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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tolerability of long term clozapine treatment (7-8 years) was investigated in 27 female patients (age 34-77 years). Diagnosis according to ICD 9 was schizophrenia in 21 patients, severe psychomotor agitation with mental deficiency in 4 patients and an "endogenous" depression in 2 patients. All patients had previously been treated with different neuroleptics but with inadequate response or distressing side effects. The duration of the disorder was 10-36 years, duration of hospitalisation 10-36 years. At the day of investigation the total dose of clozapine ranged from 52-826 g, the average total dose being 385 g. The daily dose of clozapine ranged from 75 to 600 mg, the average daily dose being 225 mg. Only 2 patients were treated exclusively with clozapine, the other 25 patients were also receiving other neuroleptics. Seventy eight per cent of the investigated patients complained about hypersalivation and 63% showed overweight. In 37% of the patients the EEG demonstrated abnormalities. Mild parkinsonism was reported in 15% and akathisia in 11% of the patients, all these patients being on combined treatment. Clozapine did not induce tardive dysakinesia (TD) in any of the patients within a treatment period of 7-8 years. It is concluded that a potential benefit of clozapine includes a low incidence of neurological side effects even after long term administration.
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PMID:Tolerability of long term clozapine treatment. 281 63

Body weight was examined in chronic schizophrenic patients. Underweight medicated patients had normal ventricular brain ratios (VBRs) on CT. Overweight patients had both normal and abnormal VBRs. Weight decreased during neuroleptic withdrawal; caloric intake and weight increased when neuroleptics were reinstituted. Weight gain on neuroleptics correlated with symptom improvement independent of VBR or gender. Weight changes and psychosis in schizophrenia may be mediated by similar neurochemical systems.
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PMID:Clinical correlates of body weight changes in schizophrenia. 804 44

Obesity and overweight are clearly associated with many serious conditions, including type II diabetes mellitus, hypertension, and coronary heart disease. Excess weight also increases the risk of death. Recent evidence suggests that weight gain itself, even if persons remain within the "normal" weight range, also increases the risk of medical illnesses and premature death. Persons who gain 5.0 to 7.9 kg (11 to 17.3 lb) as adults are 1.9 times more likely to develop type II diabetes mellitus and 1.25 times more likely to develop coronary heart disease than those who lose weight or maintain a stable weight after age 18 years. Gaining 11 to 20 kg (24.2 to 44 lb) or more in adulthood increases the risk of ischemic stroke 1.69 to 2.52 times. The relationship between weight gain and breast cancer has been difficult to study, primarily because postmenopausal hormone replacement therapy can mask the effect of weight gain on cancer risk. Accordingly, weight gain in adulthood has been associated with an increased risk of breast cancer only among women who have never used hormone replacement therapy. In addition to its adverse effects on disease outcomes, weight gain also impairs physical functioning, reduces quality of life, and is associated with poor mental health. These psychological and mental health consequences of weight gain can become an added burden for patients with schizophrenia and other mental disorders.
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PMID:Physical and psychological consequences of weight gain. 1054 35

The estimated percentage of persons with schizophrenia who are overweight is higher than the percentage of persons in the general population who are overweight. The increased mortality rate for persons with schizophrenia is largely due to obesity-related diseases. The atypical antipsychotics offer an improved therapeutic index when compared with the conventional agents, but may impart serious adverse events such as weight gain. This brief review is intended to provide the practicing clinician with an update of disparate research paradigms under investigation in an attempt to delineate the biological mechanisms that presage weight gain. Research success in this area may invite novel prevention strategies and hint at potential mechanisms of antipsychotic drug action.
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PMID:Mechanisms of antipsychotic-induced weight gain. 1160 82

Although still considered more of a cosmetic problem by both the general public and some areas of the medical community, overweight and obesity have reached epidemic proportions worldwide. Overweight and obesity have not only a significant psychological impact but also result in an increased risk for development of numerous chronic and sometimes fatal diseases. The morbidity from obesity-associated disorders increases with higher body mass index and begins within the normal weight range. The costs (direct and indirect) associated with treating obesity and its comorbid conditions are notable and increasing. Obesity rates in patients with schizophrenia are at least as high, if not higher, than in the general population. This article reviews the epidemiology and burden of obesity and its associated comorbid disorders. The guidelines from the National Heart, Lung, and Blood Institute of the National Institutes of Health for diagnosing and treating obesity are also discussed.
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PMID:Epidemiology, morbidity, and treatment of overweight and obesity. 1160 81

The available literature suggests that patients with schizophrenia are at risk for diabetes mellitus and taking antipsychotic medication further increases the chance of developing non-insulin-dependent hyperglycemia. Case reports, chart reviews, and some results from clinical drug trials implicate a relationship between glucose levels and treatment with clozapine or olanzapine in patients with schizophrenia, although a few cases of hyperglycemia have also been reported in patients taking risperidone and quetiapine. These studies indicate that hyperglycemia is not dose dependent, is reversible on cessation of treatment with clozapine or olanzapine, and reappears on reintroduction of these therapies. The postulated underlying mechanisms involved in this process in patients with schizophrenia include (1) a decreased sensitivity to insulin that is independent of atypical medication, (2) an increased insulin resistance related to atypical medications, (3) the effects of atypical medications on serotonin receptors, and (4) overuse of insulin due to weight gain. These mechanisms are discussed in detail, and recommendations for the administration of atypical antipsychotics are offered. Overweight, ethnicity, family or personal history of diabetes mellitus or hypertension, and weight gain during the course of treatment have all been identified as risk factors in the development of hyperglycemia in patients with schizophrenia. However, it is difficult to statistically assess the true incidence of diabetes within each type of antipsychotic medication group with the exclusive dependence on available case studies and without proper epidemiologic research.
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PMID:Hyperglycemia associated with the use of atypical antipsychotics. 1160 83

The advent of the novel or atypical antipsychotic drugs has improved the treatment and quality of life for many individuals. However, many of these newer agents confer a degree of weight gain that is both greater than conventional antipsychotics and of a clinically meaningful magnitude. To better place this issue into perspective, we evaluated body mass index (BMI; kg/m2) levels and the prevalence of overweight and obesity among schizophrenic versus non-schizophrenic individuals among nationally representative samples of the US adult population and evaluated whether there were changes in these rates during the decade from 1987 to 1996, a period in which use of novel/atypical agents increased. Results showed that mean BMI for individuals with schizophrenia is significantly higher than individuals who are not schizophrenic. The non-schizophrenic population shows steady and significant gains in BMI from 1987 to 1996 both as a whole and when stratified by gender and age. In contrast, time trends among the population of schizophrenic individuals show a more complex pattern. Specifically, for most groups, there is little evidence of a general trend in BMI over time. However, among females with schizophrenia ages 18-30, BMI has increased dramatically and significantly causing a much higher obesity rate among young women with schizophrenia in recent years relative to their non-schizophrenic counterparts. The mechanism that underlies this weight age and sex specific time trend is unclear.
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PMID:Changes in body mass index for individuals with and without schizophrenia, 1987-1996. 1204 51

The authors interviewed 43 women with schizophrenia who were 40 to 70 years of age about their health status, preventive health care, addictive behaviors, and comorbid medical conditions. Data were compared with those for age-matched samples from the general population. Thirty women in the study sample (71 percent) were overweight or obese, compared with 38 percent in the general population. Twenty-seven (63 percent) smoked cigarettes. Twenty-six women (62 percent) had received a mammogram in the past two years, compared with 86 percent in the general population. Rates of routine physical examinations and Pap tests did not differ markedly between the study sample and the general population. These results highlight the health impairments of older women who have schizophrenia.
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PMID:Health behaviors and health status of older women with schizophrenia. 1209 74

Issues to consider when evaluating maintenance drug therapy for patients with schizophrenia are discussed; these include potential adverse effects of antipsychotic therapy, such as weight gain, diabetes mellitus, extrapyramidal symptoms, sexual dysfunction, cognitive dysfunction, and cardiac effects, as well as quality of life. Patients with schizophrenia are more likely to be overweight than the general population. Olanzapine and clozapine have been associated with the greatest weight gain of the newer antipsychotics. While patients with schizophrenia are at increased risk of developing diabetes mellitus independent of antipsychotic therapy, diabetes may be more prevalent in patients taking the newer agents. Acute extrapyramidal symptoms occur in 75-90% of patients receiving first-generation antipsychotics like thioridazine and haloperidol. The probability of tardive dyskinesia (TD) occurring with second- and third-generation agents is less than 1% per year, compared with about 5% per year for the traditional antipsychotics. When patients are switched from a traditional antipsychotic to clozapine or olanzapine, TDs usually abate somewhat. Thioridazine causes a pronounced prolongation of the QTc interval, which can lead to ventricular arrhythmias. The slight increase in QTc interval caused by ziprasidone most likely will not be a problem in healthy individuals. Newer antipsychotics are associated with improved neurocognitive functioning and most cause less prolactin elevation, compared with traditional agents. The newer antipsychotic agents are not devoid of adverse effects, but those that do occur can be managed. Once issues related to adherence are resolved, rehabilitation of patients with schizophrenia will be a high priority.
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PMID:Clinical issues associated with maintenance treatment of patients with schizophrenia. 1222 83

The prevalence of overweight and obesity in untreated patients with severe mental illness mimicks the trends seen in the general population. Furthermore, weight gain is likely to occur with the addition of pharmacotherapy with an antipsychotic. The literature does indicate that despite fundamental cognitive and psychosocial deficits seen in patients with severe and persistent mental disorders such as schizophrenia and bipolar disorder, it is possible to effectively manage weight gain in this population. In particular, behavioral interventions have been shown to be effective in the prevention and treatment of weight gain associated with antipsychotic therapy. Some success has also been seen with the use of adjunctive medication such as amantadine, histamine (H2) antagonists, metformin, topiramate, and orlistat. Additional, prospective, controlled studies of long-term antipsychotic drug associated weight gain and its clinical consequences are needed in order to identify the most effective therapy for the reduction and maintenance of body weight in patients taking antipsychotic therapy.
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PMID:Management of weight gain associated with antipsychotics. 1283 32


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