The impact of pharmacological and non‐pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta‐review of meta‐analyses of randomized controlled trials

Abstract

We summarized and compared meta-analyses of pharmacological and non-pharmacological interventions targeting physical health outcomes among people with schizophrenia spectrum disorders. Major databases were searched until June 1, 2018. Of 3,709 search engine hits, 27 metaanalyses were included, representing 128 meta-analyzed trials and 47,231 study participants. While meta-analyses were generally of adequate or high quality, meta-analyzed studies were less so. The most effective weight reduction interventions were individual lifestyle counseling (standardized mean difference, SMD=-0.98) and exercise interventions (SMD=-0.96), followed by psychoeducation (SMD=-0.77), aripiprazole augmentation (SMD=-0.73), topiramate (SMD=-0.72), d-fenfluramine (SMD=-0.54) and metformin . Regarding waist circumference reduction, aripiprazole augmentation (SMD=-1.10) and topiramate (SMD=-0.69) demonstrated the best evidence, followed by dietary interventions . Dietary interventions were the only to significantly improve (diastolic) blood pressure (SMD=-0.39). Switching from olanzapine to quetiapine or aripiprazole (SMD=-0.71) and metformin (SMD=-0.65) demonstrated best efficacy for reducing glucose levels, followed by glucagon-like peptide-1 receptor agonists (SMD=-0.39), dietary interventions (SMD=-0.37) and aripiprazole augmentation (SMD=-0.34), whereas insulin resistance improved the most with metformin (SMD=-0.75) and rosiglitazone . Topiramate had the greatest efficacy for triglycerides (SMD=-0.68) and low-density lipoprotein (LDL)-cholesterol (SMD=-0.80), whereas metformin had the greatest beneficial effects on total cholesterol (SMD=-0.51) and high-density lipoprotein (HDL)-cholesterol (SMD=0.45). Lifestyle interventions yielded small effects for triglycerides, total cholesterol and LDL-cholesterol (SMD=-0.35 to -0.37). Only exercise interventions increased exercise capacity (SMD=1.81). Despite frequent physical comorbidities and premature mortality mainly due to these increased physical health risks, the current evidence for pharmacological and non-pharmacological interventions in people with schizophrenia to prevent and treat these conditions is still limited and more larger trials are urgently needed.People with schizophrenia have substantially poorer physi cal health than the general population 14 , which is often attrib uted to an interaction between social circumstances, lifestyle factors and treatment effects 5 . For instance, behavioral re search has demonstrated that people with schizophrenia are less physically active and exhibit more sedentary behavior than the general population 6 , have a higher quantity but lower qual ity of dietary food intake 7 , and increased adverse health behav iors, such as smoking 8 . Additionally, psychiatric treatment with antipsychotics and other commonly prescribed agents, such as mood stabilizers and antidepressants, further increases the risk of physical health conditions 9,10 . Consequently, people with schizophrenia more frequently have cardiometabolic diseases 1113 , respiratory d...

Increased mortality from somatic multimorbidity in patients with schizophrenia: a Danish nationwide cohort study

“…Therefore, residual confounders need to be considered to our finding, such as tobacco use and substance‐ or alcohol abuse, which is much more prevalent in patients with schizophrenia than in individuals without , and have shown a large contribution to mortality in patients with schizophrenia . Lack of healthy diet intake , less physical activity , and a higher impact of unnatural deaths in patients with schizophrenia might also skew the results toward a lower contribution of somatic diseases in patients with schizophrenia. Together, poor health‐seeking behaviour from patients as well as insufficient quality of care provided by caregivers could contribute to the excess mortality observed.…”

Balancing body and mind: selecting the optimal antipsychotic

“…4 This approach should combine advice and support around exercise, diet, and medications, such as metformin. 10 Management of acute schizophrenia should not be limited to medications. For instance, strong evidence supports the beneficial effects of psychosocial treatments, such as family therapy, cognitive interventions, and community-based rehabilitation.…”

Metformin add‐on vs. antipsychotic switch vs. continued antipsychotic treatment plus healthy lifestyle education in overweight or obese youth with severe mental illness: results from the IMPACT trial

“…Cardiometabolic risk monitoring in antipsychotic‐treated patients is often inadequate, especially in youth. Interventions for antipsychotic‐related weight gain and metabolic abnormalities are still insufficiently established and, especially, infrequently implemented.…”

“…Several strategies to reduce antipsychotic‐induced weight gain have been tested in adults. They include behavioral lifestyle interventions, switch to a lower‐risk antipsychotic, and addition of topiramate or metformin.…”

“…Among the pharmacological weight loss interventions for adults with severe mental illness, metformin is so far the best studied. In a meta‐analysis of 19 RCTs (N=1,279), the addition of metformin to antipsychotic treatment for an average of 3‐4 months significantly reduced body weight relative to control conditions, with a medium effect size of 0.61.…”