Examining strategies to improve accelerometer compliance for individuals living with schizophrenia.

Objective: This study examined the feasibility and effect of 2 investigator-based and 2 participant-based strategies on accelerometer wear time in individuals living with schizophrenia in order to improve accelerometry compliance.

Method: Four adults with schizophrenia were asked to wear an accelerometer for 1 week during the baseline, intervention, and follow-up phases of a study that evaluated exercise counseling. To encourage participants to wear their accelerometers, investigators modeled proper accelerometer use, provided verbal and written instructions, and placed reminder phone calls.

Acute effects of single-dose olanzapine on metabolic, endocrine, and inflammatory markers in healthy controls.

Atypical antipsychotics may "directly" influence glucose homeostasis, increasing risk of type 2 diabetes independently of changes in adiposity. Animal models suggest direct effects after even a single dose of certain atypical antipsychotics on glucose dysregulation. Here, we investigated effects of a single-dose olanzapine (OLA) on glucose metabolism in healthy volunteers, thereby minimizing confounding effects of the illness of schizophrenia and adiposity.

Effects of intracerebroventricular (ICV) olanzapine on insulin sensitivity and secretion in vivo: an animal model.

The atypical antipsychotics (AAPs) have been associated with an increased risk of type 2 diabetes. While weight gain associated with AAPs is a risk factor for diabetes, preclinical work suggests that among these medications, olanzapine, when given peripherally in a single dose, causes pronounced effects on insulin sensitivity and secretion. Given a critical role of the hypothalamus in control of glucose metabolism, we examined the effect of central administration of olanzapine.

Atypical antipsychotics and diabetic ketoacidosis: a review.

Rationale: Atypical antipsychotics have been linked to weight gain and type 2 diabetes, but are also associated with diabetic ketoacidosis (DKA), which can occur more acutely and in the absence of weight gain.

Objectives: Our aim was to review current case reports of DKA in the context of atypical antipsychotic treatment to better understand (a) the scope of the problem, (b) its relationship to different atypical agents, (c) risk factors, (d) long-term outcome, and (e) putative mechanisms of action.

Method: Searches in PubMed/Medline, as well as the University of Toronto's Scholar Portal, were performed for all relevant articles/abstracts in English.

Topiramate in schizophrenia: a review of effects on psychopathology and metabolic parameters.

Less than half of patients with schizophrenia obtain full response to antipsychotic drugs and, while clozapine represents the treatment of choice for refractory psychosis, a significant number of individuals remain only partially responsive. Despite a need for augmentation in this subpopulation, to date clear choices have not been forthcoming. Because clozapine, along with the majority of second-generation agents (SGAs), are linked to metabolic disturbances, augmentation strategies that do not further exacerbate these side effects are needed.

Atypical antipsychotics and effects of muscarinic, serotonergic, dopaminergic and histaminergic receptor binding on insulin secretion in vivo: an animal model.

The atypical antipsychotics (AAPs) have been associated with increased risk of type-2 diabetes. Evidence suggests direct, drug-related effects independent of weight gain and although mechanisms underlying this phenomenon are unclear, it has been suggested that the heterogeneous receptor binding profile of the AAPs may influence receptors implicated in glucose metabolism. This study aimed to clarify weight gain-independent mechanisms of AAP-induced changes in insulin secretion by deconstructing their binding profile with representative antagonists.

Smoking cessation in women with severe mental illness: exploring the role of exercise as an adjunct treatment.

Objective: The aim of this study was to investigate the potential role of exercise in smoking cessation in women with severe mental illness (SMI).

Methods: Semistructured interviews with 12 women diagnosed with SMI receiving smoking cessation treatment were conducted.

Results: Participants perceived three roles for exercise in assisting smoking cessation--addressing fears with preexisting chronic health conditions, emotion management and distraction, and weight management.

Antipsychotic switching for people with schizophrenia who have neuroleptic-induced weight or metabolic problems.

Background: Weight gain is common for people with schizophrenia and this has serious implications for a patient's health and well being. Switching strategies have been recommended as a management option.

Objectives: To determine the effects of antipsychotic medication switching as a strategy for reducing or preventing weight gain and metabolic problems in people with schizophrenia.

Topiramate augmentation in clozapine-treated patients with schizophrenia: clinical and metabolic effects.

Clozapine represents the treatment of choice for refractory psychosis, although a significant number of individuals demonstrate suboptimal response to it as well, leading to clozapine augmentation strategies. A variety of agents have been investigated in this regard, including mood stabilizers, such as anticonvulsants. Within this group of medications, topiramate is unique in that it is associated with weight loss, making it an attractive option because of clozapine's notable risk for associated metabolic disturbance.

Exploring the construct validity of the transtheoretical model to structure physical activity interventions for individuals with serious mental illness.

Objective: Physical activity intervention research involving individuals with serious mental illness are often not based on any theoretical framework. This study examined the construct validity of the Transtheoretical Model (TTM) in individuals with serious mental illness to guide future physical activity interventions.

Methods: Fifty-four individuals completed surveys that asked about their current stage of change for physical activity, self-efficacy, and perceived advantages and disadvantages of being more physically active.

Schizophrenia and the incidence of cardiovascular morbidity: a population-based longitudinal study in Ontario, Canada.

Objective: Despite the high rates of cardiovascular mortality among people with schizophrenia, little is known about the incidence of cardiovascular morbidity in this population. We assessed whether individuals diagnosed with schizophrenia, in comparison to a population-proxy comparison group (comprised of individuals receiving an appendicitis-related primary diagnosis), would have a significantly greater risk of subsequent readmission to an inpatient or Emergency Department setting with a cardiovascular condition.

Design: Using inpatient hospital discharge records from April 1, 2002 to March 31, 2006 in Ontario, Canada, we constructed a population-based cohort study of patients who were followed for a period up to 4 years.

Psychiatric illness and obesity: recognizing the "obesogenic" nature of an inpatient psychiatric setting.

Objective: The prevalence of obesity and obesity-related diseases is higher among individuals with psychiatric illness than in the general population. This study examined environmental factors that contribute to obesity in one psychiatric hospital in Canada.

Methods: Semistructured interviews were conducted with 25 key stakeholders from multiple professional disciplines at the hospital.

Insulin resistance and decreased glucose-stimulated insulin secretion after acute olanzapine administration.

The newer atypical antipsychotics, as a class, have been associated with an increased risk of weight gain and metabolic abnormalities. The mechanisms underlying this phenomenon are currently unclear, but there are data to suggest the possibility of an immediate (as opposed to chronic) effect of these drugs. The aim of the present study was to assess the acute effects of olanzapine on specific measures of insulin sensitivity and secretion.

Body mass index, waist circumference and quality of life in individuals with schizophrenia.

Objective: The primary objective was to examine the differential relationship between waist circumference, body mass index, and self-reported quality of life in patients with schizophrenia.

Method: Individuals with DSM-IV schizophrenia (n=90) were interviewed to obtain sociodemographic data, complete a Quality of Life questionnaire (the MOS SF-12) and have measurements taken of height, weight (kg), and waist circumference (cm). Multiple regression analysis was used to assess the associations between adiposity measures (BMI, WC) and quality of life outcomes (PCS, MCS).

Pharmacologic and nonpharmacologic strategies for weight gain and metabolic disturbance in patients treated with antipsychotic medications.

Objectives: To provide an overview of pharmacologic and nonpharmacologic strategies for antipsychotic-associated weight gain and metabolic disturbance, to identify important areas for future research, and to make practice recommendations based on current knowledge.

Methods: We undertook a selective review of interventions for weight gain and metabolic disturbance in the general population and in individuals treated with antipsychotic medications, focusing on randomized controlled trials in schizophrenia.

Results: Pharmacologic strategies include medication choice, medication dosage and formulation, choice of concomitant psychotropic medications, medication switching, medication addition to effect weight loss or prevent weight gain, and medications to increase insulin sensitivity.

Metabolic monitoring for patients treated with antipsychotic medications.

Objectives: Metabolic side effects of antipsychotic treatment include weight gain, dyslipidemia and increased susceptibility to diabetes. Patients with schizophrenia have increased coronary heart disease mortality and reduced life expectancy. There is an urgent clinical need to monitor antipsychotic-treated patients for metabolic disturbance.

Insulin resistance and adiponectin levels in drug-free patients with schizophrenia: A preliminary report.

Objective: To compare the insulin sensitivity and adiponectin levels of medication-free patients suffering from schizophrenia or schizoaffective disorder with that of matched healthy volunteers.

Method: We evaluated 9 nondiabetic patients aged 26.6 years (median 26 years, range 17 to 41 years) and matched volunteers, using the frequently sampled intravenous glucose tolerance test, minimal model analysis, and fasting adiponectin levels.

Validation of a physical activity assessment tool for individuals with schizophrenia.

Objective: Increasing physical activity must be one component of lifestyle interventions designed to prevent or treat obesity in schizophrenia and there is now a need to develop low cost, practical and accurate measures of physical activity in this population to identify the prevalence of physical (in)activity and to assess the effectiveness of physical activity interventions. The objective of this study was to provide preliminary validation of the Short-Form International Physical Activity Questionnaire (IPAQ), a measurement tool that could prove useful for both clinicians and researchers in the field.

Method: Reliability and validity data were collected from a sample of 35 outpatients with a DSM-IV diagnosis of schizophrenia.

Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome.

Objective: To determine the prevalence and characteristics of coronary heart disease (CHD) risk factors in patients with chronic schizophrenia or schizoaffective disorder.

Method: We compared individual CHD risk factors and Framingham risk predictions in a group of 240 patients with a large national sample (Canadian Heart Health Survey) matched for age and sex. In addition, we compared rates of the metabolic syndrome (syndrome X) with recently published rates in the US adult population.