O'Keefe Christopher D, Noordsy Douglas L, Liss Thomas B, Weiss Honey
Mental Health Center of Greater Manchester, Manchester, N.H., USA. christopher.o'
J Clin Psychiatry. 2003 Aug;64(8):907-12. doi: 10.4088/jcp.v64n0808.
Given growing concern about weight gain associated with treatment with antipsychotic agents, we performed a retrospective chart review of patients who reversed weight gain associated with antipsychotic treatment to determine the prevalence of reversal and both the course and methods used.
Prevalence of weight gain reversal was determined by surveying clinicians. Of 53 patients who gained >/= 20 lb (9 kg) during antipsychotic treatment, an initial sample of 12 patients (23%) who subsequently lost >/= 10 lb (5 kg) was identified. These 12 patients were combined with additional patients, identified by the authors, who met the same criteria for reversal of antipsychotic-associated weight gain to form a total sample of 35 patients. Course and methods of weight loss were determined by reviewing these patients' charts. Information about interventions and both antipsychotic and other medications was collected.
At the point of maximum weight gain, the total sample of 35 patients had gained a mean of 29.36 kg (64.73 lb) over a mean of 33 months. At the point of greatest weight loss (56 months), these patients were a mean of 10.86 kg (23.94 lb) over their baseline weight. The most recent weight for patients (63 months) indicated they were 14.81 kg (32.65 lb) over baseline. The most frequent weight loss interventions were regular dietician visits (42.9% [N = 15]), self-directed diet (28.6% [N = 10]), and weight loss as a treatment goal (25.7% [N = 9]). The least frequent interventions were no intervention (5.7% [N = 2]), psychiatrist addressing weight loss (5.7% [N = 2]), and surgery (2.9% [N = 1]). No significant change in medications prescribed was found.
Some patients who gain weight while taking antipsychotic medications are able to stop gaining and lose weight over time, largely through behavioral interventions. While patients' weight fluctuated, this group sustained a loss of approximately half their initial gain. Dietary interventions appear promising and should be explored further to prevent and reverse weight gain.
鉴于对抗精神病药物治疗相关体重增加的关注度日益提高，我们对逆转抗精神病药物治疗相关体重增加的患者进行了一项回顾性病历审查，以确定体重逆转的患病率以及所采用的过程和方法。
通过对临床医生进行调查来确定体重增加逆转的患病率。在53名在抗精神病药物治疗期间体重增加≥20磅（9千克）的患者中，初步确定了12名（23%）随后体重减轻≥10磅（5千克）的患者样本。这12名患者与作者确定的符合抗精神病药物相关体重增加逆转相同标准的其他患者合并，形成了一个35名患者的总样本。通过审查这些患者的病历确定体重减轻的过程和方法。收集了有关干预措施以及抗精神病药物和其他药物的信息。
在体重增加最多时，35名患者的总样本在平均33个月内平均体重增加了29.36千克（64.73磅）。在体重减轻最多时（56个月），这些患者的体重比基线体重平均减轻了10.86千克（23.94磅）。患者的最新体重（63个月）表明他们比基线体重重14.81千克（32.65磅）。最常见的体重减轻干预措施是定期拜访营养师（42.9% [N = 15]）、自主饮食（28.6% [N = 10]）以及将体重减轻作为治疗目标（25.7% [N = 9]）。最不常见的干预措施是不进行干预（5.7% [N = 2]）、精神科医生关注体重减轻（5.7% [N = 2]）以及手术（2.9% [N = 1]）。未发现所开药物有显著变化。
一些服用抗精神病药物时体重增加的患者能够随着时间的推移停止体重增加并减轻体重，主要通过行为干预。虽然患者体重有波动，但该组患者维持了约一半初始体重增加量的减轻。饮食干预似乎很有前景，应进一步探索以预防和逆转体重增加。
