National Institute of Mental Health, Klecany, Czech Republic.
Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Eur Psychiatry. 2024 Sep 26;67(1):e59. doi: 10.1192/j.eurpsy.2024.1761.
We need to better understand the risk factors and predictors of medication-related weight gain to improve metabolic health of individuals with schizophrenia. This study explores how trajectories of antipsychotic medication (AP) use impact body weight early in the course of schizophrenia.
We recruited 92 participants with first-episode psychosis (FEP, = 92) during their first psychiatric hospitalization. We prospectively collected weight, body mass index (BMI), metabolic markers, and exact daily medication exposure during 6-week hospitalization. We quantified the trajectory of AP medication changes and AP polypharmacy using a novel approach based on meta-analytical ranking of medications and tested it as a predictor of weight gain together with traditional risk factors.
Most people started treatment with risperidone ( = 57), followed by olanzapine ( = 29). Then, 48% of individuals remained on their first prescribed medication, while 33% of people remained on monotherapy. Almost half of the individuals (39/92) experienced escalation of medications, mostly switch to AP polypharmacy (90%). Only baseline BMI was a predictor of BMI change. Individuals in the top tercile of weight gain, compared to those in the bottom tercile, showed lower follow-up symptoms, a trend for longer prehospitalization antipsychotic treatment, and greater exposure to metabolically problematic medications.
Early in the course of illness, during inpatient treatment, baseline BMI is the strongest and earliest predictor of weight gain on APs and is a better predictor than type of medication, polypharmacy, or medication switches. Baseline BMI predicted weight change over a period of weeks, when other traditional predictors demonstrated a much smaller effect.
我们需要更好地了解与药物相关的体重增加的风险因素和预测因素，以改善精神分裂症患者的代谢健康。本研究探讨了抗精神病药物（AP）使用的轨迹如何在精神分裂症早期影响体重。
我们在首次精神病住院期间招募了 92 名首发精神病患者（FEP，=92）。我们前瞻性地收集了体重、体重指数（BMI）、代谢标志物和住院 6 周期间的精确每日药物暴露量。我们使用基于药物荟萃分析排名的新方法量化了 AP 药物变化和 AP 联合用药的轨迹，并将其作为体重增加的预测因子与传统风险因素一起进行了测试。
大多数人开始使用利培酮（=57）治疗，其次是奥氮平（=29）。然后，48%的人继续使用他们的第一种处方药物，而 33%的人继续使用单一药物治疗。几乎一半的人（39/92）经历了药物升级，主要是转为 AP 联合用药（90%）。只有基线 BMI 是 BMI 变化的预测因子。与体重增加最低三分位的个体相比，体重增加最高三分位的个体表现出更低的随访症状，有更长的住院前抗精神病治疗时间，并且接触到更多代谢问题药物的趋势。
在疾病早期，住院治疗期间，基线 BMI 是 AP 体重增加的最强和最早的预测因子，并且比药物类型、联合用药或药物转换的预测能力更强。在其他传统预测因子表现出较小影响的数周时间内，基线 BMI 预测了体重的变化。
