Weight and metabolic changes in early psychosis-association with daily quantification of medication exposure during the first hospitalization.
antipsychotics
cholesterol
dyslipidemia
first episode psychosis
schizophrenia
Journal
Acta psychiatrica Scandinavica
ISSN: 1600-0447
Titre abrégé: Acta Psychiatr Scand
Pays: United States
ID NLM: 0370364
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
30
05
2023
received:
18
02
2023
accepted:
06
07
2023
medline:
23
8
2023
pubmed:
2
8
2023
entrez:
2
8
2023
Statut:
ppublish
Résumé
The most common causes of death in schizophrenia are cardiovascular disorders, which are closely related to metabolic syndrome/obesity. To better understand the development of metabolic alterations early in the course of illness, we quantified daily medication exposure in the first days of the first hospitalization for psychosis and related it to changes in weight and metabolic markers. We recruited participants with first episode psychosis (FEP, N = 173) during their first psychiatric hospitalization and compared them to controls (N = 204). We prospectively collected weight, body mass index, metabolic markers, and exact daily medication exposure at admission and during hospitalization. Individuals with FEP gained on average 0.97 ± 2.26 BMI points or 3.46 ± 7.81 kg of weight after an average of 44.6 days of their first inpatient treatment. Greater antipsychotic exposure was associated with greater BMI increase, but only in people with normal/low baseline BMI. Additional predictors of weight gain included type of medication and duration of treatment. Medication exposure was not directly related to metabolic markers, but higher BMI was associated with higher TGC, TSH, and lower HDL. Following inpatient treatment, participants with FEP had significantly higher BMI, TGC, prolactin, and lower fT4, HDL than controls. During their first admission, people with FEP, especially those with normal/low baseline BMI, showed a rapid and clinically significant weight increase, which was associated with exposure to antipsychotics, and with metabolic changes consistent with metabolic syndrome. These findings emphasize weight monitoring in FEP and suggest a greater need for caution when prescribing metabolically problematic antipsychotics to people with lower BMI.
Sections du résumé
BACKGROUND
The most common causes of death in schizophrenia are cardiovascular disorders, which are closely related to metabolic syndrome/obesity. To better understand the development of metabolic alterations early in the course of illness, we quantified daily medication exposure in the first days of the first hospitalization for psychosis and related it to changes in weight and metabolic markers.
STUDY DESIGN
We recruited participants with first episode psychosis (FEP, N = 173) during their first psychiatric hospitalization and compared them to controls (N = 204). We prospectively collected weight, body mass index, metabolic markers, and exact daily medication exposure at admission and during hospitalization.
STUDY RESULTS
Individuals with FEP gained on average 0.97 ± 2.26 BMI points or 3.46 ± 7.81 kg of weight after an average of 44.6 days of their first inpatient treatment. Greater antipsychotic exposure was associated with greater BMI increase, but only in people with normal/low baseline BMI. Additional predictors of weight gain included type of medication and duration of treatment. Medication exposure was not directly related to metabolic markers, but higher BMI was associated with higher TGC, TSH, and lower HDL. Following inpatient treatment, participants with FEP had significantly higher BMI, TGC, prolactin, and lower fT4, HDL than controls.
CONCLUSION
During their first admission, people with FEP, especially those with normal/low baseline BMI, showed a rapid and clinically significant weight increase, which was associated with exposure to antipsychotics, and with metabolic changes consistent with metabolic syndrome. These findings emphasize weight monitoring in FEP and suggest a greater need for caution when prescribing metabolically problematic antipsychotics to people with lower BMI.
Substances chimiques
Antipsychotic Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
265-276Subventions
Organisme : CIHR
ID : 180449
Pays : Canada
Organisme : CIHR
ID : 142255
Pays : Canada
Informations de copyright
© 2023 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.
Références
Cowman M, Godfrey E, Walsh T, et al. Measures of social and occupational function in early psychosis: a systematic review and meta-analysis. Schizophr Bull. 2023;sbad062. doi:10.1093/schbul/sbad062
Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575-1586. doi:10.1016/S0140-6736(13)61611-6
Harvey PD, Bosia M, Cavallaro R, et al. Cognitive dysfunction in schizophrenia: an expert group paper on the current state of the art. Schizophr Res Cogn. 2022;29:100249. doi:10.1016/j.scog.2022.100249
Taipale H, Tanskanen A, Mehtälä J, Vattulainen P, Correll CU, Tiihonen J. 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry. 2020;19(1):61-68. doi:10.1002/wps.20699
Brown S. Excess mortality of schizophrenia: a meta-analysis. Br J Psychiatry. 1997;171(6):502-508. doi:10.1192/bjp.171.6.502
Bushe CJ, Taylor M, Haukka J. Review: mortality in schizophrenia: a measurable clinical endpoint. J Psychopharmacol (Oxf). 2010;24(4_suppl):17-25. doi:10.1177/1359786810382468
Kilbourne AM, Morden NE, Austin K, et al. Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors. Gen Hosp Psychiatry. 2009;31(6):555-563. doi:10.1016/j.genhosppsych.2009.07.008
Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annu Rev Clin Psychol. 2014;10(1):425-448. doi:10.1146/annurev-clinpsy-032813-153657
Nordentoft M, Wahlbeck K, Hallgren J, et al. Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS One. 2013;8(1932-6203 (Electronic)):e55176.
Laursen TM, Munk-Olsen T, Agerbo E, Gasse C, Mortensen PB. Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry. 2009;66(7):713-720. doi:10.1001/archgenpsychiatry.2009.61
Coodin S. Body mass index in persons with schizophrenia. Can J Psychiatry. 2001;46(6):549-555. doi:10.1177/070674370104600610
Saari K, Koponen H, Laitinen J, et al. Hyperlipidemia in persons using antipsychotic medication: a general population-based birth cohort study. J Clin Psychiatry. 2004;65(4):547-550. doi:10.4088/JCP.v65n0415
Afzal M, Siddiqi N, Ahmad B, et al. Prevalence of overweight and obesity in people with severe mental illness: systematic review and meta-analysis. Front Endocrinol. 2021;12:769309. doi:10.3389/fendo.2021.769309
Mitchell AJ, 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. doi:10.1093/schbul/sbs082
Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders-a systematic review and meta-analysis. Schizophr Bull. 2013;39(2):306-318. doi:10.1093/schbul/sbr148
Misiak B, Stańczykiewicz B, Łaczmański Ł, Frydecka D. Lipid profile disturbances in antipsychotic-naive patients with first-episode non-affective psychosis: a systematic review and meta-analysis. Schizophr Res. 2017;190:18-27. doi:10.1016/j.schres.2017.03.031
Hayes JF, Marston L, Walters K, King MB, Osborn DPJ. Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014. Br J Psychiatry. 2017;211(3):175-181. doi:10.1192/bjp.bp.117.202606
Manu P, Dima L, Shulman M, Vancampfort D, De Hert M, Correll CU. Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management. Acta Psychiatr Scand. 2015;132(2):97-108. doi:10.1111/acps.12445
Patel JK, Buckley PF, Woolson S, et al. Metabolic profiles of second-generation antipsychotics in early psychosis: findings from the CAFE study. Schizophr Res. 2009;111(1-3):9-16. doi:10.1016/j.schres.2009.03.025
Verma S, Liew A, Subramaniam M, Poon LY. Effect of treatment on weight gain and metabolic abnormalities in patients with first-episode psychosis. Aust N Z J Psychiatry. 2009;43(9):812-817. doi:10.1080/00048670903107609
Foley DL, Morley KI. Systematic review of early cardiometabolic outcomes of the first treated episode of psychosis. Arch Gen Psychiatry. 2011;68(6):609-616. doi:10.1001/archgenpsychiatry.2011.2
Bak M, Drukker M, Cortenraad S, Vandenberk E, Guloksuz S. Antipsychotics result in more weight gain in antipsychotic naive patients than in patients after antipsychotic switch and weight gain is irrespective of psychiatric diagnosis: a meta-analysis. PLoS One. 2021;16(2):e0244944. doi:10.1371/journal.pone.0244944
Bak M, Fransen A, Janssen J, van Os J, Drukker M. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS One. 2014;9(4):e94112. doi:10.1371/journal.pone.0094112
Coentre R, Levy P, Góis C, Figueira ML. Metabolic syndrome following a first episode of psychosis: results of a 1-year longitudinal study conducted in metropolitan Lisbon, Portugal. J Int Med Res. 2022;50(6):3000605221106703. doi:10.1177/03000605221106703
Vázquez-Bourgon J, Gómez-Revuelta M, Mayoral-van Son J, et al. Pattern of long-term weight and metabolic changes after a first episode of psychosis: results from a 10-year prospective follow-up of the PAFIP program for early intervention in psychosis cohort. Eur Psychiatry. 2022;65(1):e48. doi:10.1192/j.eurpsy.2022.2308
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl):20.
Fusar-Poli P, Cappucciati M, Rutigliano G, et al. Diagnostic stability of ICD/DSM first episode psychosis diagnoses: meta-analysis. Schizophr Bull. 2016;42(6):1395-1406. doi:10.1093/schbul/sbw020
Arango C, Giráldez M, Merchán-Naranjo J, et al. Second-generation antipsychotic use in children and adolescents: a six-month prospective cohort study in drug-naïve patients. J Am Acad Child Adolesc Psychiatry. 2014;53(11):1179-1190.e4. doi:10.1016/j.jaac.2014.08.009
Taylor DM, McAskill R. Atypical antipsychotics and weightgain―a systematic review: atypical antipsychotics and weight gain. Acta Psychiatr Scand. 2000;101(6):416-432. doi:10.1034/j.1600-0447.2000.101006416.x
Borison RL, Arvanitis LA, Milier BG. ICI 204,636, an atypical antipsychotic: efficacy and safety in a multicenter, placebo-controlled trial in patients with schizophrenia. J Clin Psychopharmacol. 1996;16(2):158-169. doi:10.1097/00004714-199604000-00008
Zipursky RB, Gu H, Green AI, et al. Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol. Br J Psychiatry. 2005;187(6):537-543. doi:10.1192/bjp.187.6.537
Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU. Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2013;16(6):1205-1218. doi:10.1017/S1461145712001277
Pillinger T, McCutcheon RA, Vano L, et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. Lancet Psychiatry. 2020;7(1):64-77. doi:10.1016/S2215-0366(19)30416-X
Wu H, Siafis S, Hamza T, et al. Antipsychotic-induced weight gain: dose-response meta-analysis of randomized controlled trials. Schizophr Bull. 2022;48(3):643-654. doi:10.1093/schbul/sbac001
Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet Lond Engl. 2019;394(10202):939-951. doi:10.1016/S0140-6736(19)31135-3
Sabé M, Pallis K, Solmi M, Crippa A, Sentissi O, Kaiser S. Comparative effects of 11 antipsychotics on weight gain and metabolic function in patients with acute schizophrenia: a dose-response meta-analysis. J Clin Psychiatry. 2023;84(2):22r14490. doi:10.4088/JCP.22r14490
Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1):1-48. doi:10.18637/jss.v067.i01
Addington J, Mansley C, Addington D. Weight gain in first-episode psychosis. Can J Psychiatry. 2003;48(4):272-276. doi:10.1177/070674370304800412
Lieberman JA, Tollefson G, Tohen M, et al. Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol. Am J Psychiatry. 2003;160(8):1396-1404. doi:10.1176/appi.ajp.160.8.1396
Schooler N, Rabinowitz J, Davidson M, et al. Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial. Am J Psychiatry. 2005;162(5):947-953. doi:10.1176/appi.ajp.162.5.947
Tek C, Kucukgoncu S, Guloksuz S, Woods SW, Srihari VH, Annamalai A. Antipsychotic-induced weight gain in first-episode psychosis patients: a meta-analysis of differential effects of antipsychotic medications: weight gain in FEP patients. Early Interv Psychiatry. 2016;10(3):193-202. doi:10.1111/eip.12251
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. doi:10.1017/S0033291709990407
Ratzoni G, Gothelf D, Brand-Gothelf A, 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. doi:10.1097/00004583-200203000-00014
Schimmelmann BG, Mehler-Wex C, Lambert M, et al. A prospective 12-week study of quetiapine in adolescents with schizophrenia spectrum disorders. J Child Adolesc Psychopharmacol. 2007;17(6):768-778. doi:10.1089/cap.2007.0048
Gebhardt S, Haberhausen M, Heinzel-Gutenbrunner M, 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. doi:10.1016/j.jpsychires.2008.11.001
Brecher M, Leong RW, Stening G, Osterling-Koskinen L, Jones AM. Quetiapine and long-term weight change: a comprehensive data review of patients with schizophrenia. J Clin Psychiatry. 2007;68(4):597-603. doi:10.4088/JCP.v68n0416
Kinon BJ, Basson BR, Gilmore JA, Tollefson GD. Long-term olanzapine treatment: weight change and weight-related health factors in schizophrenia. J Clin Psychiatry. 2001;62(2):92-100.
Bushe CJ, Slooff CJ, Haddad PM, Karagianis JL. Weight change by baseline BMI from three-year observational data: findings from the Worldwide Schizophrenia Outpatient Health Outcomes Database. J Psychopharmacol Oxf Engl. 2013;27(4):358-365. doi:10.1177/0269881112473789
Allison DB, Mentore JL, Heo M, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry. 1999;156(11):1686-1696. doi:10.1176/ajp.156.11.1686
Meyer JM, Koro CE. The effects of antipsychotic therapy on serum lipids: a comprehensive review. Schizophr Res. 2004;70(1):1-17. doi:10.1016/j.schres.2004.01.014
Vuk A, Kuzman MR, Baretic M, Osvatic MM. Diabetic ketoacidosis associated with antipsychotic drugs: case reports and a review of literature. Psychiatr Danub. 2017;29(2):121-135. doi:10.24869/psyd.2017.121
Perez-Iglesias R, Martínez-García O, Pardo-Garcia G, et al. 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. Int J Neuropsychopharmacol. 2014;17(1):41-51. doi:10.1017/S1461145713001053
Vázquez-Bourgon J, Ibáñez Alario M, Mayoral-van Son J, et al. A 3-year prospective study on the metabolic effect of aripiprazole, quetiapine and ziprasidone: a pragmatic clinical trial in first episode psychosis patients. Eur Neuropsychopharmacol. 2020;39:46-55. doi:10.1016/j.euroneuro.2020.08.009
Bernardo M, Rico-Villademoros F, García-Rizo C, Rojo R, Gómez-Huelgas R. Real-world data on the adverse metabolic effects of second-generation antipsychotics and their potential determinants in adult patients: a systematic review of population-based studies. Adv Ther. 2021;38(5):2491-2512. doi:10.1007/s12325-021-01689-8
Pillinger T, Beck K, Gobjila C, Donocik JG, Jauhar S, Howes OD. Impaired glucose homeostasis in first-episode schizophrenia: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(3):261-269. doi:10.1001/jamapsychiatry.2016.3803
Teff KL, Rickels MR, Grudziak J, Fuller C, Nguyen HL, Rickels K. Antipsychotic-induced insulin resistance and postprandial hormonal dysregulation independent of weight gain or psychiatric disease. Diabetes. 2013;62(9):3232-3240. doi:10.2337/db13-0430
Kowalchuk C, Castellani LN, Chintoh A, Remington G, Giacca A, Hahn MK. Antipsychotics and glucose metabolism: how brain and body collide. Am J Physiol Endocrinol Metab. 2019;316(1):E1-E15. doi:10.1152/ajpendo.00164.2018
Meyer JM. Effects of atypical antipsychotics on weight and serum lipid levels. J Clin Psychiatry. 2001;62(Suppl 27):27-34. discussion 40-41.
Bou Khalil R, Richa S. Thyroid adverse effects of psychotropic drugs: a review. Clin Neuropharmacol. 2011;34(6):248-255. doi:10.1097/WNF.0b013e31823429a7
Zhang JX, Li X. Changes in serum thyroid hormone levels in psychiatric patients treated with second-generation antipsychotics. Endokrynol Pol. 2020;71(4):292-298. doi:10.5603/EP.a2020.0036