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Psychiatr Prax 2015; 42(07): 359-369
DOI: 10.1055/s-0035-1552670
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Nichtpharmakologische Interventionen zur Prävention von Gewichtszunahme bei schizophrenen Patienten unter antipsychotischer Medikation

Systematische Übersichtsarbeit und MetaanalyseNon-Pharmacological Interventions for the Prevention of Weight Gain in Schizophrenic Patients Treated with Antipsychotic MedicationSystematic Review and Meta-Analysis
Astrid Fink
Institut für Medizinische Soziologie, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
,
Sandra Cieslak
Institut für Medizinische Soziologie, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
,
Frank Rosenbach
Institut für Medizinische Soziologie, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
› Author Affiliations
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Publication History

Publication Date:
09 July 2015 (online)

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Zusammenfassung

Ziel: Systematische Übersicht über den aktuellen Forschungsstand zu nichtpharmakologischen Interventionen zur Prävention von Gewichtszunahme bei Patienten mit Schizophrenie unter atypischer antipsychotischer Medikation.

Methode: Systematische Literaturrecherche, Einschluss aller kontrollierten Studien.

Ergebnisse: Verhaltenstherapeutische Interventionen scheinen die Gewichtszunahme zu reduzieren, hinsichtlich der Wirksamkeit von Ernährungsberatung sind die Ergebnisse widersprüchlich.

Schlussfolgerung: Weitere methodisch hochwertige Studien werden benötigt.

Abstract

Objective: To evaluate the effect of non-pharmacological interventions to prevent anti-psychotic medication induced weight gain in patients with a first episode of schizophrenia.

Methods: We searched electronic databases Medline, Embase and PsychINFO and reference lists of articles. Controlled trials evaluating the beneficial effects of non-pharmacological interventions to prevent weight gain were eligible for inclusion. Two authors independently assessed the risk of bias of the studies and extracted data.

Results: 9 studies met the inclusion criteria. Evaluation of studies was carried out separately according to the different interventions. Six studies examined the effect of behavioral interventions. Two meta-analysis were conducted and found small effects on weight management in favor of the behavioral intervention. Three studies reported the effect of nutritional counselling yielding contradictory results .

Conclusions: There is currently no clear evidence which intervention is the best to prevent antipsychotic-induced weight gain in patients with first episode of schizophrenia. Further trials of high methodological quality are necessary.

Schlüsselwörter

Schizophrenie - Gewichtszunahme - antipsychotische Medikation - nichtpharmakologische Intervention - Prävention

Keywords

schizophrenia - anti-psychotic medication - weight gain - non-pharmacological intervention - prevention
 

  • Literatur

  • 1 Meyer JM, Stahl SM. The metabolic syndrome and schizophrenia. Acta Psychiatr Scand 2009; 119: 4-14
    CrossrefPubMedGoogle Scholar
  • 2 Newcomer JW, Hennekens CH. Severe mental illness and risk of cardiovascular disease. JAMA 2007; 298: 1794-1796
    CrossrefPubMedGoogle Scholar
  • 3 Wetterling T, Schneider B, Weber B. Blutzuckerwerte bei chronisch schizophrenen Patienten unter antipsychotischer Behandlung. Psychiat Prax 2007; 34: 76-80
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Wetterling T, Schneider B, Weber B. Dyslipidämie bei langjähriger neuroleptischer Behandlung. Psychiat Prax 2007; 34: 223-229
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Yogaratnam J, Biswas N, Vadivel R et al. Metabolic complications of schizophrenia and antipsychotic medications – an updated review. East Asian Arch Psychiatry 2013; 23: 21-28
    PubMedGoogle Scholar
  • 6 American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27: 596-601
    CrossrefPubMedGoogle Scholar
  • 7 Allebeck P. Schizophrenia: a life-shortening disease. Schizophr Bull 1989; 15: 81-89
    PubMedGoogle Scholar
  • 8 Heila H, Haukka J, Suvisaari J et al. Mortality among patients with schizophrenia and reduced psychiatric hospital care. Psychol Med 2005; 35: 725-732
    CrossrefPubMedGoogle Scholar
  • 9 Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annu Rev Clin Psychol 2014; 10: 425-448
    CrossrefPubMedGoogle Scholar
  • 10 Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?. Arch Gen Psychiatry 2007; 64: 1123-1131
    CrossrefPubMedGoogle Scholar
  • 11 Allison DB, Mentore JL, Heo M et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 1999; 156: 1686-1696
    PubMedGoogle Scholar
  • 12 Coodin S. Body mass index in persons with schizophrenia. Can J Psychiatry 2001; 46: 549-555
    PubMedGoogle Scholar
  • 13 Homel P, Casey D, Allison DB. Changes in body mass index for individuals with and without schizophrenia, 1987–1996. Schizophr Res 2002; 55: 277-284
    CrossrefPubMedGoogle Scholar
  • 14 Parsons B, Allison DB, Loebel A et al. Weight effects associated with antipsychotics: A comprehensive database analysis. Schizophr Res 2009; 110: 103-110
    CrossrefPubMedGoogle Scholar
  • 15 Zimmermann U, Kraus T, Himmerich H et al. Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res 2003; 37: 193-220
    Google Scholar
  • 16 Bak M, Fransen A, Janssen J et al. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS One 2014; 9: e94112
    CrossrefPubMedGoogle Scholar
  • 17 Himmerich H, Erbguth F. Ernährung und Nahrungsergänzungsmittel bei psychiatrischen Erkrankungen. Nervenarzt 2014; 85: 1512-1520
    CrossrefPubMedGoogle Scholar
  • 18 Zipursky RB, Gu H, Green AI et al. Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol. Br J Psychiatry 2005; 187: 537-543
    CrossrefPubMedGoogle Scholar
  • 19 Theisen FM, Linden A, Geller F et al. Prevalence of obesity in adolescent and young adult patients with and without schizophrenia and in relationship to antipsychotic medication. J Psychiatr Res 2001; 35: 339-345
    CrossrefPubMedGoogle Scholar
  • 20 Alvarez-Jimenez M, Gonzalez-Blanch C, Crespo-Facorro B et al. Antipsychotic-induced weight gain in chronic and first-episode psychotic disorders: a systematic critical reappraisal. CNS Drugs 2008; 22: 547-562
    CrossrefPubMedGoogle Scholar
  • 21 Alvarez-Jimenez M, Hetrick SE, Gonzalez-Blanch C et al. Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2008; 193: 101-107
    CrossrefPubMedGoogle Scholar
  • 22 Strassnig M, Brar JS, Ganguli R. Nutritional assessment of patients with schizophrenia: a preliminary study. Schizophr Bull 2003; 29: 393-397
    CrossrefPubMedGoogle Scholar
  • 23 Weiden PJ, Mackell JA, McDonnell DD. Obesity as a risk factor for antipsychotic noncompliance. Schizophr Res 2004; 66: 51-57
    CrossrefPubMedGoogle Scholar
  • 24 Himmerich H, Schuld A, Pollmacher T. Weight gain during treatment with antipsychotics: clinical relevance, pathophysiology, and therapeutical strategies. Psychiat Prax 2004; 31 (Suppl. 02) S233-S237
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Taylor DM, McAskill R. Atypical antipsychotics and weight gain – a systematic review. Acta Psychiatr Scand 2000; 101: 416-432
    CrossrefPubMedGoogle Scholar
  • 26 Brown S, Birtwistle J, Roe L et al. The unhealthy lifestyle of people with schizophrenia. Psychol Med 1999; 29: 697-701
    CrossrefPubMedGoogle Scholar
  • 27 Daumit GL, Goldberg RW, Anthony C et al. Physical activity patterns in adults with severe mental illness. J Nerv Ment Dis 2005; 193: 641-646
    CrossrefPubMedGoogle Scholar
  • 28 Scott D, Happell B. The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues Ment Health Nurs 2011; 32: 589-597
    CrossrefPubMedGoogle Scholar
  • 29 Roick C, Fritz-Wieacker A, Matschinger H et al. Health habits of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 268-276
    CrossrefPubMedGoogle Scholar
  • 30 Dipasquale S, Pariante CM, Dazzan P et al. The dietary pattern of patients with schizophrenia: A systematic review. J Psychiatr Res 2013; 47: 197-207
    CrossrefPubMedGoogle Scholar
  • 31 McCreadie R, Macdonald E, Blacklock C et al. Dietary intake of schizophrenic patients in Nithsdale, Scotland: case-control study. BMJ 1998; 317: 784-785
    CrossrefPubMedGoogle Scholar
  • 32 Skrinar GS, Huxley NA, Hutchinson DS et al. The Role of a Fitness Intervention on People with Serious Psychiatric Disabilities. Psychiatr Rehabil J 2005; 29: 122-127
    CrossrefPubMedGoogle Scholar
  • 33 Kraus T, Zimmermann U, Schuld A et al. Zur Pathophysiologie der Gewichtsregulation im Rahmen der Therapie mit Psychopharmaka. Fortschr Neurol Psychiatr 2001; 69: 116-137
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Rege S. Antipsychotic induced weight gain in schizophrenia: mechanisms and management. Aust N Z J Psychiatry 2008; 42: 369-381
    CrossrefPubMedGoogle Scholar
  • 35 Deutsche Adipositas-Gesellschaft (DAG) e. V.. Interdisziplinäre Leitlinie der Qualität S3 zur „Prävention und Therapie der Adipositas“. 2.. Aufl. Martinsried: Deutsche Adipositas-Gesellschaft (DAG) e.V.; 2014
    Google Scholar
  • 36 Wölwer W, Toeller V, Klingberg S et al. Spezialisierte Behandlungsangebote für erstmals schizophren Erkrankte: Konzepte und Ergebnisse. Fortschr Neurol Psychiatr 2013; 81: 276-283
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Maayan L, Correll CU. Management of antipsychotic-related weight gain. Expert Rev Neurother 2010; 10: 1175-1200
    CrossrefPubMedGoogle Scholar
  • 38 Faulkner G, Cohn T, Remington G. Interventions to reduce weight gain in schizophrenia. Cochrane Database Syst Rev 2007; 1: CD005148
    PubMedGoogle Scholar
  • 39 Caemmerer J, Correll CU, Maayan L. Acute and maintenance effects of non-pharmacologic interventions for antipsychotic associated weight gain and metabolic abnormalities: A meta-analytic comparison of randomized controlled trials. Schizophr Res 2012; 140: 159-168
    CrossrefPubMedGoogle Scholar
  • 40 Shaw K, OʼRourke P, Del Mar C et al. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev 2005; 2 CD003818
    PubMedGoogle Scholar
  • 41 Brönner M, Betz C, Christ S et al. Wellness-orientierte Maßnahmen zur Prophylaxe metabolischer Störungen bei schizophren erkrankten Patienten. Psychiat Prax 2010; 37: 7-19
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Bonfioli E, Berti L, Goss C et al. Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials. BMC Psychiatry 2012; 12: 78
    CrossrefPubMedGoogle Scholar
  • 43 Alvarez-Jimenez M, Gonzalez-Blanch C, Vazquez-Barquero JL et al. Attenuation of Antipsychotic-Induced Weight Gain With Early Behavioral Intervention in Drug-Naive First-Episode Psychosis Patients: A Randomized Controlled Trial. J Clin Psychiatry 2006; 67: 1253-1260
    CrossrefPubMedGoogle Scholar
  • 44 Martinez-Ortega JM, Funes-Godoy S, Diaz-Atienza F et al. Weight gain and increase of body mass index among children and adolescents treated with antipsychotics: a critical review. Eur Child Adolesc Psychiatry 2013; 22: 457-479
    PubMedGoogle Scholar
  • 45 Evans S, Newton R, Higgins S. Nutritional intervention to prevent weight gain in patients commenced on olanzapine. A randomized controlled trial. Aust N Z J Psychiatry 2005; 39: 479-486
    CrossrefPubMedGoogle Scholar
  • 46 Higgins JPT Hrsg. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley-Blackwell; 2011
    Google Scholar
  • 47 Bradburn MJ, Deeks JJ, Altman DG. metan – a command for meta-analysis in Stata. In: Sterne JAC, ed. Meta-analysis in Stata. An updated collection from the Stata journal. 1.. Aufl. College Station, Tex.: Strata Press; 2009: 3-28
    Google Scholar
  • 48 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    CrossrefPubMedGoogle Scholar
  • 49 Egger M, Davey Smith G, Schneider M et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    CrossrefPubMedGoogle Scholar
  • 50 Egger M, Smith GD, Phillips AN. Meta-analysis: principles and procedures. BMJ 1997; 315: 1533-1537
    CrossrefPubMedGoogle Scholar
  • 51 Sterne JAC, Egger M, Smith GD. Investigating and dealing with publication and other biases in meta-analysis. BMJ 2001; 323: 101-105
    CrossrefPubMedGoogle Scholar
  • 52 Littrell KH, Hilligoss NM, Kirshner CD et al. The Effects of an Educational Intervention on Antipsychotic-Induced Weight Gain. J Nurs Scholarsh 2003; 35: 237-241
    CrossrefPubMedGoogle Scholar
  • 53 Alvarez-Jimenez M, Martinez-Garcia O, Perez-Iglesias R et al. Prevention of antipsychotic-induced weight gain with early behavioural intervention in first-episode psychosis: 2-year results of a randomized controlled trial. Schizophr Res 2010; 116: 16-19
    CrossrefPubMedGoogle Scholar
  • 54 Poulin M, Chaput J, Simard V et al. Management of antipsychotic-induced weight gain. Prospective naturalistic study of the effectiveness of a supervised exercise programme. Aust N Z J Psychiatry 2007; 41: 980-989
    CrossrefPubMedGoogle Scholar
  • 55 Ganguli R, Brar J. Prevention of weight gain by behavioural interventions in patients starting novel antipsychotics. International Congress on Schizophrenia Research, Savannah, Gorgia, Apr 2–6. Schizophr Bull 2005; 32: 561-562
    PubMedGoogle Scholar
  • 56 Cordes J, Thunker J, Regenbrecht G et al. Can an early weight management program (WMP) prevent olanzapine (OLZ)-induced disturbances in body weight, blood glucose and lipid metabolism? Twenty-four- and 48-week results from a 6-month randomized trial. World J Biol Psychiatry 2014; 15: 229-241
    CrossrefPubMedGoogle Scholar
  • 57 Scocco P, Longo R, Caon F. Weight change in treatment with olanzapine and a psychoeducational approach. Eat Behav 2006; 7: 115-124
    CrossrefPubMedGoogle Scholar
  • 58 Milano W, Grillo F, Del Mastro A et al. Appropriate intervention strategies for weight gain induced by olanzapine: a randomized controlled study. Adv Ther 2007; 24: 123-134
    CrossrefPubMedGoogle Scholar
  • 59 Moher D, Liberati A, Tetzlaff J et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009; 6: e1000097
    CrossrefPubMedGoogle Scholar