住院精神分裂症患者伴发高血糖症的相关因素调查

目的了解住院精神分裂症患者伴发高血糖症的因素。方法对随机抽取的省、市、县住院精神分裂症患者进行高血糖症相关因素调查。结果高血糖症的患病率为3．1％，单因素分析显示：超重、腹部肥胖的患者发生高血糖症危险性大；Logistic分析显示：高血糖症的发生与年龄、利培酮合并氯氮平治疗、体重指数呈正相关，与单用利培酮、医院级别呈负相关。结论导致住院精神分裂症患者发生高血糖症的危险因素较多，对相关因素进行必要干预，有助于降低精神分裂症患者发生高血糖症的风险。     

长期住院精神分裂症患者的肥胖与代谢相关障碍

目的了解长期住院精神分裂症患者的肥胖与代谢相关障碍。方法对上海市精神卫生中心分部长期住院的精神分裂症患者作调查，测定其身高、体重及各代谢指标，采用wHO亚洲标准定义肥胖，世界糖尿病联盟全球统一标准定义代谢综合征及中心性肥胖。结果共入组469人，其中男性282人（60．1％），女性187人（39．9％）。平均年龄（54．19±8．85）岁（19-82岁）。53．3％的患者肥胖，77．2％为中心性肥胖，45．8％的患者存在代谢综合征，女性中心性肥胖及代谢综合征患病率高于男性（Х^2=12．391，P=0．000；）（Х^2=19．406，P=0．000），Logistic回归发现肥胖指数、血脂紊乱、高血压与性别、腰围相关，高血糖与腰围相关，代谢综合征与性别及体重指数有关（P〈0．05）。结论在长期住院的精神分裂症患者尤其女性患者中存在较多的肥胖与代谢障碍，精神科医务人员更应关注腰围变化。     

氯丙嗪、氯氮平所致精神分裂症患者体重变化的对照分析

对氯丙嗪、氯氮平所致精神分裂症患者的体重变化作对照分析，结果表明：在服药三个月内，氯丙嗪引起体重增加显著大于氯氮平（Ｐ＜０．０５）；两者睡眠时间与体重增加的相关无显著性（Ｐ＞０．０５）；氯氮平在治疗三个月内剂量与体重增加呈负相关，第三个月相关显著（ｒ＝－０．２７６４．Ｐ＜０．０５）．本文提示药物的镇静作用可能并非是体重增加的主要因素。     

住院精神疾病患者合并糖尿病的调查

目的：调查住院精神疾病患者合并糖尿病的情况，探索相关因素。方法：自制一般情况调查表，回顾性调查住院精神疾病患者的糖尿病患病情况，检测空腹血糖、餐后2小时血糖、血脂，计算体重指数。结果：2647例住院精神疾病患者中，213例合并糖尿病，患病率8．05％，为正常人群的3．22倍。213例中体重超重的占44．13％，肥胖的占40．38％，有28．63％的患者空腹血糖控制不佳，85．92％的患者餐后2小时血糖控制不佳。合并糖尿病与超重、肥胖、高血脂、高血压等因素相关。结论：精神疾病患者中糖尿病的患病率远高于普通人群，临床上应予以关注。     

住院精神分裂症患者焦虑症状研究

目的：了解精神分裂症患者焦虑症状的发生率及其相关因素。方法：对112例精神分裂症住院患者采用自拟的一般情况调查表、汉密尔顿焦虑量表（HAMA）进行调查、评定及多因素分析。结果：住院精神分裂症患者焦虑症状的发生率为63.40%，相关因素经多元逐步回归分析，发现住院精神分裂症患者焦虑症状的发生和社会支持、住院次数、病程呈负相关，与自知力、躯体并发症呈正相关。     

住院双相障碍与精神分裂症患者代谢相关障碍的对照研究

目的 了解双相障碍住院患者的肥胖与代谢相关障碍,并与精神分裂症住院患者作一比较.方法 对上海市精神卫生中心分部2008年7月住院期间的双相障碍患者作调查,测定其身高、体重及各代谢指标,用世界糖尿病联盟全球统一标准(IDF)定义代谢综合征及中心性肥胖.随机选取同期住院的两个病房的精神分裂症患者作为比较.结果 共入组双相障碍患者30例,精神分裂症160例.代谢综合征的患病率均较高,肥胖与代谢相关指标如血压、血糖、血脂方面,双相障碍患者与精神分裂症患者的患病率均无统计学差异(P>0.05).二组的超重、高甘油三酯、低HDL及中心性肥胖的比例均明显增高(P>0.05).结论 在住院的双相障碍及精神分裂症患者中同样存在较多代谢相关障碍,需要政策层面的关注.     

精神分裂症与糖尿病关系的探讨

目的：了解住院精神分裂症患者中糖尿病的发病情况及其与抗精神病药等因素的关系。方法：回顾性调查符合CCMD－2－R诊断标准的住院精神分裂症患者中的糖尿病发病情况以及抗精神病药的使用情况等相关因素,观察体重、血糖和血脂的变化。糖尿病的诊断按照 WHO关于糖尿病的诊断标准（1980年）作出。将精神分裂症患者中的糖尿病发生率与一般人群中的患病率进行比较,并分析影响糖尿病发生的相关因素。结果：在503例精神分裂症住院患者中,糖尿病的发生率为15．1％,为普通人群（2．5％）的6倍（x^2＝18．10,P＜0．01）。抗精神病药物可引起体重的显著增加(t＝5．45,P＜0．01）。糖尿病的发生与精神分裂症的持续病程、长期住院、患者的年龄以及阳性糖尿病家族史等因素有关。氯氮平对糖尿病的影响与其他抗精神药物无显著差异（x^2＝0．38,P＞0．05）。结论：精神分裂症患者中糖尿病的发生率远高于普通人群,抗精神病药物引起的体重增加可能与此有关,临床上应予以关注。     

抗精神病药物对首发精神分裂症患者糖脂代谢和体重的影响

目的比较抗精神病药物对首发精神分裂症患者血糖、血脂及体重的影响,评价不同药物的安全性。方法对门诊／住院首发精神分裂症患者作为期一年药物治疗的随访观察,比较单一使用非典型抗精神病药（维思通、喹硫平、阿立哌唑）和典型抗精神病药（氯丙嗪）患者的空腹血糖、体重指数（BMI）、血脂的变化。结果完成一年随访患者179例,其中出现空腹血糖超标22例（12．3％）,确诊糖尿病1例;新增高甘油三脂48例（26．8％）、高胆固醇31例（17．3％）;单因素相关分析显示,血糖超标与体重指数、年龄、病程及高甘油三脂呈显著性相关,而与用药选择无显著性相关;各组药物对糖脂代谢均有影响,阿立哌唑对精神分裂症患者的体重、血糖、血脂影响最小;Logistic回归分析结果显示体重指数增加、病程长是血糖超标的危险因素。结论抗精神病药物对精神分裂症患者糖脂代谢、体重增加等方面均有不同程度的影响,应预测性评估、定期监测和提早干预。     

精神分裂症住院患者糖脂代谢异常的相关因素调查

目的 了解住院精神分裂症患者伴发糖、脂代谢异常的相关因素.方法 采用横断面调查对住院时间1年以上的精神分裂症患者230例进行糖、脂代谢异常的相关因素调查.结果 230例患者中糖尿病发生率9.6%,糖耐量异常发生率25%.有无糖代谢异常患者之间超重、腹型肥胖、高甘油三酯血症的构成比差异有统计学意义(P＜0.05), Logistic回归分析显示,患者伴发糖代谢异常的高危因素是高文化程度、高体质量指数(BMI)、高甘油三酯,运动是保护性因素.脂代谢异常的发生率是50.4%.有无脂代谢异常患者间的超重、腹型肥胖、糖代谢异常、使用舒必利等的构成比差异有统计学意义(P＜0.05), Logistic回归分析显示,患者伴发脂代谢异常的高危因素是BMI、2h血糖和使用非典型抗精神病药物,住院时间是保护性因素.结论 住院精神分裂症患者糖、脂代谢异常相互影响,危险因素均主要涉及肥胖、非典型抗精神病约物等,应对危险因素进行必要干预.     

社区慢性精神分裂症患者共患糖尿病现况调查及相关因素分析

目的调查社区慢性精神分裂症患者糖尿病的发生情况及相关因素。方法对245例社区慢性精神分裂症患者进行病例回顾,体格检查及血生化检测。结果245例患者中糖尿病患病率为16.7%,显著高于一般人群的3.21%。40-49岁的患者中糖尿病患病率增高明显。糖尿病发生与年龄、体质量超重、病程及腹型肥胖有关。氯氮平新发糖尿病患病率高于经典药物组（P〈0.01）。结论社区慢性精神分裂症患者糖尿病的患病率高于一般人群,与患者年龄、体质量超重、病程及腹型肥胖有关。氯氮平比经典药物组可能更容易导致糖尿病的发生。     

Low serum leptin level is associated with zonisamide-induced weight loss in overweight female epilepsy patients

Because iatrogenic obesity may hinder medication compliance, it would be a reasonable approach to consider antiepileptic drugs (AEDs) that promote weight loss in overweight patients. We performed an open-label, observational study to assess the effects of zonisamide on weight in overweight female epilepsy patients. In particular, we studied how the basal serum leptin level is related to changes in the weight of these patients. We recruited female epilepsy patients with basal body mass index 25 or more. Laboratory findings including serum leptin level were measured and zonisamide was administered as a monotherapy at a dose of 200 to 400mg/day. Six months later, we measured changes in the body weight. Thirty-seven female epilepsy patients enrolled in the study, and 23 of them completed the treatment. Weight loss after zonisamide treatment was correlated with initial body weight (p=0.020), follow-up weight (p=0.010), and basal serum leptin level (p=0.008), but was not correlated with patients' age, results of lipid profile, and dosage of zonisamide. The correlation of the serum leptin level with weight loss was still significant after the effect of the initial weight was adjusted (p=0.042). Our study shows that low serum leptin level is associated with weight loss in overweight female epilepsy patients. This result may be beneficial for selecting AEDs and provide clues for the pathophysiology of zonisamide-induced weight loss.     

The impact of zonisamide on weight. A clinical study in 103 patients with epilepsy

Objective – To investigate the impact of zonisamide (ZNS) on body weight in patients with epilepsy. Methods – A retrospective chart analysis of weight changes after initiation of ZNS (103 patients; 54 female; age 17–68 years). For 31 patients follow‐up data after ZNS‐withdrawal were available. Patients were categorized according to body‐mass‐index (BMI) <20, 20–25, and >25 kg/m². Results – Body weight before ZNS was 78.6 ± 16.0 kg (range 45–120 kg), BMI 26.5 ± 5.2 kg/m² (range17.6–41.3 kg/m²). Within 13 ± 7.2 months of treatment, mean body weight decreased by ?3.7% ± 9.1%, showing high interindividual variability (?36% to +32%). Weight loss >5% was documented in 35%, weight gain >5% in 14% of patients. Weight loss was more prominent in patients being overweight prior to treatment onset. At the end of follow‐up, patients with overweight had decreased by number. Weight changes under ZNS were not correlated to ZNS daily dosage. Following discontinuation of ZNS treatment weight loss proved to be reversible. Conclusion – Zonisamide reduced weight in 35% of patients, especially in patients with overweight prior to treatment. Weight loss is reversible following discontinuation of treatment with ZNS.     

Correlates of overweight and obesity in 644 patients with bipolar disorder

OBJECTIVE: Overweight and obesity are common clinical problems encountered in the treatment of bipolar disorder. We therefore assessed the prevalence and clinical correlates of overweight, obesity, and extreme obesity in 644 bipolar patients. METHOD: 644 outpatients with DSM-IV bipolar disorder in the Stanley Foundation Bipolar Treatment Outcomes Network were evaluated with structured diagnostic interviews and clinician- and self-administered questionnaires to determine bipolar disorder diagnoses, demographic and historical illness characteristics, comorbid Axis I diagnoses, medical histories, health habits, and body mass indices (BMMs). RESULTS: Fifty-eight percent of the patients with bipolar disorder were overweight, 21% were obese, and 5% were extremely obese. American patients had significantly higher mean (p < .0001) BMIs and significantly higher rates of obesity (p < .001) and extreme obesity (p < .001) than European patients. Significant associations (p < or = .001) were found between overweight, obesity. and extreme obesity and gender, age, income level, comorbid binge-eating disorder, hypertension, arthritis, diabetes mellitus, exercise habits, and coffee consumption. Current BMI and weight were each correlated with the number of weight gain-associated psychotropics to which patients had been exposed. Multinomial logistic regression (adjusted for site and eating disorder diagnosis and corrected for multiple comparisons) showed that (1) overweight was significantly associated with male gender and hypertension (p < .001), (2) obesity was significantly associated with hypertension (p < .001), and (3) extreme obesity was significantly associated with hypertension and arthritis (p < .001). CONCLUSION: Overweight, obesity, and extreme obesity were common in this group of bipolar patients, although it was unclear that their prevalence rates were truly elevated, because overweight and obesity are increasingly common public health problems among the general population. Correlates of overweight and obesity in bipolar disorder include patient and treatment variables such as gender, geographical location, comorbid binge-eating disorder, age, income level, degree of exposure to weight gain-associated psychotropics, medical disorders associated with obesity, and health habits.     

Valproic acid-associated weight gain in older children and teens with epilepsy

This research was undertaken to determine the incidence and predictors of weight gain in older children and teens treated with valproate for epilepsy. Subjects who were 10 to 17 years of age, who began valproate treatment between January 1, 1996, and December 31, 2000, and who had documented weight and height measurements at medication initiation and at least one follow-up visit were retrospectively identified. Exclusion criteria were follow-up <2 months, discontinuation of valproate within 2 months, concurrent therapy with medication known to affect weight, or gastrostomy feeding. Body mass index was calculated at initiation and either discontinuation of valproate or last follow-up and stratified into four categories: underweight, (/=eighty-fifth to ninety-fifth percentile) and overweight (ninety-fifth percentile or higher). Potential predictors of change in body mass index were examined. Mild-to-moderate weight gain was observed in 58% of the 43 subjects treated with valproate (median increase, 2; twenty-fifth to seventy-fifth percentile, 1-6.4). Seventy-nine percent remained in the same body mass index category, and 14% moved up to a potentially overweight or overweight category. The only predictor of an overweight category at follow-up was a potentially overweight or overweight category at initiation (P <0.0002). Two factors tended to predict an increase in body mass index: normal neurocognitive status (P = 0.06) and primary generalized seizure type (P = 0.07).     

Weight gain after acute deep venous thrombosis: a prospective observational study

INTRODUCTION: The onset of acute disorders often results in a significant reduction in physical exercise, thus predisposing to further increase in body weight. Weight gain is strongly associated with an increase in metabolic and cardiovascular risk factors. The aim of this study was to assess weight changes occurring after an episode of acute deep venous thrombosis (DVT). MATERIALS AND METHODS: To compare the prevalence of overweight and obesity at baseline and 6 months after acute DVT, and to compare weight changes between patients with DVT treated in hospital or at home over a similar time frame, we evaluated 72 patients (mean age 59.8+/-15.3 years, 34 men and 38 females) with objectively diagnosed DVT. Body mass index (BMI) was recorded at baseline and at 6 months; waist circumference was recorded at 6 months to assess individual patterns of body fat distribution. RESULTS: At baseline, BMI was 27.6+/-4.6 kg/m(2). Overweight and obesity were observed in 33 (45.8%) and 19 (26.4%) patients, respectively. After 6 months, BMI was 28.7+/-5.0 kg/m(2). The prevalence of overweight and obesity was 44.4% and 32%, respectively; visceral pattern of body fat distribution was found in 64.8% of overweight or obese patients. Mean weight gain was 7.12%; inpatients (n=42) showed a higher weight gain than outpatients (n=30) (8.6% and 4.9%, respectively, p=0.046). CONCLUSIONS: We observed a significant weight gain after acute DVT. This weight gain was more marked in hospitalised patients than in outpatients. Our findings suggest that weight control should be considered in all patients with acute DVT.     

Body mass index is associated with the development of the post-thrombotic syndrome

Post-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT). Little is known about prognostic factors that might identify patients at high risk for the development of PTS. Body mass index (BMI) has been previously reported to be associated to the development of PTS. The aim of this study was to assess the association between BMI and other anthropometric parameters and PTS in a general population of DVT patients. In a prospective cohort study, 83 consecutive patients with objective diagnosis of DVT underwent physical examination. BMI was recorded at baseline and at 12 months, and waist circumference was recorded at 12 months to assess individual patterns of body fat distribution. The presence of PTS at 12 months was ascertained using a validated clinical scale. Sixty-three patients (75.9%) were overweight or obese at 12 months, 60 (72.3%) had a weight gain over 1 year. Twenty patients developed PTS (24.1%). Mean BMI was significantly higher in patients who developed PTS than in patients who did not (29.6 and 27.2 Kg/m(2), respectively, p = 0.022). A BMI of > 28 Kg/m(2) predicted early onset of PTS (OR 3.54, 95% CI 1.07-12.08, p = 0.017). Neither patterns of fat distribution nor weight gain in 1 year were correlated with PTS (p = 0.918 and p = 0.775, respectively). BMI is significantly correlated with the development of PTS. Patients with DVT should be encouraged to avoid weight gain. Reducing patient weight might be an important strategy to prevent PTS.     

Maternal perception of children's weight in relation to eating disorders

Abnormal perception of body weight in girls has been reported previously (1), and distorted perception of body shape is cited as one of the pathogenetic factors in eating disorders such as anorexia and bulimia nervosa (2,3)- Parent-child relationships should also be considered as one of the factors possibly contributing to the onset of the eating disorders (3,4). In the present paper we shall examine whether mothers perceive the weight of their sons and daughters correctly or not, and we shall also compare the results with the perceptions of the children themselves, which we have reported previously in this journal (1). Five outline drawings (-20% to 20% overweight), used in the previous study (1), were shown to the mothers, who were asked to select the drawings which they considered to represent the body weight of their sons (n=130) and daughters (n=125), who were aged 6 to 18 years. The mean body weights of the boys and girls in the study sample were 6.0% and 6.6% overweight, respectively. The mothers perceived the weight of their sons to be significantly (P < 0.01) less than the actual weight of these boys. The mean difference between the perceived weight and the actual weight was 10.4%. The mothers’ perception of their daughters’ weight was also 7.9% less than the actual weight (P < 0.05) (Fig. 1).     

Self-reported body weight perception and dieting practices in community-dwelling patients with schizophrenia

INTRODUCTION: Many patients with schizophrenia are exposed to serious health risks associated with their excess body weight. Evidence exists that even a moderate amount of weight loss may have significant health benefits. Thus, weight control in schizophrenia patients has become an important treatment goal. Although studies in the general population show that satisfaction with body weight is an important predictor for engagement in various weight loss measures, the perspective of schizophrenia patients has not been assessed. METHOD: Information on self-reported weight perception, desire to lose weight as well as weight loss attempts was obtained according to methods employed in the National Health and Nutrition Examination Survey, Cycle III (NHANES III). Body weight and height were measured and body mass index (BMI) was calculated. RESULTS: Perception of body weight and desire to lose weight were correlated to BMI. Both obese female and male subjects (BMI30) were aware of their weight status. However, whereas overweight females (BMI>25< or =29.9) accurately perceived themselves so, males in this category had difficulties perceiving themselves overweight, and consequently neither wanted to lose weight, nor tried to lose weight. As means of weight loss, caloric restriction (diet) was most frequently employed (by more than 80% of study subjects); yet only a third of study subjects (34.4%) engaged in the recommended combination of diet and exercise to lose weight. Questionable weight loss practices were also frequently employed, especially among women. CONCLUSIONS: Obese patients (BMI> or =30) were generally aware of their excess body weight and wanted to lose weight. Only non-obese, yet overweight males (BMI>25< or =29.9) did not perceive themselves as overweight and consequently did not try to lose weight. Weight loss practices did not always follow established recommendations. Especially women were likely to approach weight loss with questionably appropriate and unsafe methods.     

Weight gain in children after adenotonsillectomy: undesirable weight gain or catch-up growth?

Objective/backgroundObesity and obstructive sleep apnea (OSA) are consequential conditions with significant overlap in the pediatric population. Early studies documented catch-up growth in underweight children after adenotonsillectomy, but more recent studies suggested that normal and even overweight children may experience excess weight gain after adenotonsillectomy. We performed a secondary analysis of Childhood Adenotonsillectomy Trial (CHAT) data to test whether there was an effect of early adenotonsillectomy on undesirable weight gain, defined as an increase in body mass index (BMI) Z score in an already overweight or obese child or a change from baseline normal or underweight to a follow up BMI Z score classified as overweight.Patients/methodsWe included 398 children with moderate OSA and complete anthropomorphic data randomized to adenotonsillectomy versus watchful waiting with supportive care. Pearson's χ² and independent t tests were used to compare demographic, activity, sleep and anthropomorphic characteristics between children who did and did not experience undesirable weight gain over seven months. Logistic regression was used to test for an association between adenotonsillectomy and undesirable weight gain, both unadjusted and adjusted for age, sex, Black race, average parent-reported weekly activity level, mother's body mass index, average nightly sleep duration and either baseline or follow up AHI (in separate models).ResultsForty three percent (n = 172) experienced undesirable weight gain. A similar percentage of children in both arms experienced undesirable weight gain (45% adenotonsillectomy vs 41% watchful waiting). Neither unadjusted nor adjusted regression analysis demonstrated a significant effect of adenotonsillectomy on undesirable weight gain.ConclusionAdenotonsillectomy may not be an independent risk factor for undesirable weight gain in children.