Detecting the Unidentified Victims: Recognized Versus Unrecognized Child Sexual Abuse Sarah DeGue1, John Clemmons1, David DiLillo1, and Issac Martinez2 University of Nebraska-Lincoln1 Family Violence and Injury Lab Our Lady of the Lake University2

1

An Analysis of Clozapine- and Olanzapine-Induced
Weight Gain and Associated Psychological
Effects Jason E. Vogler, Petra Kleinlein and
William D. Spaulding University of
Nebraska-Lincoln http//www.unl.edu/dsc

Introduction
Results

• A total of 32 patients receiving inpatient and
  outpatient mental health services were enrolled
  in the study. Participants were recruited from
  two sites in Lincoln, NE the Community
  Transition Program (CTP) at the Lincoln Regional
  Center (n 18), and the Community Mental Health
  Center in Lincoln (n 14). Inclusion criteria
  for the treatment group (n 16) were current use
  of clozapine (Clozaril) and/or olanzapine
  (Zyprexa).
• The mean age for all participants is 41 years
  (SD 11.48 range 22 to 56 years). Most
  participants were European-American (87.5) and
  12.5 African-American. More males (75) than
  females (25) participated in the study. Of the
  patients in the treatment group, 68.8 were
  currently taking clozapine and 31.3 were taking
  olanzapine.
• Participants in the treatment group reported
  eating an average of 3 full meals per day, and an
  average of 1.8 snacks per day. The majority
  (56.3) of patients taking clozapine and/or
  olanzapine reported to have gained weight over
  the past six months. Most patients believed that
  a persons weight is related to their eating
  habits (85). A moderate effect was found for
  patients beliefs about needing medication (73)
  and their attribution of weight gain to their
  medication (73). Perceived effectiveness of
  medication for experienced symptoms was somewhat
  smaller (67).
• A mixed groups factorial ANOVA was performed to
  examine the effects of Time and Study Group
  regarding weight gain among the control group and
  the medication group (those people taking
  clozapine and olanzapine). Table 1 shows the
  means for each condition of the design. The
  interaction of Time and Study Group as they
  relate to weight gain approached significance
  (F(3, 54) 2.683, p .056, Mse 160.94). As
  hypothesized, the pattern of this interaction was
  that weight increases over time more for the
  Medication Group than the Control Group. Despite
  having an interaction which approached
  significance, the main effect of Time (F(3, 54)
  .219, p .883) was not significant. In addition,
  the main effect for Study Group (F(1, 18) .242,
  p .628) was also not significant.
• With respect to those people taking clozapine
  and those taking olanzapine, there were no
  significant differences between location, gender,
  ethnicity, history of obesity, history of
  diabetes, familial history of obesity, or
  familial history of diabetes. Regarding
  performance on the structured interview, no
  significant differences were observed between the
  mean scores of those people taking clozapine and
  those taking olanzapine (Table 2). Despite the
  lack of statistical significance, those people
  taking clozapine had higher mean scores on the
  four domains of the interview than those taking
  olanzapine with the exception of Beliefs About
  Weight Gain. Table 2 provides the weighted means
  scores for each group for each domain and the
  standard deviation of each group.
• The graph below shows change in weight over
  time for each of the 16 participants in the study
  (each colored line represents one participant).
  There are marked co-fluctuations in weights which
  may reflect the changes in weight over time in
  which some data was incomplete, thus the changes
  look more disparate. The solid line represents
  the trend line for the medication group and the
  dashed line represents the trend line for the
  control group.

• Following the market entrance of clozapine and
  olanzapine there has been an increasing amount of
  discourse among mental health providers about the
  observed weight-gain associated with the use of
  both medications (Gothelf et al., 2002 Kinon,
  Basson, Gilmore, Tollefson, 2001 Lewis, 2002
  Malyuk, Gibson, Procyshyn, Kang, 2002).
• Examining the attitudes and beliefs about
  weight gain among people with serious mental
  illness provides information about the
  effectiveness and potential drawbacks to using
  clozapine and olanzapine as a method of treatment
  for psychotic symptoms.
• In addition, knowing how people with serious
  mental illness think and feel about their
  medication has implications for their level of
  treatment compliance, relative degree of
  depression, and vulnerability for developing
  new-onset diabetes mellitus and obesity
  (Umbricht, Flury, Bridler, 2001 Vanina et al.,
  2002 Webster, Devarajan, Gallant, Harris,
  Kopala, 2001).
• It is hypothesized that weight gain experienced
  by those persons taking clozapine or olanzapine
  will be viewed negatively, those who experience
  weight gain while taking clozapine and olanzapine
  will attribute their weight gain to the
  medications, and weight gain will contribute to
  negative beliefs about the clinical effectiveness
  of clozapine or olanzapine.

Discussion

Method

• The results of this study should be interpreted
  with caution due to the small sample size (N
  32). Thus the findings presented represent a
  first look at the relationship between weight
  gain due to clozapine and olanzapine and four
  domains which may change in relation to the
  subjective experience of weight gain due to
  antipsychotic medications. One barrier
  encountered in course of this study was the
  completeness of weight data included in patients
  medical charts. For participants in the
  medication group it was difficult to determine
  weights prior to the date on which they were
  first prescribed clozapine and olanzapine,
  because of this weight data was aggregated into
  four 6-month variables for the purpose of
  analysis.
• As indicated in the weight chart, there were
  differences in weight among those in the
  medication group and those in the control group.
  Although these results did not reach
  significance, the predicted direction of change
  is supported by the authors hypotheses and
  preliminary evidence suggested by Vanina, et al.,
  2002.
• With respect to responses to the structured
  interview, the results failed to provide a clear
  explanation for how those people taking clozapine
  and olanzapine regarded their medications.
  Although group differences approached
  significance, the results were not powerful
  enough to make this distinction clear. For this,
  a larger sample size is needed to find the
  effect. The finding that those people taking
  clozapine had higher scores on the interview
  might be a reflection of level of care, as most
  people prescribed clozapine were outpatients.
  These results may also suggest that those people
  taking clozapine regard their medications more
  highly, although this finding would need
  additional research as previous studies of
  patient satisfaction with clozapine (e.g.,
  Czobor, et al., 2002) have revealed some dislike
  due to the reported side effects.
• While more research is needed, these results
  have important implications for the course of
  treatment for those people with SMI. It has been
  suggested that those people who experience an
  increase in weight as a result of their
  medication have the potential to develop
  depression, diabetes, low self-esteem, obesity,
  an increase in suicidal ideation, and may become
  less compliant with treatment (Sheitman, et al.,
  1999 Vanina, et al., 2002).
• As treatment research and mental healthcare
  providers strive to find ways of increasing and
  improving treatment compliance, the topic of
  beliefs and attitudes about medication become
  ever more important. Additionally, as the
  pharmaceutical industry continues in its efforts
  to modify and create new medications it is
  important for them to know how the side effects
  of such medications impact their clients.

• Two groups of individuals were used in this
  research each group was comprised of inpatients
  of the Lincoln Regional Center (LRC) and people
  receiving outpatient treatment at the Community
  Mental Health Center (CMHC) of Lancaster County
  in Nebraska.
• The participants in the antipsychotic
  medication group (N 16) were receiving either
  clozapine (Clozaril) or olanzapine (Zyprexa) and
  those participants in the control group were not
  receiving clozapine or olanzapine for the
  treatment of their symptoms.
• The control group (N 16) was constructed
  using a matched-control design on the basis of
  date of birth within one year, gender, ethnicity,
  date of admission within two months, and weight
  within 10 pounds at the time the matching
  participant began pharmacological treatment.
• For those in the antipsychotic medication
  group, retrospective weights were collected from
  the medical charts for one year prior to
  antipsychotic medication treatment and
  retrospectively, for an additional year following
  initiation of antipsychotic treatment.
• For those in the control group retrospective
  weights were collected from the medical chart for
  two years, with a midpoint that matched the
  initiation of antipsychotic treatment in the
  antipsychotic medication group.
• Those participants who are currently admitted
  were given a structured interview to access their
  attitudes and beliefs about the need for
  medication, eating habits, weight gain,
  attributions of weight gain to antipsychotic
  medication, clinical effectiveness of
  antipsychotic medication, family history of
  diabetes mellitus, and family history of obesity.