Weight gain induced by Psychotropic medication

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Weight gain induced by Psychotropic medication

• Sue Henderson

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Introduction

• Over half (54) adult Australian pop overweight
  or obese (Australian Bureau of Statistics, 2007),
  Up from 45 decade ago. low incomes education
  levels, rural areas, males more likely
  overweight/obese (Australian Bureau of
  Statistics, 2007).
• Individuals schizophrenia 3 times more likely
  obese than general pop (Catapano Castle, 2004)
• Overweight/obese major risk to long term health
  by increasing risk of chronic illness (Marder et
  al., 2004) lessening life expectancy markedly,
  especially among younger adults (Fontaine,
  Redden, Wang, Westfall, Allison, 2003).

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Psychotropic medications contributing to weight
gain

• Anti-psychotics - Atypical
• Highest risk
• Clozapine
• Olanzapine
• Moderate risk
• Risperidone
• Minimal risk
• Ziprasidone
• Typicals - Chlorpromazine dose dependent

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Mood stabilisers

• Lithium (more than half on long term treatment
  gain weight) Chen and Silverstone (1990) cited in
  Malhi, Mitchell and Caterson (2001).
• Sodium valproate

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Antidepressants

• Tricyclic
• Amitriptyline
• Imipramine
• MAOI
• phenelzine

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Other contributions

• Diet high in fat and low in fibre (Brown,
  Birtwistle, Roe, Thompson, 1999)
• Lack of exercise (Brown, Birtwistle, Roe,
  Thompson, 1999) sedentary lifestyle, may have to
  stop work due to symptoms, restricted activity
  due to hospitalisation or pharmacotherapy
• Hypothyroidism (mood stabilisers can produce
  thyroid dysfunction)
• Family history of obesity or diabetes (Marder et
  al., 2004)

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Health risks of obesity

• Osteoarthritis
• Sleep apnoea (increased risk with BMI of 30 or
  greater)
• Gallbladder disease, Liver disease
• Polycystic ovarian disease
• Cancer (oesophageal, colon, endometrial, kidney,
  breast)
• Coronary Heart Disease (CHD), Cardiovascular
  disease (CVD), Hypertension, Stroke,
  Hyperlipidemia
• Type 2 Diabetes Mellitus (T2DM)
• Metabolic syndrome

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Psychological risks Obesity

• Altered body image
• Depression
• Restricted lifestyle and quality of life
• Significant factor in non compliance with
  psychotropic medication thus increasing the risk
  of relapse

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Assessment

• 3 main measures
• Body Mass Index (BMI),
• Waist circumference
• Waist to hip ratio (WHR).

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BMI

• Weight (kilograms) Height (metres) squared or
• Weight (pounds) Height (inches) squared X 704.5
  
• Use online calculator
• More reliable than scales because weight varies
  with height

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Classification BMI (WHO, 2000)
BMI Classification
18.5 Underweight
18.5 24.9 Healthy
25.0 29.9 Overweight
30 39.9 Obese
40.0 Morbidly obese
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Waist circumference

• 1. Loosen and lift clothing away from around
  waist
• 2. Position the tape mid-way between the top of
  hip bone and the bottom of the rib cage
• 3. When taking the measurement, the abdomen
  should be relaxed and breathing out
• 4. Record the measurement

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Waist to Hip Ration
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Measure hip circumference

• maximum circumference over the buttocks.
• Divide the waist circumference by the hip
  circumference to get the WHR.

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Waist circumference
Men Women Health Risk
lt 94 cm lt 80 cm Low
94 101.9 cm 80 87.9 cm Increased
102 cm 88 cm High
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Focus on Prevention

• subsequent weight loss is very difficult to
  achieve and existing interventions to promote
  weight loss are often ineffective (Marder, et
  al., 2004, p. 1336).
• Take full health history if patient has a
  family history of obesity, diabetes or has a BMI
  of 25 or higher, consider weight gain profile of
  different medication (Marder, et al., 2004)

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Prevention cont

• Monitor chart BMI waist circumference of
  every patient on psychotropic medication. For
  those on medications known to be associated with
  weight gain, weigh, measure and chart at each
  outpatient visit (or admission) for 6 months, or
  after any medication change. Encourage the
  patient to monitor and chart their own
  measurement and weight.

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Prevention cont

• Unless a patient is underweight (BMI 18.5), a
  weight gain of one BMI unit indicates the need
  for an intervention. If the waist circumference
  is 102 cm (men) or 88 cm (women) an
  intervention is needed (Marder et al., 2004).
• Aim to maintain therapeutic effects while
  minimising weight gain and consider substituting
  a suitable antipsychotic with a low weight gain
  profile.

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Reducing weight gain

• Multidisciplinary approach
• Mortality/morbidity can be reduced by loss of 5
  to 10 of body weight.
• If the WHR is over the recommended limits a
  medical review by a (GP) is indicated.
• Address issues underlying weight gain for
  example, if weight gain is related to medication
  reduce the dose to minimise weight gain while
  maintaining therapeutic effect or substitute with
  another psychotropic drug.

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Reducing weight gain

• Educate patient/carers on lifestyle changes.
• low cost or no cost programs
• Caloric reduction diet of 5 or more servings of
  fresh food and vegetables daily and reduce
  saturated and trans fatty acid intake of total
  energy intake (National Heart Foundation of
  Australia, 2007).
• Regular exercise by gradually building up
  tolerance to at least 30 minutes of moderate
  exercise for most days of the week (National
  Heart Foundation of Australia, 2007).
• Reduction alcohol intake
• Self monitoring, stress management, cognitive
  restructuring
• Bolster self-efficacy, emotional, moral support

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Weight loss meds/surgery

• Weight loss medications are a last resort as they
  may reduce the effectiveness of antipsychotic
  medication (Green, Canuso, Brenner, Wojcik,
  2003).
• Severe cases surgical intervention may be
  considered.

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References

• Australian Bureau of Statistics. (2007).
  Overweight and obesity (No. 4102.0). Canberra.
• Brown, S., Birtwistle, J., Roe, L., Thompson,
  C. (1999). The unhealthy lifestyle of people with
  schizophrenia. Psychological Medicine, 29(3),
  697-701.
• Catapano, L., Castle, D. (2004). Obesity in
  schizophrenia What can be done about it?
  Australasian Psychiatry, 12(1), 23-25.
• Fontaine, K. R., Redden, D. T., Wang, C.,
  Westfall, A. O., Allison, D. B. (2003). Years
  of life lost due to obesity. JAMA, 289(2),
  187-193.
• Green, A. I., Canuso, C. M., Brenner, M. J.,
  Wojcik, J. D. (2003). Detection and management of
  comorbidity in patients with schizophrenia.
  Psychiatric Clinics of North America, 26(1),
  115-139.
• Malhi, G. S., Mitchell, P. B., Caterson, I.
  (2001). 'Why getting fat, Doc?' Weight gain and
  psychotropic medications. Australian New
  Zealand Journal of Psychiatry, 35(3), 315-321.
• Marder, S. R., Essock, S. M., Miller, A. L.,
  Buchanan, R. W., Casey, D. E., Davis, J. M., et
  al. (2004). Physical health monitoring of
  patients with schizophrenia. American Journal of
  Psychiatry, 161(8), 1334-1349.
• National Heart Foundation of Australia. (2007).
  Reducing risk in heart disease 2007
• World Health Organisation. (2000). Obesity
  Preventing and managing the global epidemic (No.
  894). Geneva WHO.