Efficacy of behavioural interventions in managing atypical antipsychotic weight gain.

Atypical antipsychotic treatment is associated with weight gain and increased metabolic risk. This systematic literature review evaluates the current research on the effectiveness of behavioural interventions in treating and preventing atypical antipsychotic weight gain and reducing metabolic risk, describes characteristics of interventions implemented and discusses findings in the context of the RE-AIM framework. Sixteen studies were identified. When initiated at the start of treatment with an atypical antipsychotic agent, behavioural weight loss interventions decreased the amount of weight gain associated with atypical antipsychotic treatment. When behavioural interventions were initiated after the start of atypical antipsychotic treatment, these interventions were associated with weight loss. Mean weight losses across studies by treatment duration were 2.63 kg for 12- to 16-week interventions, 4.24 kg for 6-month interventions and 3.05 kg for 12- to 18-month interventions. Behavioural weight loss interventions were also found to improve insulin regulation and HbA1c. In addition to assessing efficacy, future studies should evaluate other components of the RE-AIM framework, including reach, adoption, implementation and maintenance. This information will be useful in determining what types of interventions are both effective and practical for delivery in health care or community mental health settings.

Very recent onset arthritis--clinical, laboratory, and radiological findings during the first year of disease.

OBJECTIVE: To describe clinical and radiological findings in patients with very early arthritis (< 3 months of symptoms) during one year of observation. METHODS: In an Austrian multicenter setting, patients were eligible if they had nontraumatic swelling or pain in at least one joint and laboratory signs of inflammation [elevated erythrocyte sedimentation rate, C-reactive protein, leukocytosis, or rheumatoid factor (RF)] within the last 3 months. Clinical and laboratory assessments were performed every 3 months. Radiographs of hands and feet were taken at entry and after one year. Treatment decisions were left to the discretion of the participating center. RESULTS: In total, 108 patients included between 1996 and 2000 had followup investigations during at least one year; 61.1% of these patients had rheumatoid arthritis (RA). Over 65% of RA diagnoses were made at the first visit. Lag time to referral was significantly longer in patients with RA than in patients with other inflammatory joint diseases (median 8 vs 4 weeks). Disease modifying antirheumatic drugs were started 19 +/- 10 (mean +/- SD) weeks after symptom onset in patients with RA. Patients with RA improved significantly (by American College of Rheumatology response criteria and the Disease Activity Score 28) during the first year. Erosions were present in 12.8% of RA patients' initial radiographs, compared to 27.6% after one year. Odds ratio to develop new erosions during the first year of RA was 9.7 (95% CI 1.05-89.93) in RF+ patients compared to RF- individuals (p < 0.05). CONCLUSION: When early referral of patients with arthritis is encouraged, RA can be diagnosed and treatment initiated early, with significant clinical response. Moreover, patients with RA tend to be referred later than patients with other inflammatory joint diseases; RA patients at this very early stage have low frequency of joint damage; and RF predicts erosions in the first year.