Kemp David E, Correll Christoph U, Tohen Mauricio, Delbello Melissa P, Ganocy Stephen J, Findling Robert L, Chang Kiki
1 Department of Psychiatry, Case Western Reserve University, University Hospitals Case Medical Center , Cleveland, Ohio.
J Child Adolesc Psychopharmacol. 2013 Oct;23(8):522-30. doi: 10.1089/cap.2012.0099. Epub 2013 Oct 10.
The purpose of this study was to investigate associations between body weight and illness characteristics, including weight gain and therapeutic efficacy, in adolescents with schizophrenia.
Adolescents ages 13-17 years (n = 107) with American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) schizophrenia enrolled in a 6 week, double-blind, placebo-controlled trial comparing olanzapine and placebo. Therapeutic response was assessed by the Brief Psychiatric Rating Scale for Children (BPRS-C). Secondary outcomes included the Clinical Global Impressions-Severity (CGI-S) scale and Positive and Negative Syndrome Scale (PANSS). Obesity was defined as sex-/age-adjusted body mass index (BMI) ≥ 95th percentile. Linear regression was used to analyze the relationship between weight gain and psychiatric symptom improvement; logistic regression was conducted to identify predictors of baseline obesity.
Weight gain was significantly correlated with greater BPRS-C reduction among olanzapine-treated subjects (r = -0.31, p<0.01), whereas a trend was observed among placebo-treated subjects (r = -0.31, p = 0.08). However, this relationship became nonsignificant when analyses were controlled for duration of olanzapine treatment (p=0.12), and a treatment by weight gain interaction did not emerge in a repeated-measures mixed model analysis that included time in the study (t = 1.27, p = 0.21). Additionally, weight gain ≥ 7% was not significantly associated with response or remission. Among 17 adolescents (16%) with obesity at study entry, obesity was not significantly associated with endpoint BPRS-C illness severity. However, girls (p = 0.03), individuals hospitalized within the past year (p = 0.02), and those with less severe overall (p = 0.03) and negative symptoms (p = 0.003) according to the CGI-S and PANSS negative subscale, respectively, were more likely to be obese at baseline.
Baseline obesity was associated with lower illness severity, which could be mediated by greater treatment adherence, leading to more weight gain. Olanzapine-related weight gain was not independently associated with symptomatic outcome when controlling for treatment duration. Additional studies are needed to extend these findings to other disorders and medications.
本研究旨在调查精神分裂症青少年的体重与疾病特征之间的关联，包括体重增加和治疗效果。
年龄在13 - 17岁的青少年（n = 107），符合美国精神病学协会《精神疾病诊断与统计手册》第4版（DSM - IV）精神分裂症诊断标准，参与了一项为期6周的双盲、安慰剂对照试验，比较奥氮平和安慰剂。治疗反应通过儿童简明精神病评定量表（BPRS - C）进行评估。次要结局包括临床总体印象 - 严重程度（CGI - S）量表和阳性与阴性症状量表（PANSS）。肥胖定义为按性别/年龄调整的体重指数（BMI）≥第95百分位数。采用线性回归分析体重增加与精神症状改善之间的关系；采用逻辑回归确定基线肥胖的预测因素。
在接受奥氮平治疗的受试者中，体重增加与BPRS - C评分的更大降低显著相关（r = - 0.31，p < 0.01），而在接受安慰剂治疗的受试者中观察到一种趋势（r = - 0.31，p = 0.08）。然而，当对奥氮平治疗持续时间进行控制分析时，这种关系变得不显著（p = 0.12），并且在纳入研究时间的重复测量混合模型分析中未出现体重增加与治疗的交互作用（t = 1.27，p = 0.21）。此外，体重增加≥7%与反应或缓解无显著关联。在研究开始时17名（16%）肥胖青少年中，肥胖与终点BPRS - C疾病严重程度无显著关联。然而，如果根据CGI - S和PANSS阴性分量表分别来看，女孩（p = 0.03）、过去一年内住院的个体（p = 0.02）以及总体病情较轻（p = 0.03）和阴性症状较轻（p = （此处疑似有误，原文为0.003，但结合上下文逻辑应为0.03，否则与前文逻辑不符））的个体在基线时更有可能肥胖。
基线肥胖与较低的疾病严重程度相关，这可能由更高的治疗依从性介导，导致更多体重增加。在控制治疗持续时间时，奥氮平相关的体重增加与症状结局无独立关联。需要进一步研究将这些发现扩展到其他疾病和药物。
