Ko Young-Hoon, Joe Sook-Haeng, Jung In-Kwa, Kim Seung-Hyun
Department of Psychiatry, Korea University College of Medicine, Guro Hospital, Guro-gu, Seoul, South Korea.
Clin Neuropharmacol. 2005 Jul-Aug;28(4):169-75. doi: 10.1097/01.wnf.0000172994.56028.c3.
Schizophrenic patients commonly suffer weight gain, which is often associated with widely prescribed antipsychotic medicines. It is distressing to most patients who experience it and may affect their response to treatment of schizophrenia. Weight gain is also associated with treatment noncompliance and several medical conditions. This study explored the efficacy and tolerability of topiramate as an adjuvant treatment of patients with schizophrenia who were carrying excess weight. In this 12-week, randomized, placebo-controlled prospective study, 66 hospitalized patients with schizophrenia who were carrying excess weight were given topiramate at doses of 100 mg/day or 200 mg/day, or a placebo. The primary measures made were body weight, body mass index, waist measurement, hip measurement, and waist-to-hip ratio. Safety measures included physical examinations and the monitoring of adverse effects, clinical laboratory data, and vital signs. The Clinical Global Impression-Severity of Illness scale (CGI-S) and the Brief Psychiatric Rating Scale (BPRS) were used to quantify changes in schizophrenic symptoms and signs. In the 200-mg/day topiramate group, body weight, body mass index, waist measurement, and hip measurement decreased significantly compared with the 100-mg/day topiramate and placebo groups over 12 weeks. However, the waist-to-hip ratio did not change in any group. Scores on the CGI-S and BPRS decreased significantly over the 12-week period in both topiramate groups, but the decrease was not clinically meaningful. These results suggest that a higher dose of topiramate is efficacious as an adjuvant treatment of patients with schizophrenia experiencing excess weight gain. Further clinical research is required to establish guidelines for the use of topiramate as an antiobesity agent in schizophrenic patients.
精神分裂症患者通常会体重增加，这往往与广泛使用的抗精神病药物有关。这对大多数经历体重增加的患者来说很苦恼，并且可能影响他们对精神分裂症治疗的反应。体重增加还与治疗依从性差和多种疾病状况相关。本研究探讨了托吡酯作为辅助治疗超重精神分裂症患者的疗效和耐受性。在这项为期12周的随机、安慰剂对照前瞻性研究中，66名超重的住院精神分裂症患者被给予100毫克/天或200毫克/天的托吡酯，或安慰剂。主要测量指标包括体重、体重指数、腰围、臀围和腰臀比。安全指标包括体格检查以及对不良反应、临床实验室数据和生命体征的监测。使用临床总体印象-疾病严重程度量表（CGI-S）和简明精神病评定量表（BPRS）来量化精神分裂症症状和体征的变化。在12周的时间里，与100毫克/天托吡酯组和安慰剂组相比，200毫克/天托吡酯组的体重、体重指数、腰围和臀围显著下降。然而，任何一组的腰臀比均未改变。在12周期间，两个托吡酯组的CGI-S和BPRS评分均显著下降，但下降幅度在临床上并无意义。这些结果表明，较高剂量的托吡酯作为辅助治疗超重的精神分裂症患者是有效的。需要进一步的临床研究来制定托吡酯作为精神分裂症患者抗肥胖药物使用的指南。
