Full Text Full Text (PDF) Citation Map Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Fenton, W. S. Articles by Chavez, M. R. Search for Related Content Articles by Fenton, W. S. Articles by Chavez, M. R.

Medication-Induced Weight Gain and Dyslipidemia in Patients With Schizophrenia

"Mr. P," a 40-year-old unmarried man, sought treatment after a move to live closer to his sister. He had attended a first-rate university and worked as a legal researcher before suffering a psychotic episode in 1994 as a first-year law student at age 28. With thiothixene treatment, he improved quickly and returned to school after a brief hospitalization. Mr. P soon stopped his medication, and in 1995 police found him attempting to break into a professor's office to "collect evidence." He was rehospitalized and treated with 6 mg/day of risperidone. After several weeks of treatment, he realized that his delusions were implausible. He was discharged after 1 month and returned home to live with his parents. On admission, he had appeared emaciated and disheveled; during his hospitalization he gained 14 lbs., and at discharge he weighed 145 lbs. Now, at age 40, Mr. P was taking 1.5 mg of risperidone daily and no other medications. Working alone at home, he had published two articles in a local law newsletter. He was reconciled to being a lone scholar and had abandoned dreams of having a girlfriend or getting married. He spent his days reading, writing, or watching television. Over time he had gained weight, and when ziprasidone and quetiapine became available, Mr. P had attempted to switch to these new medications, hoping to lose weight and have more energy. Despite careful cross-titration during these trials, each attempt ended with the reemergence of psychotic symptoms. After these frightening near-relapse experiences, by the time aripiprazole became available in 2003, Mr. P did not want to take a chance with another new medication. At initial assessment, Mr. P weighed 203 lbs. at 5 ft. 8 in. tall (body mass index [BMI] = 30.9) and had a waist circumference of 44 in. His blood pressure was 135/85 mm Hg. His total cholesterol was 211 mg/dl; triglycerides, 225 mg/dl (low-density lipoprotein [LDL] cholesterol, 148 mg/dl, high-density lipoprotein [HDL] cholesterol = 32 mg/dl), fasting plasma glucose, 102 mg/ dl. Thyroid function tests, blood chemistry, and urinalysis were unremarkable. Mr. P does not smoke and rarely consumes alcohol. His sister and his previous doctor encouraged him to exercise and diet, but he was unable to sustain efforts in either. Mr. P's family history was significant for a paternal aunt who had a psychotic disorder and a maternal grandmother who had died at age 50 from complications of diabetes. His father had died at age 55 of a myocardial infarction. Mr. P was free of psychotic symptoms, but despite a keen intelligence, he felt too fatigued to work. He wanted to take a class at a local college but felt humiliated because he could not fit into the lecture hall desk and chair. Does this patient have the metabolic syndrome? What is his risk of developing diabetes or heart disease? What treatment or prevention strategies should be considered?

(Reprinted with permission from the American Journal of Psychiatry 2006; 163:1697–1704)

Get information about faster international access.

Privacy Policy

Copyright © 2008 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us