Bipolar and Depressive Disorders Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, CB2 0QQ, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, PE29 3RJ, UK.
J Psychiatr Res. 2019 Aug;115:29-35. doi: 10.1016/j.jpsychires.2019.05.004. Epub 2019 May 4.
Antipsychotic induced weight gain is a frequent reason for treatment discontinuation in psychosis, subsequently increasing the risk of relapse and negatively affecting patient well-being. The metabolic effect of weight gain and the subsequent risk of obesity constitute a major medical problem on the long term. Despite its consequences, to date few risk factors have been identified (age, gender, body mass index at baseline), with some authors suggesting the implication of early life stressful events, such as perinatal conditions. We aim to describe if a surrogate marker of intrauterine environment (birth weight) might predict weight gain in a cohort of 23 antipsychotic naïve patients at the onset of the psychotic disease evaluated during 16 weeks with olanzapine treatment and in another cohort of 24 psychosis-resistant patients initiating clozapine assessed for 18 weeks. Two independent linear mixed model analyses were performed in each cohort of patients, with prospective weight gain as the dependent variable, age, gender, body mass index, duration of treatment and time as independent variables. Only in naïve patients, weight gain due to antipsychotics was significantly associated with birth weight, while male gender and body mass index at baseline were associated in both cohorts of patients. Treatment-resistant psychotic patients under clozapine were older, had previous antipsychotic treatment and more years of disease, confounders that might have influence a non significant association. Our results suggest that early environmental events might be playing a role in weight evolution in naïve patients treated with antipsychotics.
抗精神病药引起的体重增加是精神分裂症患者停药的常见原因，随后会增加复发的风险，并对患者的健康产生负面影响。体重增加的代谢效应及随后的肥胖风险是长期存在的主要医学问题。尽管后果严重，但迄今为止，只有少数危险因素得到了确认（年龄、性别、基线时的体重指数），一些作者认为，生命早期应激事件（如围产期状况）可能与体重增加有关。我们旨在描述，在接受奥氮平治疗的 23 名抗精神病药初治患者和接受氯氮平治疗的 24 名精神病性耐药患者队列中，一种宫内环境的替代标志物（出生体重）是否可以预测体重增加。在每个患者队列中进行了两项独立的线性混合模型分析，将前瞻性体重增加作为因变量，年龄、性别、体重指数、治疗持续时间和时间作为自变量。只有在初治患者中，抗精神病药引起的体重增加与出生体重显著相关，而在两个患者队列中，男性和基线时的体重指数均与体重增加相关。服用氯氮平的耐药性精神病患者年龄较大，以前接受过抗精神病治疗，且患病时间更长，这些混杂因素可能导致非显著相关。我们的结果表明，早期环境事件可能在接受抗精神病药物治疗的初治患者的体重变化中发挥作用。
