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Weight gain in first-episode psychosis over three years
Schizophrenia Research 86 (2006) 335 – 336 www.elsevier.com/locate/schres
Letter to the Editors Weight gain in first-episode psychosis over three years Dear Editors, It is well established that 40–80% of patients on first (FGAs) and second (SGAs) generation antipsychotics experience weight gain (Allison et al., 1999). For people with schizophrenia obesity and weight gain increase the risk for type II diabetes and cardiovascular disease (Muller et al., 2004). Weight gain is a particular problem for adolescents (Van Bruggen et al., 2001) due to their sensitivity to issues of body image and vulnerability to later health problems. We report on a consecutive sample of 189 first-episode patients (126 men, 63 women; mean age = 24.7 years, range 15–53) admitted to the Calgary Early Psychosis Program (EPP) (Addington and Addington, 2001). The majority were single (85%), lived with their family (78.3%), were Caucasian (76.7%), and had at least a high school education (63.0%) and were started on medications at baseline (57% olanzapine, 32% risperidone, 11% other SGAs). By the 3-year follow-up 29% were on olanzapine, 31% risperidone, 10% clozapine, 6% quetiapine, 9% FGAs and 15% no medications. Over three years only 39% remained on the same medication with the rest switching. Reasons for switching were not systematically collected, but side effects and patient requests were the common reasons. Weight was not measured in sequence with stopping and starting concomitant medications. Anticholinergic use was minimal (b 1%) and antidepressants, almost exclusively SSRIs, were used in up to 27%. Anxiolytics, predominantly benzodiazepines and nonbenzodiazepine hypnotics, were prescribed for 4 to 8% of subjects at different assessment periods. Assessments were conducted at baseline, 3, 6, 12, 24 and 36 months. Data is available for 189 at baseline, 147 at 3 months, 137 at 6 months, 135 at 12 months, 107 at 24 months and 92 at 36 months. Sixty subjects completed all 5 follow-up assessments. After complete description of the study to the subjects, written informed consent was obtained. At each assessment subjects Body Mass Index 0920-9964/$ - see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2006.06.035
(BMI) was calculated (BMI = weight [kg] / height2 [m]). Typical BMI ranges are normal 18.5 to 24.9, overweight 25 to 29.9 and obese greater that 30 (Statistics Canada, 2001a). Subjects had an average BMI of 24.47 (SD = 4.69) at baseline. BMIs at 3,6,12, 24 and 36 months respectively were 25.76, 26.50, 27.49, 28.14, and 28.75. Dropouts did not differ in BMI. At baseline, 66% of the sample was either underweight or normal but by the 3-year mark only 34% were categorized this way (See Fig. 1). There was an overall BMI gain of 17.5% of original body weight over the 3 years, with the largest gain occurring in the first 3 months. Increases in weight were 5.3% at 3 months from baseline, 2.8% from 3 to 6 months, 3.9% from 6 to 12 months, 2.3% from 12 to 24 months and 2.2% from 24 to 36 months. For those who completed all 5 assessments, a repeated measures analysis demonstrated that the model was significant (F = 22.39, df 60, 5, p b 0.0005). Using paired t-tests for BMI scores, there was a significant difference found between baseline and 3 months (t = −10.1, p b 0. 001), 3 months and 6 months (t = −4.2, p b 0. 001) and 24 months and 36 months (t = −2.87, p b 0.01). Increase in BMI was not related to CPZ equivalents. Over three years there was no change in weight for 8% of the sample, 32% gained weight and then lost weight with 18% returning to baseline levels. However, for 60% there was continued weight increase of on average 27% of their baseline weight having a mean BMI of 31.
Fig. 1. BMI classifications at yearly follow-ups.
336
Letter to the Editors
Thus, significant weight gain continues over a threeyear period with a 12% increase in weight over the first year and by three years a 17.5% weight increase with the number of overweight or obese individuals increasing from 34% to 66%. In contrast in Canada 37.4% of persons aged 20–34 are overweight or obese (Statistics Canada, 2001b). Since 31% did in fact lose weight, this unfortunately means for those who continued to gain weight there is on average a 27% weight increase. Limitations of this study are that we cannot comment on the differential effects of different compounds and cannot attribute weight gain only to medications. SSRIs were the most frequently used concomitant medications and were unlikely to have affected weight gain. Weight loss may have been due to non-compliance which would suggest an underestimation of weight gain. In summary, although, 31% did lose weight 60% continued to gain weight for three years reaching a mean BMI of 31. This 60%, not usually reported independently in the literature, are at very serious health risk (NIH, 1998). References Addington, J., Addington, D., 2001. Early intervention for psychosis: the Calgary early psychosis treatment and prevention program. Can. Psychiatr. Assoc. Bull. 33, 11–16. Allison, D.B., Mentore, J.L., Moonseong, H., Chandler, L.P., Cappelleri, J.C., Infante, M.C., et al., 1999. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am. J. Psychiatry 156, 686-6. Muller, D.J., Muglia, P., Fortune, T., Kennedy, J.L., 2004. Pharmacogenetics of antipsychotic-induced weight gain. Pharmacol. Res. 49, 309–329.
NIH, 1998. National heart lung and blood institute: clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. U.S. Department of health and human services, Bethesda, MD. Statistics Canada, 2001a. Canadian community health survey, version 1.1. Author, Ottawa, ON. Available: http://www.statcan.ca/english/ sdds/3226.htm. Statistics Canada, 2001b. Health indicators, vol. 3. Author, Ottawa, ON. Available: http://www.statcan.ca/english/freepub/82-221-XIE/ 01201/defin1.htm. Van Bruggen, M.J., Linszen, D.H., Dingemans, P.M., Lenior, M.E., 2001. A long term comparison of olanzapine and risperidone on weight gain as side effect in adolescents with recent onset schizophrenia. Schizophr. Res. 49, 290.
Jean Addington Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Department of Psychiatry, University of Calgary, Canada E-mail address: [email protected]. Corresponding author: CAMH, 250 College Street, Toronto, Ontario, Canada, M5T 1R8. Tel.: +1 416 535 8501x4360; fax: +1 416 979 6936. Huma Saeedi Centre for Addiction and Mental Health, Toronto, Canada Donald Addington Department of Psychiatry, University of Calgary, Canada 4 March 2006
Letter to the Editors Weight gain in first-episode psychosis over three years Dear Editors, It is well established that 40–80% of patients on first (FGAs) and second (SGAs) generation antipsychotics experience weight gain (Allison et al., 1999). For people with schizophrenia obesity and weight gain increase the risk for type II diabetes and cardiovascular disease (Muller et al., 2004). Weight gain is a particular problem for adolescents (Van Bruggen et al., 2001) due to their sensitivity to issues of body image and vulnerability to later health problems. We report on a consecutive sample of 189 first-episode patients (126 men, 63 women; mean age = 24.7 years, range 15–53) admitted to the Calgary Early Psychosis Program (EPP) (Addington and Addington, 2001). The majority were single (85%), lived with their family (78.3%), were Caucasian (76.7%), and had at least a high school education (63.0%) and were started on medications at baseline (57% olanzapine, 32% risperidone, 11% other SGAs). By the 3-year follow-up 29% were on olanzapine, 31% risperidone, 10% clozapine, 6% quetiapine, 9% FGAs and 15% no medications. Over three years only 39% remained on the same medication with the rest switching. Reasons for switching were not systematically collected, but side effects and patient requests were the common reasons. Weight was not measured in sequence with stopping and starting concomitant medications. Anticholinergic use was minimal (b 1%) and antidepressants, almost exclusively SSRIs, were used in up to 27%. Anxiolytics, predominantly benzodiazepines and nonbenzodiazepine hypnotics, were prescribed for 4 to 8% of subjects at different assessment periods. Assessments were conducted at baseline, 3, 6, 12, 24 and 36 months. Data is available for 189 at baseline, 147 at 3 months, 137 at 6 months, 135 at 12 months, 107 at 24 months and 92 at 36 months. Sixty subjects completed all 5 follow-up assessments. After complete description of the study to the subjects, written informed consent was obtained. At each assessment subjects Body Mass Index 0920-9964/$ - see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2006.06.035
(BMI) was calculated (BMI = weight [kg] / height2 [m]). Typical BMI ranges are normal 18.5 to 24.9, overweight 25 to 29.9 and obese greater that 30 (Statistics Canada, 2001a). Subjects had an average BMI of 24.47 (SD = 4.69) at baseline. BMIs at 3,6,12, 24 and 36 months respectively were 25.76, 26.50, 27.49, 28.14, and 28.75. Dropouts did not differ in BMI. At baseline, 66% of the sample was either underweight or normal but by the 3-year mark only 34% were categorized this way (See Fig. 1). There was an overall BMI gain of 17.5% of original body weight over the 3 years, with the largest gain occurring in the first 3 months. Increases in weight were 5.3% at 3 months from baseline, 2.8% from 3 to 6 months, 3.9% from 6 to 12 months, 2.3% from 12 to 24 months and 2.2% from 24 to 36 months. For those who completed all 5 assessments, a repeated measures analysis demonstrated that the model was significant (F = 22.39, df 60, 5, p b 0.0005). Using paired t-tests for BMI scores, there was a significant difference found between baseline and 3 months (t = −10.1, p b 0. 001), 3 months and 6 months (t = −4.2, p b 0. 001) and 24 months and 36 months (t = −2.87, p b 0.01). Increase in BMI was not related to CPZ equivalents. Over three years there was no change in weight for 8% of the sample, 32% gained weight and then lost weight with 18% returning to baseline levels. However, for 60% there was continued weight increase of on average 27% of their baseline weight having a mean BMI of 31.
Fig. 1. BMI classifications at yearly follow-ups.
336
Letter to the Editors
Thus, significant weight gain continues over a threeyear period with a 12% increase in weight over the first year and by three years a 17.5% weight increase with the number of overweight or obese individuals increasing from 34% to 66%. In contrast in Canada 37.4% of persons aged 20–34 are overweight or obese (Statistics Canada, 2001b). Since 31% did in fact lose weight, this unfortunately means for those who continued to gain weight there is on average a 27% weight increase. Limitations of this study are that we cannot comment on the differential effects of different compounds and cannot attribute weight gain only to medications. SSRIs were the most frequently used concomitant medications and were unlikely to have affected weight gain. Weight loss may have been due to non-compliance which would suggest an underestimation of weight gain. In summary, although, 31% did lose weight 60% continued to gain weight for three years reaching a mean BMI of 31. This 60%, not usually reported independently in the literature, are at very serious health risk (NIH, 1998). References Addington, J., Addington, D., 2001. Early intervention for psychosis: the Calgary early psychosis treatment and prevention program. Can. Psychiatr. Assoc. Bull. 33, 11–16. Allison, D.B., Mentore, J.L., Moonseong, H., Chandler, L.P., Cappelleri, J.C., Infante, M.C., et al., 1999. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am. J. Psychiatry 156, 686-6. Muller, D.J., Muglia, P., Fortune, T., Kennedy, J.L., 2004. Pharmacogenetics of antipsychotic-induced weight gain. Pharmacol. Res. 49, 309–329.
NIH, 1998. National heart lung and blood institute: clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. U.S. Department of health and human services, Bethesda, MD. Statistics Canada, 2001a. Canadian community health survey, version 1.1. Author, Ottawa, ON. Available: http://www.statcan.ca/english/ sdds/3226.htm. Statistics Canada, 2001b. Health indicators, vol. 3. Author, Ottawa, ON. Available: http://www.statcan.ca/english/freepub/82-221-XIE/ 01201/defin1.htm. Van Bruggen, M.J., Linszen, D.H., Dingemans, P.M., Lenior, M.E., 2001. A long term comparison of olanzapine and risperidone on weight gain as side effect in adolescents with recent onset schizophrenia. Schizophr. Res. 49, 290.
Jean Addington Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Department of Psychiatry, University of Calgary, Canada E-mail address: [email protected]. Corresponding author: CAMH, 250 College Street, Toronto, Ontario, Canada, M5T 1R8. Tel.: +1 416 535 8501x4360; fax: +1 416 979 6936. Huma Saeedi Centre for Addiction and Mental Health, Toronto, Canada Donald Addington Department of Psychiatry, University of Calgary, Canada 4 March 2006