Cochrane Database Syst Rev. 2007 Jan 24(1):CD005148.
Faulkner G, Cohn T, Remington G.
University of Toronto, 55 Harbord St, Toronto, Ontario,Canada, M5S 2W6.
guy.faulkner@utoronto.ca
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 STRATEGY: 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.
Publication Types:
Meta-Analysis
Review
PMID: 17253540 [Pubmed - indexed for MEDLINE]
Related Links
Early intervention for psychosis. [Cochrane Database Syst Rev. 2006]
PMID:17054213
Sertindole for schizophrenia. [Cochrane Database Syst Rev. 2005] PMID:16034864
Systematic reviews of the effectiveness of day care for people with severe mental
disorders: (1) acute day hospital versus admission; (2) vocational
rehabilitation; (3) day hospital versus outpatient care. [Health Technol Assess.
2001] PMID:11532238
Zuclopenthixol dihydrochloride for schizophrenia. [Cochrane Database Syst Rev.
2005] PMID:16235403
Olanzapine for schizophrenia. [Cochrane Database Syst Rev. 2005] PMID:15846619
