Transcript Weight gain induced by

Weight gain induced by
Psychotropic medication
Sue Henderson
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).
Psychotropic medications
contributing to weight gain
Anti-psychotics - Atypical
Highest risk
• Clozapine
• Olanzapine
Moderate risk
• Risperidone
Minimal risk
• Ziprasidone
Typicals - Chlorpromazine – dose dependent
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
Antidepressants
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Tricyclic
Amitriptyline
Imipramine
MAOI
phenelzine
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)
Health risks of obesity
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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
Psychological risks: Obesity
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Altered body image
Depression
Restricted lifestyle and quality of life
Significant factor in non compliance with
psychotropic medication thus increasing
the risk of relapse
Assessment
3 main measures:
1. Body Mass Index (BMI),
2. Waist circumference
3. Waist to hip ratio (WHR).
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
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
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
Waist to Hip Ration
Measure hip circumference
• maximum circumference over the
buttocks.
• Divide the waist circumference by the hip
circumference to get the WHR.
Waist circumference
Men
Women
Health Risk
< 94 cm
< 80 cm
Low
≥ 94 – 101.9 cm ≥ 80 – 87.9 cm
Increased
≥ 102 cm
High
≥ 88 cm
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)
Prevention cont…
• Monitor & chart BMI & waist circumference
of every patient on psychotropic
medication. For those on medication’s
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.
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.
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.
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
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.
References
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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.