Outcomes of obese, clozapine-treated inpatients with schizophrenia placed on a six-month diet and physical activity program

OBJECTIVE: Patients with schizophrenia treated with clozapine often gain weight. This study evaluated the effects of dietary control and physical activity among obese inpatients with schizophrenia being treated with clozapine. METHODS: Fifty-three clozapine-treated obese patients with schizophrenia in a veterans hospital in eastern Taiwan who had a body mass index greater than 27 (weight divided by height in meters squared) and who were taking clozapine were randomly assigned to a study group of 28 or a control group of 25. The study group was placed on a diet that reduced calorie intake by 200 to 300 kcal per day (to 1,300 to 1,500 kcal per day for women and to 1,600 to 1,800 kcal per day for men) and a six-month regimen of regular physical activity in which participants used approximately 600 to 750 kcal per week (level walking and walking on stairs for 60 minutes three days per week). Anthropometric, metabolic, and hormonal parameters were measured after three and six months by using anthropometry, an enzyme autoanalyzer, immunoassay, and enzyme-linked immunosorbent assay. RESULTS: Compared with the control group, the study group showed a significant decrease in body weight, body mass index (5.4% reduction), waist circumference (3.3 cm), and hip circumference (3.3 cm) after three months and after six months. Triglyceride and insulin-like growth factor-binding protein-3 (IGFBP-3) decreased significantly only after six months. CONCLUSIONS: A program of dietary control and regular physical activity can significantly reduce body weight and improve metabolic profiles of insulin, triglyceride, and IGFBP-3 among obese inpatients taking clozapine for the treatment of schizophrenia.     

A program for managing weight gain associated with atypical antipsychotics

This study assessed the efficacy of a weight control program for patients taking atypical antipsychotics. Thirty-one patients with schizophrenia or schizoaffective disorder participated in a 12-week weight control program that incorporated nutrition, exercise, and behavioral interventions. Changes in patients' weight and in body mass index (BMI) were recorded and compared with those of 15 patients in a control group. The intervention group had a mean weight loss of 2.7 kg (six pounds) and a mean reduction of.98 BMI points, compared with a mean weight gain of 2.9 kg (6.4 pounds) and a mean gain of 1.2 BMI points in the control group. These data suggest that the intervention was effective in this group of patients. Professionals treating persons who are taking atypical antipsychotics should encourage them to engage in weight control activities.     

Weight gain among schizophrenic patients treated with clozapine.

A retrospective chart review was used to assess weight changes in 36 chronic schizophrenic inpatients who were treated with clozapine after being treated with standard neuroleptics. The average weight gain during 6 months of clozapine treatment was 16.9 lb; 75.0% of the patients gained at least 10 lb. The results confirm previous findings of clozapine-associated weight gain.     

Electroacupuncture treatment of obesity with psychological symptoms

The aim was to study the effect of placebo EA, electroacupuncture (EA), and diet on obesity and accompanying psychological symptoms. One hundred and sixty-five volunteer women participated in the study. There were three groups: (i) Placebo EA, (ii) EA, and (iii) diet restriction group. EA was performed by using three ear and six body points. There was a 4.8% reduction in weight of patients with EA application, whereas patients with a diet restriction and placebo EA had a 2.5% and 2.7% weight reduction, respectively. There were significant decreases in phobia, anger, anxiety, obsession, paranoid symptoms, and depression in the EA groups compared to those of the placebo EA and diet groups. It was suggested that electroacupuncture may be an effective therapy for obesity including the psychological signs and symptoms in women.     

Serum thyrotropin (TSH) responses to thyrotropin-releasing hormone (TRH) in patients with anorexia nervosa and bulimia: influence of changes in body weight and eating disorders

Serum thyrotropin (TSH) responses to thyrotropin-releasing hormone (TRH) were studied in 47 women with anorexia nervosa (AN) (group I) and in 11 bulimic patients of normal weight (group II). In group I, TSH responses were low in nine patients, delayed in 32 and normal in six. Patients with a normal TSH response had a lesser degree of anorexia than those with a delayed TSH response. Bulimia and vomiting were more frequently observed in the low response group. The maximum increase in TSH concentrations following TRH administration in the group I patients with vomiting (4.0 +/- 0.90 microU/ml, mean +/- S.E.) was significantly lower than that in the group I patients without vomiting or in normal controls (11.2 +/- 0.82 microU/ml and 11.1 +/- 2.34 microU/ml, respectively). Twenty-five patients with abnormal TSH responses in group I were retested after weight gain. Initially, TSH responses were low in six and delayed in 19. Following weight recovery, responses continued to be abnormal in five of the six and in eight of the 19, respectively. The symptoms of eating disorders continued in all patients with abnormal TSH responses even after weight recovery, whereas patients with normal responses after weight gain recovered from all symptoms. Of 11 patients in group II, six had abnormal TSH responses to TRH; the responses were delayed in four and low in two. Patients with normal responses had a lesser degree of eating disorder, compared with abnormal responders. These observations suggest that abnormal TSH responses in patients with AN were not necessarily due to weight loss alone; rather, they may be related to the eating disorder itself.     

Awareness of Obesity and Weight Issues Among Chronically Mentally Ill Inpatients: A Pilot Study

Obesity in psychotic patients is a subject of increasing scrutiny, but there is a dearth of data regarding awareness about weight related issues among chronic inpatients. To assess this issue state hospital patients voluntarily completed an anonymous questionnaire concerning obesity, weight gain variables, concern about weight, and methods to control weight gain. Sex, age, weight, and height were collected with completed surveys. A total of 128 respondents completed the questionnaire of which 85% were male. Respondents' mean age was 39.8 years, mean BMI 30.84 kg/m² with 46.6% obese. There was a significant correlation between BMI and awareness of current weight status (p = 0.005), but not between BMI and level of concern about weight among all respondents (p = 0.308) or in the obese subgroup (p = 0.693). Significantly fewer obese patients indicated no weight problem, or no need to control their weight compared to the nonobese (p = 0.004), yet only 10% of obese patients requested to be placed on a mandatory monitored diet. Chronically mentally ill inpatients thus accurately perceive their obesity status, but level of concern does not correlate with BMI, and the obese are reluctant to choose mandatory dieting as a remedy. These findings have significant implications for programmatic measures to control weight gain among chronic inpatients, and for use of atypicals that have a greater propensity to cause weight gain.     

Changes in the frequency distribution pattern of body weight in patients with major depression

To compare the frequency distribution of body weight of the depressed patients with that of a standard group and to evaluate the change in distribution during treatment, body weight was measured in 106 depressed inpatients with major depressive disorder as defined by DSM-III criteria both on admission and on discharge. The body weight distribution in the depressed patients skewed towards a high frequency of lower weights on admission but shifted to the normal pattern on discharge. In women, this tendency was more obvious and was statistically significant. The body weight distribution in the depressed patients with melancholia maintained high frequencies of lower body weight on discharge, while that in those without melancholia did not, suggesting that there could be a difference in the pattern of body weight distributions between those with endogenous and nonendogenous depression. Three tricyclic antidepressants examined (imipramine, clomipramine and desipramine) did not seem to have the side effect of pathological weight gain in the frequency distribution pattern.     

A cognitive-behavioral group for patients with various anxiety disorders

OBJECTIVE: Cognitive-behavioral therapy (CBT) protocols for each of the anxiety disorders are robust and effective but are best suited for specialty clinics. This study assessed a format more suitable for general clinics: a single protocol based on standard CBT techniques designed to treat patients who have different anxiety disorders in the same group. METHODS: Potential participants in Vancouver, British Columbia, were administered a structured clinical interview to identify those with major anxiety disorders: panic disorder, with or without agoraphobia; obsessive-compulsive disorder; social phobia; generalized anxiety disorder; specific phobia; and posttraumatic stress disorder. Forty-three percent of participants had more than one current anxiety diagnosis. Those with active substance abuse or dependence or with psychosis were excluded. A total of 152 patients were randomly assigned to immediate treatment in the 11-week CBT group or to a wait-list control group. The Beck Anxiety Inventory (BAI) was administered at baseline, at the end of treatment or of the waiting period, and six months later. RESULTS: Reductions in BAI scores for participants in the immediate-treatment groups were greater than those for the control group participants. Patients with panic disorder in particular appeared to benefit. Outcomes for the immediate-treatment group were superior in terms of clinically significant changes, defined as a 20% or 40% improvement. Reductions in BAI scores continued to be present six months later. The improvements correspond to a medium effect size (Cohen's d=.50). CONCLUSIONS: A group CBT protocol for mixed anxiety disorders may make effective treatment more widely available.     

Weight management in a cohort of Irish inpatients with serious mental illness (SMI) using a modular behavioural programme. A preliminary service evaluation

Background

Weight gain is commonly observed during psychotropic treatments for chronic forms of severe mental illness and is most rapid during the early treatment phases. All formats of behavioural weight intervention programmes have suggested that weight gain can be prevented or reversed in some patients. There is no data on these programmes in acutely unwell inpatients whom may be the major beneficiaries.

Methods

A modular behavioural intervention programme (Solutions for Wellness) used in SMI outpatients since 2002 in Ireland has been adapted for inpatient use. Preliminary data is reported from 5 centres in Ireland.

Results

In 47 inpatients the mean weight change was +0.26 kg (SD 2.02) with a median change of 0 kg. Mean follow-up was 23.7 (SD 21.6) days, and median 14 days (range 6–98 days). There was no difference in mean weight change in those patients involved for > 35 days compared with < 35 days (+0.26 kg; 0.25 kg; p = 0.5). Weight loss or maintenance was seen in 70% of patients.

Conclusion

These preliminary data are supportive of the concept that acutely unwell inpatients with SMI may engage with a behavioural weight programme. Weight change observed contrasts with the significant weight gain often seen in most subjects. Further clinical trials are warranted.     

Over-representation of Myers Briggs Type Indicator introversion in social phobia patients

The purpose of this study is to profile the personalities of patients with social phobia. Sixteen patients with social phobia were compared with a normative population of 55,971, and with 24 hospitalized Major Depressive Disorder inpatients, using the Myers Briggs Type Indicator. The Myers Briggs Type Indicator, a popular personality survey, divides individuals into eight categories: Extroverts versus Introverts, Sensors versus Intuitives, Thinkers versus Feelers, and Judgers versus Perceivers. Social phobia patients were significantly more often Introverts (93.7%) than were subjects in the normative population (46.2%). In addition, using continuous scores, the social phobia patients scored as significantly more introverted than did the patients with Major Depressive Disorder, who also scored as Introverted. Introversion is a major component of social phobia, and this observation may have both etiological and therapeutic significance.