The present study showed that cases are more likely to experience significant change in weight than controls and that both typical and atypical antipsychotic medications are associated with weight gain. This is in harmony with earlier studies (Alp and Wolfag, 2008; Limosin et al, 2008) in Istanbul, and France among patients with schizophrenia who received antipsychotic medications.
However, it is noteworthy that weight gain has been reported with nearly every antipsychotic drug on the market (Ganguli, 2000).
Concerning weight gain, the class of antipsychotic is an important determinant. This study found that atypical antipsychotic medications are more significantly associated with weight gain than typical antipsychotic medications. This finding is in agreement with previous studies (Mackin,Watkinson and Young, 2005; Taylor and McAskill, 2001)which also reported similar findings, and added that all atypical antipsychotics (except ziprasidone) are associated with weight gain.
80 In the French study mentioned above (Limosin, Gasquet, Leguay et al 2008), about 29% of the cases were overweight and 16.4% were obese. These values are at variance with the values in this study (Overweight=25%, Obesity=5.3%).
It is important to note that in the French study the patients were followed up for 6 months whereas in this study cases were followed up for only 4 months.
This is a relevant factor because the duration of antipsychotic treatment is an important predictor of weight gain (McIntyre, McCann and Kennedy, 2002).
This study found that there was no association between gender and weight gain. This finding agrees with a previous study among patients with schizophrenia receiving antipsychotic medications (Lee, Leung and Wong, 2004). Nevertheless, another study reported that females have a higher risk for developing weight gain than their male counterparts (O.R=1.76, 95% C.I=1.5-2.04, P<0.001) (Limosin, Gasquet, Leguay et al,2008). It should be noted that in the later study, most of the patients who received atypical antipsychotic medication were females, and it has been reported in a previous study (Mackin,Watkinson and Young, 2005) that atypical antipsychotic medications are significantly associated with weight gain than typical antipsychotic drugs.
This may explain the observed gender difference that was reported.
Concerning weight gain, this study found that there is a correlation between it and change in fasting blood sugar level. This is similar to the report of one study (Newcomer, 2005), but it is at variance with the report of another study (Henderson, Cagliero, Gray et al, 2000). The latter study found that the
81 relationship between weight gain and change in fasting blood sugar was not statistically significant. This later study relied on fasting blood sugar and weight data from case notes. It has been shown that case note documentation may not be very accurate (Taylor, Young, Esop et al, 2004). This may be responsible for the nature of their report.
82 Implications of this study
This study has contributed to the already existing body of knowledge that shows an association between the use of antipsychotics, blood glucose dysregulation, and weight gain. In clinical practice, all patients receiving antipsychotics may need to undergo regular testing for hyperglycaemia as well as regular weight and height measurements. This will ensure prompt identification of possible fasting blood glucose and weight changes. This way, room for prevention and early intervention may be opened.
For scientists, efforts should be geared towards the production of newer drug molecules that actually possess antipsychotic properties with little or no propensity for causing hyperglycaemia or weight gain. This will encourage better drug compliance, and thus enhance the overall quality of life of patients with schizophrenia.
Policymakers should ensure that any new antipsychotic medication is subjected to epidemiologically sound clinical trials to be sure that they are devoid of deleterious side effects (like hyperglycaemia and weight gain) while possessing antipsychotic properties. This should be done routinely before any antipsychotic is licensed for clinical use in Nigeria.
Patients may need to be adequately informed about possible side effects of antipsychotics (such as hyperglycaemia and weight gain), and be educated about the symptoms and signs of these conditions. They should be encouraged to promptly report these to their psychiatrist whenever they occur. This should
83 be done before any patient with schizophrenia receives an antipsychotic prescription. This will ensure early intervention and reduce complications that may arise from untreated hyperglycaemia and weight gain.
84 Limitations
A major limitation of this study is the duration of follow-up. This is very relevant since the duration of antipsychotic use is an important determinant of hyperglycaemia and weight gain (McIntyre, McCann and Kennedy, 2002).
However, other studies (Allison, Mentore and Heo, 1999; Lindenmeyer, Czobor and Volavka, 2002) had even shorter follow-up periods.
The statistically significant difference between the age of the cases and those of the controls in this study may be responsible for the differential blood glucose level between the two groups at the end of the study.
This is a hospital based study, and the findings may not be generalizable to the general population. Despite these caveats, the findings from this prospective study, being the first of its kind, to the Author’s best knowledge in this locality, could serve as a baseline data for comparison in the future.
85 Conclusion
An association was found between the use of antipsychotic medications and the development of both hyperglycaemia and weight gain. However, this may not be sufficient to establish causality, because some other important predictors of hyperglycaemia and weight gain like lifestyle, physical activity and dietary considerations were not controlled for.
86 Future research
A long term, large scale, multicentre study is needed to further establish an understanding of the true long term picture of the nature of association between antipsychotic medications, hyperglycaemia, and weight gain. Such studies should also control for important determinants of hyperglycaemia and weight gain that could act as confounders.
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98 APPENDIX I
Socio-Demographic Data Questionnaire
Your state of health both physically and emotionally is of concern to the medical staff and the undersigned. This questionnaire is designed to obtain some basic information about you and your health. Your co-operation in answering the following under listed questions will be appreciated. Thank you.
……….
Dr Olose, Omamurhomu Emmanuel.
Please circle or tick as appropriate.
Name of patient:
1. Sex of patient: (male) (female) 2. Marital status
(Married) (Single) (Divorced) (Separated) 3. Age of patient 4. Level of education
(No formal education) (Post secondary education) (Primary school) (Undergraduate)
(Secondary school) (Graduate)
99 5.Employment status:
(Employed) (Retired) (Student) (Unemployed)
6.Religion:………
(Christianity) (Traditional) (Islam) (Others)
7.LGA/Tribe………..
8. a) Medical diagnosis i) ………
ii) ………
(To be obtained from case notes)
b) Psychiatric diagnosis………
9. Have you been on any medications?
(a) yes (b) no 10. If yes in 9 above
i) Please list the names of these medications ………..
……….
ii) How long have you been on them?
11. Is there any illness that is common in your family?
(a) yes (no)
100 12. If yes in 11 above
i) Please state the nature of the illness ii) State diagnosis if you know it
13. Initial weight = Final weight = 14. Initial height = Final height =
15. Time of last meal……….