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1.
Nord J Psychiatry ; 70(3): 190-4, 2016.
Article in English | MEDLINE | ID: mdl-26450657

ABSTRACT

BACKGROUND: Increased body weight and hyperlipidemia caused by antipsychotics may be associated with improved antipsychotic efficacy in schizophrenia. If this association has a causal interrelationship via a genuine pathophysiological mechanism, then body weight loss in antipsychotic-treated patients would be accompanied by worsened psychopathology. This could have clinical implications. AIM: To explore whether the decreased body weight in these patients is associated with a worsened psychopathology. METHODS: In our previously published study, a 16 week treatment period with add-on orlistat (but not placebo) resulted in body weight loss in male (but not female) clozapine- or olanzapine-treated overweight or obese patients. In the current study, we investigated whether body weight loss in those male patients could worsen psychosis. Changes in the Positive and Negative Syndrome Scale (PANSS) scores within groups and body weight changes and lipid profiles over the treatment period were analysed by the paired samples t-test. Between-group comparisons were analysed by the independent samples t-test. RESULTS: Over the treatment period body weight decreased by 2.56 ± 3.25 kg from initial 106.02 ± 12.61 kg (p = 0.04) for the orlistat group, with no statistically significant changes for the placebo group. Lipid levels did not change in either group. The orlistat-induced weight decrease was not associated with worsening in the PANSS scores. CONCLUSIONS: Weight loss was not associated with a worsening of psychosis. The interrelationship between the antipsychotic-induced weigh gain and improved schizophrenia psychopathology observed in earlier studies appears to be indirect. Orlistat treatment in our study did not worsen psychopathology in this population.


Subject(s)
Anti-Obesity Agents/adverse effects , Antipsychotic Agents/adverse effects , Lactones/adverse effects , Lipid Metabolism/drug effects , Obesity/drug therapy , Schizophrenia/drug therapy , Adult , Anti-Obesity Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Benzodiazepines/adverse effects , Benzodiazepines/therapeutic use , Clozapine/adverse effects , Clozapine/therapeutic use , Double-Blind Method , Female , Humans , Lactones/therapeutic use , Lipid Metabolism/physiology , Male , Middle Aged , Obesity/chemically induced , Olanzapine , Orlistat , Psychiatric Status Rating Scales , Psychopathology , Schizophrenia/metabolism , Schizophrenia/physiopathology , Weight Loss/drug effects , Weight Loss/physiology
2.
Neuropharmacology ; 64: 248-53, 2013 Jan.
Article in English | MEDLINE | ID: mdl-22750079

ABSTRACT

We aimed to evaluate predictors and mediators of enhancing effect of adjunctive mirtazapine on cognition in schizophrenia. Patients with difficult-to-treat schizophrenia received either mirtazapine (n = 19) or placebo (n = 18) in a double-blind fashion for six weeks. Mirtazapine outperformed placebo on the Block Design and Stroop Dots. In the present subsidiary study, factors underlying this difference were explored with Path Analysis. Add-on mirtazapine had an independent enhancing effect on the Block Design-measured visuo-spatial functioning. Further, this effect was mediated via changes in positive, depressive and parkinsonism symptoms, but not in negative symptoms. This effect was predicted by higher doses of FGAs, longer duration of illness and lower initial Block Design scores. Path Analysis model fit was good. Mirtazapine may have direct and indirect favorable effects on visuo-spatial functioning, but further research is needed. Path analysis may be a feasible statistical method for further research of neurocognition in psychopharmacological interventions in schizophrenia. This article is part of a Special Issue entitled 'Cognitive Enhancers'.


Subject(s)
Adrenergic alpha-2 Receptor Antagonists/therapeutic use , Cognition Disorders/prevention & control , Histamine Antagonists/therapeutic use , Mianserin/analogs & derivatives , Molecular Targeted Therapy , Nootropic Agents/therapeutic use , Schizophrenia/drug therapy , Adrenergic alpha-2 Receptor Antagonists/adverse effects , Adult , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/therapeutic use , Cognition/drug effects , Cognition Disorders/etiology , Double-Blind Method , Drug Monitoring , Female , Histamine Antagonists/adverse effects , Humans , Male , Mianserin/adverse effects , Mianserin/therapeutic use , Mirtazapine , Models, Biological , Nootropic Agents/adverse effects , Psychiatric Status Rating Scales , Schizophrenia/physiopathology , Spatial Behavior/drug effects , Statistics as Topic , Vision Disorders/etiology , Vision Disorders/prevention & control
3.
Int Clin Psychopharmacol ; 28(2): 67-70, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23187856

ABSTRACT

Constipation is a common and potentially fatal side effect of clozapine treatment. Another important side effect of clozapine may also be significant weight gain. Orlistat is a weight-control medication that is known to induce loose stools as a common side effect. This study aimed to explore whether orlistat used to control clozapine-induced weight gain can simultaneously tackle clozapine-related constipation. In this 16-week randomized-controlled study, clozapine-treated patients received add-on orlistat (n=30) or add-on placebo (n=24). Colonic function was measured using the Bristol Stool Form Scale. There was a significant (P=0.039) difference in the prevalence of constipation in favor of orlistat over placebo in completers (n=40) at the endpoint. A decrease in the prevalence of constipation within the orlistat group (P=0.035) was observed (vs. no statistically significant changes in the placebo group). In clozapine-treated patients, orlistat may be beneficial not only for weight control but also as a laxative. As no established treatments for clozapine-induced constipation exist, orlistat can be considered for this population, although more studies are required.


Subject(s)
Anti-Obesity Agents/therapeutic use , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Constipation/prevention & control , Lactones/therapeutic use , Obesity/drug therapy , Overweight/drug therapy , Anti-Obesity Agents/adverse effects , Antipsychotic Agents/therapeutic use , Benzodiazepines/adverse effects , Benzodiazepines/therapeutic use , Clozapine/therapeutic use , Colon/drug effects , Colon/physiopathology , Constipation/chemically induced , Constipation/physiopathology , Cross-Sectional Studies , Diarrhea/chemically induced , Double-Blind Method , Finland/epidemiology , Humans , Incidence , Lactones/adverse effects , Laxatives/adverse effects , Laxatives/therapeutic use , Obesity/psychology , Olanzapine , Orlistat , Overweight/psychology , Patient Dropouts , Prevalence , Psychotic Disorders/complications , Psychotic Disorders/drug therapy , Schizophrenia/complications , Schizophrenia/drug therapy , Severity of Illness Index , Weight Loss/drug effects
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