Clinical Institute of Neurosciences, Hospital Clínic of Barcelona.
University of Coimbra, Coimbra, Portugal.
J Clin Psychopharmacol. 2022;42(1):75-80. doi: 10.1097/JCP.0000000000001483.
Antipsychotic-associated weight gain is a common adverse effect with several negative outcomes in the clinical evolution of patients, which might also affect patients' self-identity from physical appearance and imply treatment discontinuation. However, recent research has drawn attention to an unexpected clinical improvement associated with weight gain, mostly in patients under treatment with clozapine or olanzapine.
Twenty-three treatment-resistant psychosis patients initiating clozapine were evaluated. Longitudinal psychopathological assessment through the Positive and Negative Syndrome Scale (PANSS) and anthropometric evaluation were performed at baseline, week 8, and 18.
Body mass index (BMI) change during clozapine treatment was associated with clinical improvement measured with PANSS total score at week 8 (P = 0.021) while showed a trend at week 18 (P = 0.058). The PANSS general score was also associated with weight gain at week 8 (P = 0.022), whereas negative subscale score showed a trend at week 8 (P = 0.088) and was associated between week 8 and 18 (P = 0.018). Sex differences applied at week 8 for PANSS total score, where clinical improvement was significantly associated with BMI in male subjects (P = 0.024). We also stratified for time to initiate clozapine, finding significant associations in negative symptom at week 8 (P = 0.023) and week 18 (P = 0.003) for subjects, which started clozapine after 3 years of illness.
Our results suggest that in subjects initiating clozapine, clinical improvement is associated with BMI increase, mostly in negative symptom and in patients after 3 years of antipsychotic use. Our findings were already described in the preantipsychotic era, suggesting some pathophysiological mechanism underlying both conditions.
抗精神病药相关的体重增加是患者临床转归的常见不良反应，会对患者的外貌产生负面影响，导致自我认同出现问题，甚至可能导致治疗中断。然而，最近的研究引起了人们的关注，体重增加与意料之外的临床改善有关，这种改善在接受氯氮平或奥氮平治疗的患者中更为常见。
对 23 名开始服用氯氮平的治疗抵抗性精神病患者进行评估。通过阳性和阴性综合征量表（PANSS）进行纵向的精神病理学评估，并在基线、第 8 周和第 18 周进行人体测量评估。
氯氮平治疗期间体重指数（BMI）的变化与第 8 周时 PANSS 总分的临床改善有关（P = 0.021），在第 18 周时有趋势（P = 0.058）。PANSS 一般评分也与第 8 周时的体重增加有关（P = 0.022），而阴性子量表评分在第 8 周时有趋势（P = 0.088），且在第 8 周和第 18 周之间存在关联（P = 0.018）。第 8 周时，性别差异适用于 PANSS 总分，其中男性患者的临床改善与 BMI 显著相关（P = 0.024）。我们还根据氯氮平开始时间进行了分层，发现对于患病 3 年后开始服用氯氮平的患者，第 8 周和第 18 周时阴性症状与 PANSS 总分有显著相关性（P = 0.023 和 P = 0.003）。
我们的结果表明，在开始服用氯氮平的患者中，临床改善与 BMI 增加有关，尤其是在阴性症状和使用抗精神病药物 3 年后的患者中。这些发现早在抗精神病药物出现之前就已经被描述过，提示这两种情况可能存在一些共同的病理生理机制。
