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Almost all antipsychotics result in weight gain. Meta-analysis

A meta-analysis shows that almost all antipsychotics result in weight gain, which can lead to severe physical problems and decreased life expectancy in people with severe mental illness. This study also explores the impact of duration of antipsychotic use and the association with different diagnostic groups.

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Almost all antipsychotics result in weight gain. Meta-analysis

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  1. Almost all antipsychotics result in weight gain. Meta-analysis Maarten Bak

  2. Severe Mental Illness Health

  3. People with SMI decease at a younger age Munk-Laursen 2014 Ann Rev Clin Psych

  4. In SMI life expectancy is shortened Man Female Nordentoft 2013 PlosOne

  5. Risks of severe physical problems in SMI GAP =General Australian population Gladigau 2014 IMJ

  6. Physical problems & SMI: review De Hert 2011 World Psych

  7. DM-II MetS Heald 2010 Eur Psych

  8. CVD risico McLean 2014 Schiz Res

  9. People with Schizophrenia decease at a younger age Munk-Laursen 2014 Ann Rev Clin Psych

  10. Treatment of physical problems & SMI OR Meta-analysis of treatment with: Antiviral compounds, ACE-blockers, β-blockers, anticoagulants and Cholesterol decreasing medication Mitchell 2012 BJP

  11. Severe MentalIllness Medication Health

  12. Mortality risk & AP Largely explained by reduced risk of suicide Tiihonen 2009 Lancet

  13. Mortality and medication Tenback 2012 J Clin PsyPharm

  14. Monitor side effects Antipsychotic monitor (APM)

  15. Monitor volksgezondheid 2015 + AP Monitor 2016

  16. Monitor volksgezondheid 2015 + AP Monitor 2016

  17. First review: AP associated with weight gain Allison et al, 1999 Am J Psych

  18. Weight change: meta-analysis Study duration: 4-12 wks Compared with haloperidol Leucht 2009 Lancet

  19. BMI changes in first episode schizophrenia Tarricone 2010 Psychol Med

  20. Are all AP associated with weight gain? Are AP-naive patients more at risk? Is duration of AP-use related with more weight gain?

  21. Flow chart Bak 2014 PlosOne

  22. Figure 2. Weight change (in kg) per period per antipsychotic medication. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  23. Figure 3. Weight change (kg) per period only including AP-naive samples. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  24. Figure 4. BMI change per period. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  25. Figure 5. BMI change in AP naive patients per time period. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  26. Figure 6. Proportion of weight increase per antipsychotic per time period. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  27. Figure 7. Proportion of weight increase in AP naïve. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  28. Figure 8. Proportion of weight reduction. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  29. Table 1. Metaregression of weight changes per period. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  30. Table 2. Metaregression of weight changes per period in drug-naive patients. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112

  31. Is diagnosis a factor? Data period: 1960 – 2015 437 papers

  32. Remt “reward” systeem D2  blokkade negatieve feedback  Leptine stijgt  Appetite stijgt Vergroot honger gevoel en eetlust  Meer voedsel intake

  33. Intake changes in rats after AP use Kaur & Kulkarni 2002 PNBP

  34. Conclusion • All antipsychotics result in weight gain • Three risk groups • Limited: aripiprazol, amisulpride, ziprasidone • Moderate: haloperidol, risperidon, paliperidon, quetiapine • Severe: olanzapine & clozapine • Weight gain is not associated with diagnosis

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