some clinical value, and the behavioral effect would add to the physical health value of preventing excessive weight gain.…”

mentioning

confidence: 99%

Moderators, Mediators, and Other Predictors of Risperidone Response in Children with Autistic Disorder and Irritability

Arnold

Farmer

Kraemer

et al. 2010

Journal of Child and Adolescent Psychopharmacology

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Objective/Background: The National Institute of Mental Health (NIMH) Research Units on Pediatric Psychopharmacology (RUPP) Autism Network found an effect size of d ¼ 1.2 in favor of risperidone on the main outcome measure in an 8-week double-blind, placebo-controlled trial for irritability in autistic disorder. This paper explores moderators and mediators of this effect. Method: Intention-to-treat (ITT) analyses were conducted with suspected moderators and mediators entered into the regression equations. MacArthur Foundation Network subgroup guidelines were followed in the evaluation of the results. Results: Only baseline severity moderated treatment response: Higher severity showed greater improvement for risperidone but not for placebo. Weight gain mediated treatment response negatively: Those who gained more weight improved less with risperidone and more with placebo. Compliance correlated with outcome for risperidone but not placebo. Higher dose correlated with worse outcome for placebo, but not risperidone. Of nonspecific predictors, parent education, family income, and low baseline prolactin positively predicted outcome; anxiety, bipolar symptoms, oppositional-defiant symptoms, stereotypy, and hyperactivity negatively predicted outcome. Risperidone moderated the effect of change in 5 0 -nucleotidase, a marker of zinc status, for which decrease was associated with improvement only with risperidone, not with placebo.

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Lifestyle Intervention and Metformin for Treatment of Antipsychotic-Induced Weight Gain

Cited by 311 publications

References 36 publications

Weight Gain and its Correlates among Forensic Inpatients

Weight Gain and its Correlates among Forensic Inpatients

Metformin for Weight Control in Pediatric Patients on Atypical Antipsychotic Medication

Moderators, Mediators, and Other Predictors of Risperidone Response in Children with Autistic Disorder and Irritability

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