Weight gain from atypical neuroleptics--an underreported adverse effect?

After the introduction of the so-called "atypical neuroleptics" in the clinical experience a marked weight gain was frequently observed in patients treated with some of these agents. In this review the frequency, amount and conditions of weight gain during the medication with 'atypical' neuroleptics were evaluated. A comparison is limited by the different designs and recruitment procedures of the reviewed studies. The available data show that the frequency as well as the amount of weight gain is particularly high in patients treated with clozapine, olanzapine, and likely also quetiapine and zotepine. Moderate changes of weight have been observed in the treatment with risperidone and probably also with amisulpride, while ziprasidone seems to induce only clinically irrelevant weight changes. Weight gain most frequently occurs in the first weeks of treatment. Underweighted patients are at highest risk to gain weight. The underlying pathomechanism still remains widely unclear. The relative receptor affinities of the atypical antipsychotics for histamine H1 as well as their quotient of 5-HT2/D2 receptor affinity appear to be a correlate of weight gain. Furthermore, the induction of leptin secretion may have an important impact on weight gain in subjects treated with atypical neuroleptics. Although many questions concerning the conditions of weight gain remain unsolved, this side-effect has to be considered in the medication with many atypical neuroleptics, particularly in view of compliance in long-term treatment and possible medical complications.     

Attention and sensory gain control: a peripheral visual process?

Attention-related sensory gain control in human extrastriate cortex is believed to improve the acuity of visual perception. Yet given wide variance in the spatial resolution of vision across the retina, it remains unclear whether sensory gain operates homogenously between foveal and nonfoveal retinotopic locations. To address this issue, we used event-related potentials (ERPs) in a variant of the canonical spatial attention task. Participants were cued to expect targets at either fixation (foveal targets) or at a location several degrees above fixation (parafoveal targets). At both target locations, manual reaction times were shorter for cued relative to uncued targets, indicating that attention was consistently oriented to the cued location. Nevertheless, attention-related increases in sensory-evoked cortical activity were only observed at the parafoveal target location, as measured by the amplitude of the lateral occipital P1 ERP component. A second experiment replicated this data pattern using targets with lower stimulus contrast, indicating that the absence of a P1 effect for foveal targets could not be attributed to a saturated P1 response under higher-contrast stimulus conditions. When considered in light of retinogeniculate projections to cortex showing systematic changes in their physiological organization beginning within a degree of visual angle of the fovea, our findings support the proposal that the strategic functions of visual attention may vary with the retinotopic location involved.     

Enhanced redundancy gain in schizophrenics: a correlate of callosal dysfunction?

An abnormal pattern of hemispheric asymmetry, possibly as a result of disturbed interhemispheric communication, is widely, albeit by no means unanimously, held as a major cause of schizophrenia. To behaviourally test interhemispheric communication in schizophrenia we used a task that has been shown to be a reliable indicator of callosal functioning, namely, the redundant signals effect (RSE). It consists of the speeding of simple reaction time when responding to double as opposed to single visual stimuli. When the stimuli in a pair are presented to different hemispheres patients who underwent total commissurotomy or suffer from callosal agenesis show a paradoxically enhanced RSE with respect to healthy controls. Therefore, if schizophrenia patients have a callosal abnormality they ought to show a similar effect. In three experiments we tested a total of 55 patients with a diagnosis of schizophrenia and 51 healthy controls. In Experiment 1 we presented unilateral single stimuli and bilateral simultaneous double stimuli. The RSE was reliably larger in schizophrenics than in controls. In Experiment 2 the temporal interval between the two stimuli in a pair was varied. We found that while in controls the RSE disappeared with interstimulus intervals longer than 17ms, in schizophrenia patients there was a RSE only for simultaneous double stimuli. Finally, in Experiment 3 we found that there was no enhanced redundancy gain in schizophrenics when the double stimuli were presented to one and the same hemisphere, and therefore, with no need for callosal transmission. All in all, the present results provide evidence of a callosal dysfunction in schizophrenia that impairs interhemispheric integration.     

Epilepsy and sodium channel gene mutations: gain or loss of function?

Mutations in voltage-gated sodium channel genes (SCN1A, SCN2A, SCN1B) have been reported to be responsible for some epilepsies. Although studying such mutations to elucidate the disease mechanisms would be indispensable for the development of effective therapies, the functional consequences of these mutations remain controversial. Here, I propose a novel hypothesis for an epileptic disease mechanism which could drive the design of further studies to understand the molecular pathology of these diseases.     

Does long-term use of valproate cause weight gain in prepubertal epileptic children?

In this experiment, we studied the effect of valproate (VPA) on weight gain, and serum leptin levels in prepubertal epileptic children receiving VPA. Our purpose was to determine whether or not long-term use of VPA causes weight gain in childhood, and to evaluate serum leptin levels in a group of prepubertal children receiving VPA. Our study included 15 patients (9 males, 6 females) with new diagnosed epilepsy and 16 healthy age-matched controls (9 males, 7 females). The subjects' ages ranged from 9 months to 12 years. Weight gain was noted in 9 (60%) of 15 patients in the study group, and 8 (50%) of 16 subjects in the control group (p > .05). There was no difference between the groups for body mass index (BMI) and serum leptin levels. Although higher serum leptin levels were found in the patients treated with VPA weight gaining (5.65 +/- 3.06 ng/ml vs. 3.28 +/- 1.69 ng/ml), we did not find a difference between the patients weight gaining and nonweight gaining (p > .05). While a significant correlation between BMI and serum leptin levels was found in the study group (r = .704; p = .003), it was not significant in the control group (r = .330; p = .211). In conclusion, our findings showed that long-term use of VPA did not cause weight gain in a group of prepubertal children receiving VPA and, parallel to this, serum leptin levels were similar in both the control and study group.     

Olanzapine-induced weight gain in anorexia nervosa: Involvement of leptin and ghrelin secretion?

BACKGROUND: Olanzapine (OLA) administration has been reported to induce weight gain in experimental animals and humans, through not yet fully defined mechanisms of action. Aim of this study was to determine whether in patients with Anorexia Nervosa (AN) OLA induces weight gain through the modulation of the hunger-satiety regulatory peptides leptin and ghrelin. METHODS: Twenty anorexic probands received a 3 months course of cognitive-behavioral psychotherapy and programmed nutritional rehabilitation, combined with OLA PO (2.5 mg for 1 month and 5 mg for 2 months) in ten patients and with placebo PO (PL) in the other 10. Weight, measured as body mass index (BMI), leptin and ghrelin plasma values were monitored before starting the therapy and then monthly for 3 months. Plasma leptin was measured by ELISA, and plasma ghrelin by radioimmunoassay. RESULTS: BMI increased significantly but not differently in both treatment groups. Leptin and ghrelin secretion did not change during the course of the treatments. No correlations were observed between BMI values and leptin and ghrelin levels. CONCLUSIONS: Our data suggest that the weight gain observed in our OLA-treated patients was not linked to drug administration. Moreover, leptin and ghrelin secretions were not responsible for BMI changes.     

Loss in risk-taking: absence of optimal gain or reduction in one's own resources?

Determining how living beings react to tasks that reflect realistic situations of risk has given rise to a vast literature. However, I argue that the methodologies traditionally used to test humans and nonhumans relative to risk often fail to achieve their goal. When risk is modelled in laboratory, potential decision cost (or potential loss) typically denotes an absence of optimal gain. In contrast, when risk occurs in real-life situations, potential loss denotes the reduction in an individual's limited resources - whether energetic, social, financial, etc. This conceptual difference about the nature of risk may have important implications for the understanding of the parameters that control risk-taking behaviour.     

Distinct neural responses used to gain insight into hallucinatory perception in patients with schizophrenia

ObjectiveMost patients with schizophrenia suffer from various types of hallucinations, which commonly produce distress, functional disability or behavioral dyscontrol. The neural process of adapting to hallucinations in patients with schizophrenia remains unknown.MethodsFunctional magnetic resonance imaging (MRI) responses to an unusual threatening visual stimulus designed to simulate a hallucinatory experience were compared between 16 patients with schizophrenia and 17 healthy controls. Linear and quadratic repetition-variant as well as repetition-invariant responses to the stimulus were compared between the two groups.ResultsRepetition-invariant responses were similar between patients with schizophrenia and healthy controls. Patients with schizophrenia exhibited a linear activation pattern in the anterior cingulate, whereas healthy controls exhibited a parabolic activation pattern in the anterior prefrontal cortex, occipito-temporal junction and amygdala.ConclusionsThese results provide us with a better understanding of the neural processes involved in gaining insight into unreality. Patients with schizophrenia may use a salience-related region instead of reality monitoring-related regions to react to the unusual stimuli, and this peculiarity of the neural processes may be related to vulnerability to psychosis.     

Multimodal brain predictors of current weight and weight gain in children enrolled in the ABCD study ®

Multimodal neuroimaging assessments were utilized to identify generalizable brain correlates of current body mass index (BMI) and predictors of pathological weight gain (i.e., beyond normative development) one year later. Multimodal data from children enrolled in the Adolescent Brain Cognitive Development Study® at 9-to-10-years-old, consisted of structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), resting state (rs), and three task-based functional (f) MRI scans assessing reward processing, inhibitory control, and working memory. Cross-validated elastic-net regression revealed widespread structural associations with BMI (e.g., cortical thickness, surface area, subcortical volume, and DTI), which explained 35% of the variance in the training set and generalized well to the test set (R² = 0.27). Widespread rsfMRI inter- and intra-network correlations were related to BMI (R²_train = 0.21; R²_test = 0.14), as were regional activations on the working memory task (R²_train = 0.20; (R² _test = 0.16). However, reward and inhibitory control tasks were unrelated to BMI. Further, pathological weight gain was predicted by structural features (Area Under the Curve (AUC)_train = 0.83; AUC_test = 0.83, p < 0.001), but not by fMRI nor rsfMRI. These results establish generalizable brain correlates of current weight and future pathological weight gain. These results also suggest that sMRI may have particular value for identifying children at risk for pathological weight gain.     

Traumatic brain injury and the frontal lobes: What can we gain with diffusion tensor imaging?

Traumatic brain injury (TBI) is a leading cause of death in the young population and long-term disability in relation to pervasive cognitive-behavioural disturbances that follow frontal lobe damage. To date, emphasis has been placed primarily on the clinical correlates of frontal cortex damage, whilst identification of the contribution of subjacent white matter lesion is less clear. Our poor understanding of white matter pathology in TBI is primarily due to the low sensitivity of conventional neuroimaging to identify pathological changes in less severe traumatic injury and the lack of methods to localise white matter pathology onto individual frontal lobe connections. In this paper we focus on the potential contribution of diffusion tensor imaging (DTI) to TBI. Our review of the current literature supports the conclusion that DTI is particularly sensitive to changes in the microstructure of frontal white matter, thus providing a valuable biomarker of the severity of traumatic injury and prognostic indicator of recovery of function. Furthermore we propose an atlas approach to TBI to map white matter lesions onto individual tracts. In the cases presented here we showed a direct correspondence between the clinical manifestations of the patients and the damage to specific white matter tracts. We are confident that in the near future the application of DTI to TBI will improve our understanding of the complex and heterogeneous clinical symptomatology which follows a TBI, especially mild and moderate head injury, which still represents 70-80% of all clinical population.     

Weight gain in children and adolescents during 45 weeks treatment with clozapine,olanzapine and risperidone

The aim of this study was to evaluate long-term weight gain associated with clozapine, olanzapine, and risperidone treatment and its clinical risk factors in children and adolescents. At four child and adolescent psychiatric departments, the weight and body mass index of initially hospitalized patients (aged 9.0–21.3 years) treated with clozapine (n = 15), olanzapine (n = 8), and risperidone (n = 10) were prospectively monitored for 45 weeks. Clinical risk factors (age, gender, baseline weight, dosage, drug-naivety) were tested for their association with weight gain in the three groups. All three groups experienced significant weight gain between baseline and endpoint. The absolute and percentage average weight gains were significantly higher for the olanzapine group (16.2 ± 8.8 kg; 30.1 ± 18.9%) than for the clozapine (9.5 ± 10.4 kg; 14.8 ± 15.8%) and the risperidone (7.2 ± 5.3 kg; 11.5 ± 6.0%) groups. Olanzapine is associated with extreme long-term weight gain in children and adolescents that, in addition, is much higher than that expected in adults. Clozapine and risperidone are associated with a less marked weight gain in children and adolescents but also much higher than that expected in adults. These differences may affect compliance with medication and health risk. This research was supported in part by a nonrestricted grant from Janssen-Cilag, Neuss, Germany.     

Immediate gain is long-term loss: Are there foresighted decision makers in the Iowa Gambling Task?

Background

The Somatic Marker Hypothesis suggests that normal subjects are "foreseeable" and ventromedial prefrontal patients are "myopic" in making decisions, as the behavior shown in the Iowa Gambling Task. The present study questions previous findings because of the existing confounding between long-term outcome (expected value, EV) and gain-loss frequency variables in the Iowa Gambling Task (IGT). A newly and symmetrically designed gamble, namely the Soochow Gambling Task (SGT), with a high-contrast EV between bad (A, B) and good (C, D) decks, is conducted to clarify the issue about IGT confounding. Based on the prediction of EV (a basic assumption of IGT), participants should prefer to choose good decks C and D rather than bad decks A and B in SGT. In contrast, according to the prediction of gain-loss frequency, subjects should prefer the decks A and B because they possessed relatively the high-frequency gain.

Methods

The present experiment was performed by 48 participants (24 males and 24 females). Most subjects are college students recruited from different schools. Each subject played the computer version SGT first and completed a questionnaire for identifying their final preference. The IGT experimental procedure was mostly followed to assure a similar condition of decision uncertainty.

Results

The SGT experiment demonstrated that the prediction of gain-loss frequency is confirmed. Most subjects preferred to choose the bad decks A and B than good decks C and D. The learning curve and questionnaire data indicate that subjects can not "hunch" the EV throughout the game. Further analysis of the effect of previous choice demonstrated that immediate gain increases the probability to stay at the same deck.

Conclusion

SGT provides a balanced structure to clarify the confounding inside IGT and demonstrates that gain-loss frequency rather than EV guides decision makers in these high-ambiguity gambles. Additionally, the choice behavior is mostly following the "gain-stay, lose-randomize" strategy to cope with the uncertain situation. As demonstrated in SGT, immediate gain can bring about a long-term loss under uncertainty. This empirical result may explain some shortsighted behaviors in real life.     

How does a specific learning and memory system in the mammalian brain gain control of behavior?

This review addresses a fundamental, yet poorly understood set of issues in systems neuroscience. The issues revolve around conceptualizations of the organization of learning and memory in the mammalian brain. One intriguing, and somewhat popular, conceptualization is the idea that there are multiple learning and memory systems in the mammalian brain and they interact in different ways to influence and/or control behavior. This approach has generated interesting empirical and theoretical work supporting this view. One issue that needs to be addressed is how these systems influence or gain control of voluntary behavior. To address this issue, we clearly specify what we mean by a learning and memory system. We then review two types of processes that might influence which memory system gains control of behavior. One set of processes are external factors that can affect which system controls behavior in a given situation including task parameters like the kind of information available to the subject, types of training experience, and amount of training. The second set of processes are brain mechanisms that might influence what memory system controls behavior in a given situation including executive functions mediated by the prefrontal cortex; switching mechanisms mediated by ascending neurotransmitter systems, the unique role of the hippocampus during learning. The issue of trait differences in control of different learning and memory systems will also be considered in which trait differences in learning and memory function are thought to potentially emerge from differences in level of prefrontal influence, differences in plasticity processes, differences in ascending neurotransmitter control, differential access to effector systems like motivational and motor systems. Finally, we present scenarios in which different mechanisms might interact. This review was conceived to become a jumping off point for new work directed at understanding these issues. The outcome of this work, in combination with other approaches, might improve understanding of the mechanisms of volition in human and non‐human animals. © 2013 Wiley Periodicals, Inc.     

Reduction in pain: Is it worth the gain? The effect of opioids on the GI tract

The use of opioid medications for acute and chronic pain has increased significantly in the past 20 years in the United States. Given the high density of opioid receptors in the gastrointestinal tract, side effects are common in these patients including constipation, dysphagia, bloating, nausea, and vomiting. These side effects, which are experienced by most patients who take opioids, can lead to significant impairment in quality of life. Unlike other side effects from opioids, gastrointestinal side effects do not diminish with continued use, often leading patients to reduce or discontinue their opioid treatment to relieve these side effects. Therefore, physicians must be aware and anticipate potential side effects in patients receiving opioids to ensure appropriate pain management.