Interventions to reduce weight gain in schizophrenia

 

Abstract

Background

Weight gain is common for people with schizophrenia and this has serious implications for health and well being.

Objectives

To determine the effects of both pharmacological (excluding medication switching) and non pharmacological strategies for reducing or preventing weight gain in people with schizophrenia.

Search methods

We searched key databases and the Cochrane Schizophrenia Group's trials register (April 2006), reference sections within relevant papers, hand searched key journals, and contacted the first author of each relevant study and other experts to collect further information.

Selection criteria

We included all clinical randomised controlled trials comparing any pharmacological or non pharmacological intervention for weight gain (diet and exercise counselling) with standard care or other treatments for people with schizophrenia or schizophrenia-like illnesses.

Data collection and analysis

We reliably selected, quality assessed and extracted data from studies. As weight is a continuous outcome measurement, weighted mean differences (WMD) of the change from baseline were calculated. The primary outcome measure was weight loss.

Main results

Twenty-three randomised controlled trials met the inclusion criteria for this review. Five trials assessed a cognitive/behavioural intervention and eighteen assessed a pharmacological adjunct. In terms of prevention, two cognitive/behavioural trials showed significant treatment effect (mean weight change) at end of treatment (n=104, 2 RCTs, WMD -3.38 kg CI -4.2 to -2.0). Pharmacological adjunct treatments were significant with a modest prevention of weight gain (n=274, 6 RCTs, WMD - 1.16 kg CI -1.9 to -0.4). In terms of treatments for weight loss, we found significantly greater weight reduction in the cognitive behavioural intervention group (n=129, 3 RCTs, WMD -1.69 kg CI -2.8 to -0.6) compared with standard care.

Authors' conclusions

Modest weight loss can be achieved with selective pharmacological and non pharmacological interventions. However, interpretation is limited by the small number of studies, small sample size, short study duration and by variability of the interventions themselves, their intensity and duration. Future studies adequately powered, with longer treatment duration and rigorous methodology will be needed in further evaluating the efficacy and safety of weight loss interventions for moderating weight gain. At this stage, there is insufficient evidence to support the general use of pharmacological interventions for weight management in people with schizophrenia.

 

Plain language summary

Interventions to reduce weight gain in schizophrenia

Weight gain and obesity is a common problem for people with schizophrenia and both pharmacological (medication) and non pharmacological (diet/exercise) interventions have been tried to treat this problem. In this review we are able to show that small weight loss is possible with selective pharmacological or non-pharmacological interventions but it is difficult to be sure of the results because the studies were small and compared different interventions over different time periods.

 

摘要

背景

減少精神分裂症病人增加體重的介入處置

體重增加是精神分裂症患者常見的現象，而且會嚴重地影響他們的身心健康

目標

探討藥物處置(換藥除外)和非藥物處置對於減少或預防精神分裂症患者體重增加的效果

搜尋策略

我們搜尋一些主要的資料庫和the Cochrane Schizophrenia Group's trials register (2006,3)、相關文章的引用文獻、查詢相關重要的期刊以及聯絡每個相關研究的第一作者及其他專家來蒐集進一步的資料。

選擇標準

我們納入所有針對精神分裂症或類精神分裂症的患者(不管是標準的治療方式或是其他的處理模式)的體重增加而去比較藥物或非藥物處置(包括飲食和運動諮詢)效果的臨床隨機對照試驗。

資料收集與分析

我們篩選有品質的研究並且從中提取數據，由於體重是一個持續的結果變項，所以我們去計算改變自基準體重的加權平均差(WMD)。因此主要的結果變項是體重下降的程度。

主要結論

有23篇隨機對照試驗符合此次文獻回顧的納入標準。其中有5篇試驗是評估認知/行為的介入處置，有8篇是評估藥物輔助的效果。就預防體重增加方面，當中有2篇是以認知/行為的介入處置方式使得在治療結束後在平均體重的改變上達到顯著的效果(n = 104, 2 RCTs, WMD −3.38 kg CI −4.2 to −2.0)，至於藥物的輔助治療也呈現出有意義的中等程度預防體重增加的效果(n = 274, 6 RCTs, WMD  1.16 kg CI −1.9 to −0.4)。而在治療體重增加的部分，比起一般標準的治療模式，認知行為治療的那一組顯現出有意義的體重下降(n = 129, 3 RCTs, WMD −1.69 kg CI −2.8 to −0.6)。

作者結論

使用選擇的藥物和非藥物處置能適度的降低體重。然而因為只有少數的研究、少數的樣本數、短暫的研究期間和處置本身的變異性、處置的強度及處置的期間，使得這樣的解釋是有限的。未來的研究需要較長的研究期間、嚴格的方法學來評估減輕體重處置的有效性及安全性。在目前的階段並沒有足夠的證據支持對精神分裂症病人使用藥物處置來控制體重。

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

增加體重和肥胖是精神分裂症病人常見的問題，通常我們都使用藥物處置和非藥物的處置(飲食/運動)來處理這樣的問題。在這篇回顧的文獻中，我們能呈現當使用選擇的藥物或非藥物的處置是可能產生少數的病人降低體重。因為研究的數目少，而且是比較不同的期間的不同處置方式，所以我們很難確信這樣的結果。