Weight change in the acute treatment of bipolar I disorder: A naturalistic observational study of psychiatric inpatients

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Journal of Affective Disorders (Impact Factor: 3.38). 02/2008; 105(1-3):45-52. DOI: 10.1016/j.jad.2007.04.006
Source: PubMed


Bipolar patients have increased prevalence rates of overweight and obesity compared with the general population. Recent increases in the use of atypical antipsychotics and combination therapies have led to growing concern about obesity and metabolic disturbances. We therefore evaluated weight change and its correlates during the treatment of acute mania in a closed-ward hospital setting.
We evaluated weight change over 4 weeks in 179 consecutive patients with bipolar I disorder presenting with acute manic symptoms.
Overall weight change was +2.7+/-3.0 kg (+4.6+/-5.2%). Whereas 24.6% of patients were obese at baseline, 36.3% were obese after 4 weeks. Duration of illness was correlated with weight change, but its effect was not robust. Baseline weight/BMI, sex, age of onset, and history of previous medication were not significantly correlated with weight changes. Patients prescribed olanzapine plus valproate showed the largest increase in weight (3.8+/-2.9 kg). Overall, patients on any kind of atypical antipsychotics showed greater weight gain than those on typical antipsychotics or without antipsychotics. Combination treatment with antipsychotics and mood stabilizer resulted in greater weight gain than monotherapy with an antipsychotic or mood stabilizer.
The short-term assessment (4 weeks) of weight change and the lack of variables previously reported to be related to weight gain, such as number of depressive episodes, warrant caution in the interpretation of our results.
Even during short period of acute treatment, bipolar patients showed significant weight gain and became obese in a closed-ward setting. Clinicians prescribing combination therapies should pay more attention to weight gain and obesity.

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    • "Some factors related to MetS were also recorded, such as alcohol dependence or abuse diagnosed based on the SCID, smoking habit, a regular exercise habit, pharmacotherapy factors, and other factors including parents’ history of diabetes mellitus, past history of psychiatric admission, and past history of attempted suicide. Antipsychotic, mood stabilizer, and antidepressant use were recorded, because the three psychotropics are commonly used in mood and anxiety disorders and have been reported to be related to MetS or weight gain [8-10]. The total numbers and costs of the three medication categories as well as the total years of psychiatric pharmacotherapy were calculated. "
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    ABSTRACT: Background Few studies have simultaneously compared the impacts of pharmacotherapy and mental diagnoses on metabolic syndrome (MetS) among psychiatric outpatients with mood and anxiety disorders. This study aimed to investigate the impacts of pharmacotherapy and mental diagnoses on MetS and the prevalence of MetS among these patients. Methods Two-hundred and twenty-nine outpatients (men/women = 85/144) were enrolled from 1147 outpatients with mood and anxiety disorders by systematic sampling. Psychiatric disorders and MetS were diagnosed using the Structured Clinical Interview for DSM-IV-TR and the new International Diabetics Federation definition, respectively. The numbers of antipsychotics, mood stabilizers, and antidepressants being taken were recorded. Logistic regression was used to investigate the impacts of pharmacotherapy and psychiatric diagnoses on MetS. Results Among 229 subjects, 51 (22.3%) fulfilled the criteria for MetS. The prevalence of MetS was highest in the bipolar I disorder (46.7%) patients, followed by bipolar II disorder (25.0%), major depressive disorder (22.0%), anxiety-only disorders (16.7%), and no mood and/or anxiety disorders (14.3%). The percentages of MetS among the five categories were correlated with those of the patients being treated with antipsychotics and mood stabilizers. Use of antipsychotics and/or mood stabilizers independently predicted a higher risk of MetS after controlling for demographic variables and psychiatric diagnoses. When adding body mass index (BMI) as an independent variable in the regression model, BMI became the most significant factor to predict MetS. Conclusion BMI was found to be an important factor related to MetS. Pharmacotherapy might be one of underlying causes of elevated BMI. The interactions among MetS, BMI, pharmacotherapy, and psychiatric diagnoses might need further research.
    Full-text · Article · Jun 2014 · BMC Psychiatry
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    • "Psychiatric patients often receive polypharmacy with antipsychotics and mood stabilizers in real practice. It has been noted that patients on polypharmacy regimens have a higher prevalence of metabolic abnormalities [4,5] and more enhanced weight gain [6]. "
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    ABSTRACT: Metabolic and cardiovascular side effects have been noted with the use of second generation antipsychotics (SGAs) and mood stabilizers. Since Omega-3 fatty acids have been known to prevent some cardiovascular risks, this preliminary study was designed to evaluate the cardiovascular benefits of omega-3 when added to the combinations of olanzapine with mood stabilizers. This study was a randomized, double-blind, placebo-controlled, within-subject trial in adult psychiatric patients who were receiving olanzapine combined with lithium (Li) or valproate sodium (VPA). Omega-3 as fish oil with less than 1 g/day of EPA/DHA or its placebo was added to patients' olanzapine and mood stabilizer regimens for 6 weeks. Metabolic parameters including anthropometric variables, lipid profile, metabolic syndrome indices, C-reactive protein, fibrinogen and lipoprotein (a) [(Lp) (a)] were assessed for participants. Forty one participants completed this study; 20 patients received omega-3 and 21 patients received placebo, added to their regimen of SGA and mood stabilizer. Omega-3 addition did not modulate anthropometric, metabolic syndrome and lipid parameter changes in 6 weeks. However, fibrinogen levels significantly decreased, Lp (a) did not increase and non-high-density lipoprotein cholesterol (non-HDL-C) did not go beyond its target level after omega-3 supplementation. Additionally, a significant inter-group effect was noted for Lp(a). This study suggests that use of short-term omega-3 supplementation added to a combined regimen of olanzapine and mood stabilizer may have a small modulating effect on some cardiovascular risk factors. Trials in longer periods of time and with larger number of patients are needed to further evaluate the effects of omega-3 supplements on preventing cardiovascular risk factors.This trial is registered at and its Identifier is as following: IRCT138712231764N1.
    Full-text · Article · Oct 2012 · DARU-JOURNAL OF FACULTY OF PHARMACY
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    • "It is well-known that the combination of various anti-psychotics and mood stabilizers is more effective than a mood stabilizer alone for patients with acute bipolar mania.24 However, olanzapine,25 risperidone,26,27 and quetiapine28 in combination with a mood stabilizer have been shown to cause significant weight gain. Obesity has been correlated with a poor outcome in patients with bipolar I disorder,29 and other adverse long-term health consequences. "
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    ABSTRACT: We investigated the efficacy and tolerability of ziprasidone combined with divalproex to determine the relationship between the initial dose of ziprasidone and the treatment effect among Korean patients with acute bipolar manic or mixed disorders. This study was a 6-week, open-label, prospective investigation of Korean patients with an acute manic or mixed episode of bipolar disorder. Sixty-five patients were recruited. The patients were categorized based on the initial dose of ziprasidone as follows: low (20-79 mg/day) and standard (80 mg/day). Ziprasidone was given in combination with divalproex in flexible doses, according to the clinical response and tolerability. The response and remission rates were significantly higher in the standard-dose group than the low-dose group. The combination of ziprasidone and divalproex was well-tolerated and adverse events were mostly mild with no statistically significant increase in body weight. The results of this study showed that a standard starting dose of ziprasidone in combination with divalproex for bipolar disorder is more effective than a low starting dose.
    Full-text · Article · Sep 2011 · Psychiatry investigation
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