A Ventriglio1, A Gentile2, R J Baldessarini3, S Martone2, G Vitrani2, A La Marca2, A Bellomo2. 1. Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Via Gugliemo Marconi 3, 71041 Carapelle (FG), Foggia, Italy. Electronic address: a.ventriglio@libero.it. 2. Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Via Gugliemo Marconi 3, 71041 Carapelle (FG), Foggia, Italy. 3. Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.
Abstract
PURPOSE: As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psycho-education and medical monitoring on metabolic changes among severely mentally ill patients. MATERIALS AND METHODS: During repeated, systematic psycho-education about general health among 66 consecutive patients diagnosed with DSM-IV-TR schizophrenia (n=33) or type-I bipolar disorder (n=33), we evaluated (at intake 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, recorded physiological parameters, and assessed attitudes about medication. RESULTS: At intake, patients with schizophrenia vs bipolar disorder were receiving 3-7 times more psychotropic medication, with 14% higher initial body-mass index (BMI: 29.1 vs 25.6 kg/m²), 12 times more obesity, and significantly higher serum lipid concentrations. During 6-months follow-up, among bipolar disorder patients, polytherapy and serum lipid concentrations declined more than among schizophrenia patients (e.g., total cholesterol+triglycerides, by 3.21 vs 1.75%/month). BMI remained stable. Declining lipid levels were associated with older age, bipolar disorder, being unemployed, higher antipsychotic doses, and lower initial BPRS scores (all P ≤ 0.001). CONCLUSIONS: Psychotropic treatments were more complex, and metabolic measures more abnormal among bipolar disorder than schizophrenia patients. Intensive psycho-education, clinical monitoring, and encouragement of weight-control for six months were associated with improvements in metabolic measures (but not to BMI), and more realistic attitudes about medication.
PURPOSE: As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psycho-education and medical monitoring on metabolic changes among severely mentally illpatients. MATERIALS AND METHODS: During repeated, systematic psycho-education about general health among 66 consecutive patients diagnosed with DSM-IV-TR schizophrenia (n=33) or type-I bipolar disorder (n=33), we evaluated (at intake 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, recorded physiological parameters, and assessed attitudes about medication. RESULTS: At intake, patients with schizophrenia vs bipolar disorder were receiving 3-7 times more psychotropic medication, with 14% higher initial body-mass index (BMI: 29.1 vs 25.6 kg/m²), 12 times more obesity, and significantly higher serum lipid concentrations. During 6-months follow-up, among bipolar disorderpatients, polytherapy and serum lipid concentrations declined more than among schizophreniapatients (e.g., total cholesterol+triglycerides, by 3.21 vs 1.75%/month). BMI remained stable. Declining lipid levels were associated with older age, bipolar disorder, being unemployed, higher antipsychotic doses, and lower initial BPRS scores (all P ≤ 0.001). CONCLUSIONS: Psychotropic treatments were more complex, and metabolic measures more abnormal among bipolar disorder than schizophreniapatients. Intensive psycho-education, clinical monitoring, and encouragement of weight-control for six months were associated with improvements in metabolic measures (but not to BMI), and more realistic attitudes about medication.