Professional Issues >> Total Wellness

Many patients who gain weight on antipsychotic treatment do so because they previously were homeless or jobless due to the psychosis, and as they improve, they eat more; they may be able to work and buy regular meals, such as fast food, or they may go to live in a residence where meals are provided. Aquila and Emanuel 31 monitored the effect of an intervention strategy to control weight gain in a retrospective study of 32 patients with DSM-TV schizophrenia or schizoaffective disorder. The patients had taken clozapine, olanzapine, risperidone, or ziprasidone for at least 1 year. All patients were residents in an adult care facility for formerly homeless persons with serious mental illness.

Intervention consisted of health services (complete medical and psychiatric care); nutrition care (low-calorie, monitored diet and nutritional education); and supportive care. (Table A). In general, as the negative symptoms of schizophrenia improved, patients became more proactive in their health care. Aquila and Emanuel 31 found that the incidence of weight gain decreased after the intervention (Table B), and this change was consistent across all antipsychotics taken. The researchers concluded that a patient's diet appears to be a better predictor of weight gain than the choice of novel antipsychotic medication and suggested that clinicians might prescribe nutritional and lifestyle changes alongside medications with weight gain potential. Also, since all medications in the study were provided under supervised conditions, compliance was 100%. Therefore, the patients had full benefit from the agents, and as their schizophrenia symptoms lessened, the patients' motivation to care for themselves increased. These patients proved to be highly educable and responsible to positive interventions regarding their weight, blood sugar levels, and cholesterol levels. The effectiveness of these interventions was evident early on and encouraged continuing patient participation. This study suggests that if the physician encourages compliance with treatment and healthy eating habits, weight gain is a manageable adverse event of antipsychotic therapy.

 

Strategies for Managing Weight in Patients Treated With Novel Antipsychotics

Health and Medical issues Monitor general health Monitor psychiatric health Switch to optimal atypical antipsychotic agent Use medical intervention for comorbid conditions Nutrition Issues Encourage healthy diet, increased consumption of fresh produce, and portion control Nutritionist visit for patients with obesity, hypercholesterolemia, or diabetes Group Support Weight reduction support Nutritionist directed education Diabetes support

Table A. Data from Aquila and Emanuel31