Improvements in metabolic abnormalities among overweight schizophrenia and bipolar disorder patients.
OBJECTIVE
As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psycho-education and medical monitoring on metabolic changes among severely mentally ill patients.


METHODS
During repeated, systematic psycho-education about general health among 66 consecutive patients diagnosed with DSM-IV-TR schizophrenia (n=33) or type-I bipolar disorder (n=33), we evaluated (at intake 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, recorded physiological parameters, and assessed attitudes about medication.


RESULTS
At intake, patients with schizophrenia vs bipolar disorder were receiving 3-7 times more psychotropic medication, with 14% higher initial body-mass index (BMI: 29.1 vs 25.6 kg/m²), 12 times more obesity, and significantly higher serum lipid concentrations. During 6-months follow-up, among bipolar disorder patients, polytherapy and serum lipid concentrations declined more than among schizophrenia patients (e.g., total cholesterol+triglycerides, by 3.21 vs 1.75%/month). BMI remained stable. Declining lipid levels were associated with older age, bipolar disorder, being unemployed, higher antipsychotic doses, and lower initial BPRS scores (all P ≤ 0.001).


CONCLUSIONS
Psychotropic treatments were more complex, and metabolic measures more abnormal among bipolar disorder than schizophrenia patients. Intensive psycho-education, clinical monitoring, and encouragement of weight-control for six months were associated with improvements in metabolic measures (but not to BMI), and more realistic attitudes about medication.
Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Via Gugliemo Marconi 3, 71041 Carapelle (FG), Foggia, Italy. Electronic address: a.ventriglio@libero.it.
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Ventriglio
Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Via Gugliemo Marconi 3, 71041 Carapelle (FG), Foggia, Italy.
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Gentile
Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.
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Baldessarini
Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Via Gugliemo Marconi 3, 71041 Carapelle (FG), Foggia, Italy.
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Martone
Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Via Gugliemo Marconi 3, 71041 Carapelle (FG), Foggia, Italy.
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Vitrani
Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Via Gugliemo Marconi 3, 71041 Carapelle (FG), Foggia, Italy.
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La Marca
Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Via Gugliemo Marconi 3, 71041 Carapelle (FG), Foggia, Italy.
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Bellomo
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D024821:Metabolic Syndrome / Q000139:chemically induced / Q000378:metabolism / Q000628:therapy*; D008875:Middle Aged; D050177:Overweight / Q000139:chemically induced / Q000378:metabolism / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods*; D012559:Schizophrenia / Q000188:drug therapy* / Q000378:metabolism; D014280:Triglycerides / Q000378:metabolism
D014150:Antipsychotic Agents; D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides
Antipsychotic drugs; Bipolar disorder; Metabolic syndrome; Obesity; Schizophrenia; Weight-gain