A Clinical Trial of Topiramate for Weight Loss in Schizophrenia with Overweight or Obesity / 대한정신약물학회지

OBJECTIVE: Antipsychotic-induced weight gain is associated with treatment noncompliance and is also known to be associated with several medical conditions in schizophrenia. Topiramate, a relatively new antiepileptic drug, is currently used for mood and eating disorders, and also offers the advantage of weight loss. This study explored the efficacy and tolerability of topiramate as an adjuvant treatment of schizophrenia with overweight or obesity. METHODS: In this 8-week, prospective open trial, 30 hospitalized, schizophrenic patients took topiramate at a mean maintenance dosage of 159.37+/-61.15 mg/day. The primary measures were weight, body mass index (BMI), waist circumference, hip circumference, and waist-to-hip ratio. The safety measures included adverse events, physical examination, clinical laboratory data, and vital signs. The Clinical Global Impression Severity (CGI-S) Scale was used to quantify changes in schizophrenic symptoms and signs. RESULTS: Body weight, BMI, waist circumference, and hip circumference decreased significantly after treatment but the waist-to-hip ratio did not. The changes of body weight and BMI during 8 weeks treatment with topiramate were significantly correlated with the maintenance dose of topiramate. The high dose group (>100 mg/d) was significantly more changed in body weight and BMI between baseline and 8 weeks than the low dose group (< or =100 mg/d). The scores on the CGI-S scale decreased significantly over the 8 weeks of treatment. CONCLUSION: The results suggest that topiramate is both efficacious and tolerable for the short-term adjuvant treatment of schizophrenia with overweight or obesity. Further placebo controlled studies included larger samples would be needed to confirm these results. And much more clinical researches should be required to establish guideline for the optimal dose and duration of treatment using topiramate as an antiobesity agent in schizophrenia.

Quality of Life in Patients with Parkinson's Disease

BACKGROUND: Quality of life (QoL) has emerged as an important issue to patients with chronic illness. Parkinson's disease (PD) is a chronic neurodegenerative disorder requiring life-time treatment and supportive care, which affects not only physical activity but also cognition, mood, and daily living. The author investigated the QoL of patients with PD and aimed to find factors that have an influence on the QoL. METHODS: One hundred thirty patients with PD were evaluated. The QoL was measured and assessed by the Parkinson's disease quality of life questionnaire (PDQL). The author analyzed demographic and social data and clinical profiles. The Beck Depression Inventory (BDI) and Spielburger's State-Trait Anxiety Inventory were used to evaluate depressive symptoms and anxiety levels. RESULTS: The mean age of onset of parkinsonian symptom was 55.2 +/-10.9 years and the average duration of treatment was 34.7 +/-36.9 months. Patients with high BDI score, low Schwab and England activities of daily living scale (SEADLS) score, high bradykinesia score, progressed Hoehn and Yahr stage, high Unified Parkinson's disease rating scale score, low educational period and high economic state were all correlated with low PDQL scores. Multivariate regression analysis showed that BDI score, bradykinesia score, SEADLS score, and educational period were significantly associated with PDQL score. CONCLUSIONS: In order of magnitude, BDI, bradykinesia, SEADLS and educational period were influenc-ing factors on PDQL. Therefore, to improve the QoL in patients with PD, we should consider not only physical disabili-ty, but also psychological factors, including depressive mood.