How do body weight and metabolic parameters change in patients first hospitalized for psychosis?
The most common cause of death in patients with schizophrenia is cardiovascular disease, which is closely related to obesity or metabolic syndrome. The study presented below examined changes in body weight and metabolic parameters during the first hospitalization of these patients.
Study Methodology and Population
A total of 173 patients first hospitalized for schizophrenia (ICD F20) or acute and transient psychotic disorder (ICD F23) diagnosed less than 24 months ago at one of 10 psychiatric wards in the Czech Republic, and 204 individuals without a history of psychiatric disorders (control group), were included in a prospective observational study between 2016 and 2021. All participants were aged 18–35 years, with a total of 61 psychotic patients without chronic psychiatric medication. During hospitalization, body weight, BMI, metabolic parameters (including thyroid hormones and prolactin levels or lipidogram), and antipsychotic exposure were monitored.
Results
During an average hospitalization period of 44.6 days, patients with psychiatric disorders experienced an average weight gain of 3.46 ± 7.81 kg and a BMI increase of 0.97 ± 2.26 kg/m2. The proportion of individuals with overweight or obesity nonsignificantly increased from 18.3% and 7.3% to 24.3% and 8.5%, respectively.
Higher exposure (cumulative and average daily dose) to clozapine, olanzapine, and quetiapine was associated with BMI increases, but only in patients with ideal body weight or underweight by baseline BMI. This trend was not observed in less-risky antipsychotics like haloperidol, levomepromazine, amisulpride, or risperidone.
Antipsychotic use did not directly correlate with changes in metabolic markers; however, higher BMI values were associated with higher levels of triglycerides and thyroid-stimulating hormone and lower HDL levels.
Conclusion
The results of the above-described study suggest the need for caution in prescribing antipsychotics, particularly clozapine, olanzapine, and quetiapine, due to the risk of weight gain and BMI increase, which are closely linked to an increased cardiovascular risk. Caution is especially warranted in patients with ideal weight or underweight based on BMI.
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Source: Vochosková K., McWhinney S. R., Fialová M. et al. Weight and metabolic changes in early psychosis – association with daily quantification of medication exposure during the first hospitalization. Acta Psychiatr Scand 2023; 148 (3): 265–276, doi: 10.1111/acps.13594.
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