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More evidence links high-potency marijuana use to first-episode psychosis
SAN DIEGO – High-potency marijuana use appears to be associated with an increased risk of a first psychotic episode, based on a case-control study conducted in Europe.
“Daily users of a strong type of cannabis face a significant increase in the probability of developing a psychotic disorder,” reported Marta Di Forti, MD, PhD, MRC, lead author of a study whose preliminary results were presented at the International Congress on Schizophrenia Research.
Dr. Di Forti spawned a media boomlet in 2015 when she and her colleagues raised the prospect of a possible association between so-called “skunk” marijuana and first psychotic episodes. In their study of subjects in London with first-time psychotic episodes and matched population controls, those who had psychotic episodes were three times (adjusted odds ratio: 2.92; 95% confidence interval, 1.52-3.45; P = .001) as likely as controls to have used “skunk” marijuana (Lancet Psychiatry. 2015 Mar;2[3]:233-8).
In the new study, Dr. Di Forti and her colleagues analyzed 1,200 first-incident cases of psychosis that were captured between the years 2010 and 2013 by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions project (EU-GEI). The researchers compared the cases to 1,300 population-based controls in five unidentified European countries and found that daily users of high-potency marijuana had the highest adjusted odds ratio (4.5-8, statistical significance not available) of a psychotic episode (Schizophr Bull. 2017 Mar:43:S30. doi: 10.1093/schbul/sbx021.078). “This effect is significant even after controlling for other drugs of abuse such as stimulants, tobacco and alcohol, and main sociodemographic confounders,” the researchers wrote in their abstract.
“The biology of cannabis-associated psychosis is still unclear,” Dr. Di Forti said in an interview. “Nevertheless, we know that THC (tetrahydrocannabinol) binds with two receptors called CB1 and CB2. They’re part of the endocannabinoid system, which from uterus onward protects our central nervous systems from insults. It activates on demand if the brain goes on hypoxia or we experience a brain injury.”
“CB1 activation leads to changes in the transmission of both GABA and glutamate. Downstream, they affect the dopamine system, which is biologically linked to psychosis.”
Dr. Di Forti dismissed the idea that people at risk for psychosis are drawn to high-potency marijuana. “Using genetic data, we’ve showed that cannabis users – both cases and controls – did not have a higher genetic load for schizophrenia than those who never used (marijuana),” she said (Lancet Psychiatry. 2015 May;2[5]:381-2).
The findings point to the importance of asking patients – and students and children – about more than just whether they have ever used marijuana. History-taking for marijuana use needs to be comparable to that performed for alcohol use, she said. “I always ask my patients for details about their past and present use but also try to understand why they use (marijuana). When possible, once I know how frequently and what type (of marijuana) they use, I can negotiate some harm-reduction strategy.”
The study is funded by the U.K.’s Medical Research Council and a European Union grant. Dr. Di Forti reports no relevant disclosures.
SAN DIEGO – High-potency marijuana use appears to be associated with an increased risk of a first psychotic episode, based on a case-control study conducted in Europe.
“Daily users of a strong type of cannabis face a significant increase in the probability of developing a psychotic disorder,” reported Marta Di Forti, MD, PhD, MRC, lead author of a study whose preliminary results were presented at the International Congress on Schizophrenia Research.
Dr. Di Forti spawned a media boomlet in 2015 when she and her colleagues raised the prospect of a possible association between so-called “skunk” marijuana and first psychotic episodes. In their study of subjects in London with first-time psychotic episodes and matched population controls, those who had psychotic episodes were three times (adjusted odds ratio: 2.92; 95% confidence interval, 1.52-3.45; P = .001) as likely as controls to have used “skunk” marijuana (Lancet Psychiatry. 2015 Mar;2[3]:233-8).
In the new study, Dr. Di Forti and her colleagues analyzed 1,200 first-incident cases of psychosis that were captured between the years 2010 and 2013 by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions project (EU-GEI). The researchers compared the cases to 1,300 population-based controls in five unidentified European countries and found that daily users of high-potency marijuana had the highest adjusted odds ratio (4.5-8, statistical significance not available) of a psychotic episode (Schizophr Bull. 2017 Mar:43:S30. doi: 10.1093/schbul/sbx021.078). “This effect is significant even after controlling for other drugs of abuse such as stimulants, tobacco and alcohol, and main sociodemographic confounders,” the researchers wrote in their abstract.
“The biology of cannabis-associated psychosis is still unclear,” Dr. Di Forti said in an interview. “Nevertheless, we know that THC (tetrahydrocannabinol) binds with two receptors called CB1 and CB2. They’re part of the endocannabinoid system, which from uterus onward protects our central nervous systems from insults. It activates on demand if the brain goes on hypoxia or we experience a brain injury.”
“CB1 activation leads to changes in the transmission of both GABA and glutamate. Downstream, they affect the dopamine system, which is biologically linked to psychosis.”
Dr. Di Forti dismissed the idea that people at risk for psychosis are drawn to high-potency marijuana. “Using genetic data, we’ve showed that cannabis users – both cases and controls – did not have a higher genetic load for schizophrenia than those who never used (marijuana),” she said (Lancet Psychiatry. 2015 May;2[5]:381-2).
The findings point to the importance of asking patients – and students and children – about more than just whether they have ever used marijuana. History-taking for marijuana use needs to be comparable to that performed for alcohol use, she said. “I always ask my patients for details about their past and present use but also try to understand why they use (marijuana). When possible, once I know how frequently and what type (of marijuana) they use, I can negotiate some harm-reduction strategy.”
The study is funded by the U.K.’s Medical Research Council and a European Union grant. Dr. Di Forti reports no relevant disclosures.
SAN DIEGO – High-potency marijuana use appears to be associated with an increased risk of a first psychotic episode, based on a case-control study conducted in Europe.
“Daily users of a strong type of cannabis face a significant increase in the probability of developing a psychotic disorder,” reported Marta Di Forti, MD, PhD, MRC, lead author of a study whose preliminary results were presented at the International Congress on Schizophrenia Research.
Dr. Di Forti spawned a media boomlet in 2015 when she and her colleagues raised the prospect of a possible association between so-called “skunk” marijuana and first psychotic episodes. In their study of subjects in London with first-time psychotic episodes and matched population controls, those who had psychotic episodes were three times (adjusted odds ratio: 2.92; 95% confidence interval, 1.52-3.45; P = .001) as likely as controls to have used “skunk” marijuana (Lancet Psychiatry. 2015 Mar;2[3]:233-8).
In the new study, Dr. Di Forti and her colleagues analyzed 1,200 first-incident cases of psychosis that were captured between the years 2010 and 2013 by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions project (EU-GEI). The researchers compared the cases to 1,300 population-based controls in five unidentified European countries and found that daily users of high-potency marijuana had the highest adjusted odds ratio (4.5-8, statistical significance not available) of a psychotic episode (Schizophr Bull. 2017 Mar:43:S30. doi: 10.1093/schbul/sbx021.078). “This effect is significant even after controlling for other drugs of abuse such as stimulants, tobacco and alcohol, and main sociodemographic confounders,” the researchers wrote in their abstract.
“The biology of cannabis-associated psychosis is still unclear,” Dr. Di Forti said in an interview. “Nevertheless, we know that THC (tetrahydrocannabinol) binds with two receptors called CB1 and CB2. They’re part of the endocannabinoid system, which from uterus onward protects our central nervous systems from insults. It activates on demand if the brain goes on hypoxia or we experience a brain injury.”
“CB1 activation leads to changes in the transmission of both GABA and glutamate. Downstream, they affect the dopamine system, which is biologically linked to psychosis.”
Dr. Di Forti dismissed the idea that people at risk for psychosis are drawn to high-potency marijuana. “Using genetic data, we’ve showed that cannabis users – both cases and controls – did not have a higher genetic load for schizophrenia than those who never used (marijuana),” she said (Lancet Psychiatry. 2015 May;2[5]:381-2).
The findings point to the importance of asking patients – and students and children – about more than just whether they have ever used marijuana. History-taking for marijuana use needs to be comparable to that performed for alcohol use, she said. “I always ask my patients for details about their past and present use but also try to understand why they use (marijuana). When possible, once I know how frequently and what type (of marijuana) they use, I can negotiate some harm-reduction strategy.”
The study is funded by the U.K.’s Medical Research Council and a European Union grant. Dr. Di Forti reports no relevant disclosures.
REPORTING FROM THE ICSR BIENNIAL MEETING
VIDEO: What role does autoimmune dysfunction play in schizophrenia?
SAN DIEGO – Researchers are looking at the potential role that autoimmune reactions, such as inflammation, play in the pathogenesis of schizophrenia, both with and without comorbid substance use.
“What we see is evidence of autoimmune involvement through the lifespan in schizophrenia,” explained Brian Miller, MD, PhD, of the department of psychiatry at Augusta (Georgia) University. “We know there is a bidirectional association between schizophrenia and autoimmune disorders, [where] starting with either increases the chances of the other occurring comorbidly.”
Previous studies have shown that adding anti-inflammatory agents to second-generation antipsychotics has been associated with greater symptomatic improvement in schizophrenia than with second-generation antipsychotics alone. Now, Dr. Miller and his colleagues are conducting a randomized, controlled study using the systemic immunotherapy siltuximab to see if adjunct anti-inflammatory treatments can improve cognition in schizophrenia. They are using the monoclonal antibody instead of nonsteroidal anti-inflammatory drugs because of its precise ability to target specific autoimmune pathways, according to Dr. Miller.
In addition, Dr. Miller and his colleagues conducted a post-hoc analysis of data from the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study to determine if there was a difference between those patients with comorbid substance in schizophrenia, compared with those without. He and his coinvestigators found in a post-hoc analysis that the higher the level of certain inflammatory markers, the higher the Positive and Negative Syndrome Scale (PANSS) psychopathology score in people who’d tested positive for marijuana use at baseline.
The results, he said, beg the question about whether trial inclusion criteria for schizophrenia research need revisiting.
“What we really need to do is investigate, in a well-controlled, well-designed, prospective sample of patients who have this substance use comorbidity, [whether] we see alterations in these immune markers, and then how they vary over the course of illness,” Dr. Miller explained in a video interview at the International Congress on Schizophrenia Research. “It’s an important selection bias that as a field we’ve ignored. Maybe that’s a population that is enriched for some kind of immune dysfunction that might be targeted by some kind of anti-inflammatory or other immunotherapy strategy.”
On Twitter @whitneymcknight
SAN DIEGO – Researchers are looking at the potential role that autoimmune reactions, such as inflammation, play in the pathogenesis of schizophrenia, both with and without comorbid substance use.
“What we see is evidence of autoimmune involvement through the lifespan in schizophrenia,” explained Brian Miller, MD, PhD, of the department of psychiatry at Augusta (Georgia) University. “We know there is a bidirectional association between schizophrenia and autoimmune disorders, [where] starting with either increases the chances of the other occurring comorbidly.”
Previous studies have shown that adding anti-inflammatory agents to second-generation antipsychotics has been associated with greater symptomatic improvement in schizophrenia than with second-generation antipsychotics alone. Now, Dr. Miller and his colleagues are conducting a randomized, controlled study using the systemic immunotherapy siltuximab to see if adjunct anti-inflammatory treatments can improve cognition in schizophrenia. They are using the monoclonal antibody instead of nonsteroidal anti-inflammatory drugs because of its precise ability to target specific autoimmune pathways, according to Dr. Miller.
In addition, Dr. Miller and his colleagues conducted a post-hoc analysis of data from the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study to determine if there was a difference between those patients with comorbid substance in schizophrenia, compared with those without. He and his coinvestigators found in a post-hoc analysis that the higher the level of certain inflammatory markers, the higher the Positive and Negative Syndrome Scale (PANSS) psychopathology score in people who’d tested positive for marijuana use at baseline.
The results, he said, beg the question about whether trial inclusion criteria for schizophrenia research need revisiting.
“What we really need to do is investigate, in a well-controlled, well-designed, prospective sample of patients who have this substance use comorbidity, [whether] we see alterations in these immune markers, and then how they vary over the course of illness,” Dr. Miller explained in a video interview at the International Congress on Schizophrenia Research. “It’s an important selection bias that as a field we’ve ignored. Maybe that’s a population that is enriched for some kind of immune dysfunction that might be targeted by some kind of anti-inflammatory or other immunotherapy strategy.”
On Twitter @whitneymcknight
SAN DIEGO – Researchers are looking at the potential role that autoimmune reactions, such as inflammation, play in the pathogenesis of schizophrenia, both with and without comorbid substance use.
“What we see is evidence of autoimmune involvement through the lifespan in schizophrenia,” explained Brian Miller, MD, PhD, of the department of psychiatry at Augusta (Georgia) University. “We know there is a bidirectional association between schizophrenia and autoimmune disorders, [where] starting with either increases the chances of the other occurring comorbidly.”
Previous studies have shown that adding anti-inflammatory agents to second-generation antipsychotics has been associated with greater symptomatic improvement in schizophrenia than with second-generation antipsychotics alone. Now, Dr. Miller and his colleagues are conducting a randomized, controlled study using the systemic immunotherapy siltuximab to see if adjunct anti-inflammatory treatments can improve cognition in schizophrenia. They are using the monoclonal antibody instead of nonsteroidal anti-inflammatory drugs because of its precise ability to target specific autoimmune pathways, according to Dr. Miller.
In addition, Dr. Miller and his colleagues conducted a post-hoc analysis of data from the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study to determine if there was a difference between those patients with comorbid substance in schizophrenia, compared with those without. He and his coinvestigators found in a post-hoc analysis that the higher the level of certain inflammatory markers, the higher the Positive and Negative Syndrome Scale (PANSS) psychopathology score in people who’d tested positive for marijuana use at baseline.
The results, he said, beg the question about whether trial inclusion criteria for schizophrenia research need revisiting.
“What we really need to do is investigate, in a well-controlled, well-designed, prospective sample of patients who have this substance use comorbidity, [whether] we see alterations in these immune markers, and then how they vary over the course of illness,” Dr. Miller explained in a video interview at the International Congress on Schizophrenia Research. “It’s an important selection bias that as a field we’ve ignored. Maybe that’s a population that is enriched for some kind of immune dysfunction that might be targeted by some kind of anti-inflammatory or other immunotherapy strategy.”
On Twitter @whitneymcknight
AT THE ICSR BIENNIAL MEETING
Schizophrenia patients’ mortality is 14.5 years shorter
SAN DIEGO – A new systematic review and meta-analysis, the first of its kind, suggests that most people with schizophrenia – especially men – do not survive past their 60s.
According to findings released at the 2017 International Congress on Schizophrenia Research, schizophrenia patients appear to die a weighted average of 14.5 years earlier than the rest of the population (95% confidence interval, 11.2-17.8).
The weighted average life expectancy for schizophrenia patients was 64.7 years (95% CI, 61.1-71.3) – 59.9 years for men (95% CI, 55.5-64.3) and 67.6 years for women (95% CI, 63.1-72.1).
“There were no indications that this is improving over time,” lead author Carsten Hjorthøj, PhD, senior researcher at the University of Copenhagen, said in an interview.
The researchers launched their paper in order to provide a wider perspective on lives lost in schizophrenia.
Previous studies had used measures like the standardized mortality ratio, which compared schizophrenia patients with a matched group from the general population, Dr. Hjorthøj said. “Saying that people with schizophrenia are, for instance, 2.5 times more likely to die at any given age may be a little difficult to understand. Identifying the actual number of years they die earlier than the rest of the population is easily understood and will probably also make the issue more obvious to policymakers.”
The researchers, whose findings were previously published in Lancet Psychiatry (2017 Apr;4[4]:295-301), examined 11 studies, mostly from Europe (n = 5) and North America (n = 3) with single studies from Africa, Asia, and Australia. (The lowest life expectancies were reported in Asia and Africa.)
One study was published in 1991, and the rest from 2001-2016. Together, the studies tracked 302,691 patients with schizophrenia.
What explains the gap between the life expectancies in men and women? “We did not investigate the reasons for this,” Dr. Hjorthøj said, “but men typically have worse adherence to treatment than women, and men typically also have poorer health-seeking behavior than women even in the general population. Given that schizophrenia is associated with a multitude of adverse somatic outcomes, this could then be aggravated by this difference in health-seeking behavior.”
In addition, he said, “It could also be the case that use of alcohol, tobacco, and illicit substances is even more skewed in schizophrenia than in the general population. Finally, it could also be attributed in part to the fact that men are more likely than women to die from suicide.”
Dr. Hjorthøj said that the findings emphasize the importance of treating physical symptoms in people with schizophrenia.
“I am aware of several cases where physical complaints were not taken seriously because they were raised by people who were known to suffer from delusions,” he said. “But, I do believe that most psychiatrists are aware of this, and the problem is perhaps more that the system in general is underfunded and that somatic and psychiatric hospitals are not good enough at communicating with each other.”
The researchers report no funding and no disclosures.
SAN DIEGO – A new systematic review and meta-analysis, the first of its kind, suggests that most people with schizophrenia – especially men – do not survive past their 60s.
According to findings released at the 2017 International Congress on Schizophrenia Research, schizophrenia patients appear to die a weighted average of 14.5 years earlier than the rest of the population (95% confidence interval, 11.2-17.8).
The weighted average life expectancy for schizophrenia patients was 64.7 years (95% CI, 61.1-71.3) – 59.9 years for men (95% CI, 55.5-64.3) and 67.6 years for women (95% CI, 63.1-72.1).
“There were no indications that this is improving over time,” lead author Carsten Hjorthøj, PhD, senior researcher at the University of Copenhagen, said in an interview.
The researchers launched their paper in order to provide a wider perspective on lives lost in schizophrenia.
Previous studies had used measures like the standardized mortality ratio, which compared schizophrenia patients with a matched group from the general population, Dr. Hjorthøj said. “Saying that people with schizophrenia are, for instance, 2.5 times more likely to die at any given age may be a little difficult to understand. Identifying the actual number of years they die earlier than the rest of the population is easily understood and will probably also make the issue more obvious to policymakers.”
The researchers, whose findings were previously published in Lancet Psychiatry (2017 Apr;4[4]:295-301), examined 11 studies, mostly from Europe (n = 5) and North America (n = 3) with single studies from Africa, Asia, and Australia. (The lowest life expectancies were reported in Asia and Africa.)
One study was published in 1991, and the rest from 2001-2016. Together, the studies tracked 302,691 patients with schizophrenia.
What explains the gap between the life expectancies in men and women? “We did not investigate the reasons for this,” Dr. Hjorthøj said, “but men typically have worse adherence to treatment than women, and men typically also have poorer health-seeking behavior than women even in the general population. Given that schizophrenia is associated with a multitude of adverse somatic outcomes, this could then be aggravated by this difference in health-seeking behavior.”
In addition, he said, “It could also be the case that use of alcohol, tobacco, and illicit substances is even more skewed in schizophrenia than in the general population. Finally, it could also be attributed in part to the fact that men are more likely than women to die from suicide.”
Dr. Hjorthøj said that the findings emphasize the importance of treating physical symptoms in people with schizophrenia.
“I am aware of several cases where physical complaints were not taken seriously because they were raised by people who were known to suffer from delusions,” he said. “But, I do believe that most psychiatrists are aware of this, and the problem is perhaps more that the system in general is underfunded and that somatic and psychiatric hospitals are not good enough at communicating with each other.”
The researchers report no funding and no disclosures.
SAN DIEGO – A new systematic review and meta-analysis, the first of its kind, suggests that most people with schizophrenia – especially men – do not survive past their 60s.
According to findings released at the 2017 International Congress on Schizophrenia Research, schizophrenia patients appear to die a weighted average of 14.5 years earlier than the rest of the population (95% confidence interval, 11.2-17.8).
The weighted average life expectancy for schizophrenia patients was 64.7 years (95% CI, 61.1-71.3) – 59.9 years for men (95% CI, 55.5-64.3) and 67.6 years for women (95% CI, 63.1-72.1).
“There were no indications that this is improving over time,” lead author Carsten Hjorthøj, PhD, senior researcher at the University of Copenhagen, said in an interview.
The researchers launched their paper in order to provide a wider perspective on lives lost in schizophrenia.
Previous studies had used measures like the standardized mortality ratio, which compared schizophrenia patients with a matched group from the general population, Dr. Hjorthøj said. “Saying that people with schizophrenia are, for instance, 2.5 times more likely to die at any given age may be a little difficult to understand. Identifying the actual number of years they die earlier than the rest of the population is easily understood and will probably also make the issue more obvious to policymakers.”
The researchers, whose findings were previously published in Lancet Psychiatry (2017 Apr;4[4]:295-301), examined 11 studies, mostly from Europe (n = 5) and North America (n = 3) with single studies from Africa, Asia, and Australia. (The lowest life expectancies were reported in Asia and Africa.)
One study was published in 1991, and the rest from 2001-2016. Together, the studies tracked 302,691 patients with schizophrenia.
What explains the gap between the life expectancies in men and women? “We did not investigate the reasons for this,” Dr. Hjorthøj said, “but men typically have worse adherence to treatment than women, and men typically also have poorer health-seeking behavior than women even in the general population. Given that schizophrenia is associated with a multitude of adverse somatic outcomes, this could then be aggravated by this difference in health-seeking behavior.”
In addition, he said, “It could also be the case that use of alcohol, tobacco, and illicit substances is even more skewed in schizophrenia than in the general population. Finally, it could also be attributed in part to the fact that men are more likely than women to die from suicide.”
Dr. Hjorthøj said that the findings emphasize the importance of treating physical symptoms in people with schizophrenia.
“I am aware of several cases where physical complaints were not taken seriously because they were raised by people who were known to suffer from delusions,” he said. “But, I do believe that most psychiatrists are aware of this, and the problem is perhaps more that the system in general is underfunded and that somatic and psychiatric hospitals are not good enough at communicating with each other.”
The researchers report no funding and no disclosures.
At the ICSR Biennial Meeting
Key clinical point:
Major finding: Schizophrenia patients die a weighted average of 14.5 years earlier than those in the general population (95% CI, 11.2-17.8), and their weighted average life expectancy is 64.7 years (95% CI, 61-71.3) – 59.9 for men (95% CI, 55.5-64.3) and 67.6 for women (95% CI, 63.1-72.1).
Data source: Review and meta-analysis of 11 studies of 302,691 schizophrenia patients.
Disclosures: No specific funding was reported, and the authors reported no disclosures.
Intervention may help stem weight gain tied to antipsychotics
SAN DIEGO – Extra pounds are a perennial problem for schizophrenia patients who take antipsychotic medications with weight-boosting side effects. Now, a new randomized study finds that veterans who took part in a 12-month behavioral intervention program performed better on weight-loss measurements than those in a control group.
The difference between the two groups was far from large, with those undergoing the intervention losing an average of 1.04 centimeters in waist circumference over a year, compared with an average gain of 0.25 centimeters in the control group (P less than .001).
A recent meta-analysis found that weight gain is a potential side effect from prolonged use of “virtually all” antipsychotic medications, especially in those who have not taken the drugs previously (PLoS One. 2014 Apr 24;9[4]:e94112).
“Some of the most effective medications are associated with the highest weight-gain liability,” Dr. Ames said in an interview, “and patients with medication-resistant psychosis who don’t want to gain weight will resist taking these medications.”
As the meta-analysis notes, research suggests that the weight gain prompted by antipsychotics may boost mortality risk in patients with severe mental illness. The metabolic havoc linked to schizophrenia may be another factor: A 2010 summary of research notes that newer second-generation antipsychotics “generally tend to cause more problems relating to metabolic syndrome, such as obesity and type 2 diabetes mellitus,” compared with first-generation antipsychotics (FGA).
Weight gain “can be rapid and difficult to control,” the summary authors write,” adding that “the effect is worse with clozapine and olanzapine; minimal with aripiprazole and ziprasidone; and intermediate with other antipsychotics, including low-potency FGAs” (Am Fam Physician. 2010 Mar 1;81[5]:617-22).
For the new study, researchers randomly assigned 121 overweight or obese subjects with serious mental illness to either a “lifestyle balance” (LB) program (n = 62) or a usual care (UC) program (n = 59). All had become obese while taking an antipsychotic.
Subjects in the LB program met with registered dietitians for individual health coaching, weekly for 8 weeks and then monthly for up to 10 months. They also took part in 16 group nutrition and exercise classes over 2 months.
The UC group, meanwhile, met with case managers weekly for 8 weeks and then monthly for up to 10 months. They answered health questionnaires, underwent weight checks, and received self-help materials, Dr. Ames reported at the International Congress on Schizophrenia Research.
All of the participants lost weight, although waist circumference only declined in the intervention group. Body fat percentage declined in both groups, but by more (0.4% vs. 0.2%) in the intervention group, compared with UC (P = .038).
Judging by food diaries kept by 92% of the intervention group participants, their average daily caloric intake declined from 2,055 to 1,650 (P less than 0.001). The UC participants did not keep food diaries, so their caloric intake isn’t available.
Shouldn’t the intervention participants have lost more weight in light of such a large caloric decline? “Not necessarily,” Dr. Ames said. “Participants who were successful at making dietary changes began making these changes at different times throughout the study, some early and some well into the yearlong study. Decreases made in the latter part of the study would result in less weight lost. Also, exercise activity was variable, so decreased caloric intake could be offset by decreased physical activity.”
Other findings: Women did better than men at losing weight, and reducing waist circumference and body fat. There wasn’t a significant difference in the level of exercise between the groups. And researchers linked psychiatric illness insight in the LB group to greater weight loss but not in the UC group.
The study is supported by a $1.9 million VA grant for research from 2010 to 2017, Dr. Ames said.
In regard to cost-effectiveness, she said “a psychiatrist, nurse, or other mental health professional could easily weave these interventions into the care of patients in mental health settings. And the cost savings to patients by even losing just a few pounds could be enormous.”
The researchers hope to examine whether the intervention reduces the cost of medications, emergency department visits, and hospitalizations, she said.
Dr. Ames reports no relevant disclosures.
SAN DIEGO – Extra pounds are a perennial problem for schizophrenia patients who take antipsychotic medications with weight-boosting side effects. Now, a new randomized study finds that veterans who took part in a 12-month behavioral intervention program performed better on weight-loss measurements than those in a control group.
The difference between the two groups was far from large, with those undergoing the intervention losing an average of 1.04 centimeters in waist circumference over a year, compared with an average gain of 0.25 centimeters in the control group (P less than .001).
A recent meta-analysis found that weight gain is a potential side effect from prolonged use of “virtually all” antipsychotic medications, especially in those who have not taken the drugs previously (PLoS One. 2014 Apr 24;9[4]:e94112).
“Some of the most effective medications are associated with the highest weight-gain liability,” Dr. Ames said in an interview, “and patients with medication-resistant psychosis who don’t want to gain weight will resist taking these medications.”
As the meta-analysis notes, research suggests that the weight gain prompted by antipsychotics may boost mortality risk in patients with severe mental illness. The metabolic havoc linked to schizophrenia may be another factor: A 2010 summary of research notes that newer second-generation antipsychotics “generally tend to cause more problems relating to metabolic syndrome, such as obesity and type 2 diabetes mellitus,” compared with first-generation antipsychotics (FGA).
Weight gain “can be rapid and difficult to control,” the summary authors write,” adding that “the effect is worse with clozapine and olanzapine; minimal with aripiprazole and ziprasidone; and intermediate with other antipsychotics, including low-potency FGAs” (Am Fam Physician. 2010 Mar 1;81[5]:617-22).
For the new study, researchers randomly assigned 121 overweight or obese subjects with serious mental illness to either a “lifestyle balance” (LB) program (n = 62) or a usual care (UC) program (n = 59). All had become obese while taking an antipsychotic.
Subjects in the LB program met with registered dietitians for individual health coaching, weekly for 8 weeks and then monthly for up to 10 months. They also took part in 16 group nutrition and exercise classes over 2 months.
The UC group, meanwhile, met with case managers weekly for 8 weeks and then monthly for up to 10 months. They answered health questionnaires, underwent weight checks, and received self-help materials, Dr. Ames reported at the International Congress on Schizophrenia Research.
All of the participants lost weight, although waist circumference only declined in the intervention group. Body fat percentage declined in both groups, but by more (0.4% vs. 0.2%) in the intervention group, compared with UC (P = .038).
Judging by food diaries kept by 92% of the intervention group participants, their average daily caloric intake declined from 2,055 to 1,650 (P less than 0.001). The UC participants did not keep food diaries, so their caloric intake isn’t available.
Shouldn’t the intervention participants have lost more weight in light of such a large caloric decline? “Not necessarily,” Dr. Ames said. “Participants who were successful at making dietary changes began making these changes at different times throughout the study, some early and some well into the yearlong study. Decreases made in the latter part of the study would result in less weight lost. Also, exercise activity was variable, so decreased caloric intake could be offset by decreased physical activity.”
Other findings: Women did better than men at losing weight, and reducing waist circumference and body fat. There wasn’t a significant difference in the level of exercise between the groups. And researchers linked psychiatric illness insight in the LB group to greater weight loss but not in the UC group.
The study is supported by a $1.9 million VA grant for research from 2010 to 2017, Dr. Ames said.
In regard to cost-effectiveness, she said “a psychiatrist, nurse, or other mental health professional could easily weave these interventions into the care of patients in mental health settings. And the cost savings to patients by even losing just a few pounds could be enormous.”
The researchers hope to examine whether the intervention reduces the cost of medications, emergency department visits, and hospitalizations, she said.
Dr. Ames reports no relevant disclosures.
SAN DIEGO – Extra pounds are a perennial problem for schizophrenia patients who take antipsychotic medications with weight-boosting side effects. Now, a new randomized study finds that veterans who took part in a 12-month behavioral intervention program performed better on weight-loss measurements than those in a control group.
The difference between the two groups was far from large, with those undergoing the intervention losing an average of 1.04 centimeters in waist circumference over a year, compared with an average gain of 0.25 centimeters in the control group (P less than .001).
A recent meta-analysis found that weight gain is a potential side effect from prolonged use of “virtually all” antipsychotic medications, especially in those who have not taken the drugs previously (PLoS One. 2014 Apr 24;9[4]:e94112).
“Some of the most effective medications are associated with the highest weight-gain liability,” Dr. Ames said in an interview, “and patients with medication-resistant psychosis who don’t want to gain weight will resist taking these medications.”
As the meta-analysis notes, research suggests that the weight gain prompted by antipsychotics may boost mortality risk in patients with severe mental illness. The metabolic havoc linked to schizophrenia may be another factor: A 2010 summary of research notes that newer second-generation antipsychotics “generally tend to cause more problems relating to metabolic syndrome, such as obesity and type 2 diabetes mellitus,” compared with first-generation antipsychotics (FGA).
Weight gain “can be rapid and difficult to control,” the summary authors write,” adding that “the effect is worse with clozapine and olanzapine; minimal with aripiprazole and ziprasidone; and intermediate with other antipsychotics, including low-potency FGAs” (Am Fam Physician. 2010 Mar 1;81[5]:617-22).
For the new study, researchers randomly assigned 121 overweight or obese subjects with serious mental illness to either a “lifestyle balance” (LB) program (n = 62) or a usual care (UC) program (n = 59). All had become obese while taking an antipsychotic.
Subjects in the LB program met with registered dietitians for individual health coaching, weekly for 8 weeks and then monthly for up to 10 months. They also took part in 16 group nutrition and exercise classes over 2 months.
The UC group, meanwhile, met with case managers weekly for 8 weeks and then monthly for up to 10 months. They answered health questionnaires, underwent weight checks, and received self-help materials, Dr. Ames reported at the International Congress on Schizophrenia Research.
All of the participants lost weight, although waist circumference only declined in the intervention group. Body fat percentage declined in both groups, but by more (0.4% vs. 0.2%) in the intervention group, compared with UC (P = .038).
Judging by food diaries kept by 92% of the intervention group participants, their average daily caloric intake declined from 2,055 to 1,650 (P less than 0.001). The UC participants did not keep food diaries, so their caloric intake isn’t available.
Shouldn’t the intervention participants have lost more weight in light of such a large caloric decline? “Not necessarily,” Dr. Ames said. “Participants who were successful at making dietary changes began making these changes at different times throughout the study, some early and some well into the yearlong study. Decreases made in the latter part of the study would result in less weight lost. Also, exercise activity was variable, so decreased caloric intake could be offset by decreased physical activity.”
Other findings: Women did better than men at losing weight, and reducing waist circumference and body fat. There wasn’t a significant difference in the level of exercise between the groups. And researchers linked psychiatric illness insight in the LB group to greater weight loss but not in the UC group.
The study is supported by a $1.9 million VA grant for research from 2010 to 2017, Dr. Ames said.
In regard to cost-effectiveness, she said “a psychiatrist, nurse, or other mental health professional could easily weave these interventions into the care of patients in mental health settings. And the cost savings to patients by even losing just a few pounds could be enormous.”
The researchers hope to examine whether the intervention reduces the cost of medications, emergency department visits, and hospitalizations, she said.
Dr. Ames reports no relevant disclosures.
AT THE ICSR BIENNIAL MEETING
Gotta catch ’em all: Is Pokémon Go an intervention for schizophrenia?
San Diego – A 22-year-old Minnesota patient with schizophrenia tried to “catch ’em all” during last year’s Pokémon Go craze, and he ended up landing something even more important: motivation to get outside and meet people.
That’s the word from clinicians who report that the game dramatically transformed the young man’s life, coaxing him to leave his house, chat with other players, and even stop worrying so much about his movement disorder.
Could Pokémon Go become a treatment for people with mental illness who need motivation to leave their homes? It’s not clear, and the decline of the Pokémon Go phenomenon may make it difficult for researchers to find out, at least until another version sweeps the nation.
The Minnesota clinicians want to study the idea; they also want to know why it seems – based on a tiny sample – that patients with schizophrenia may have trouble tolerating the “augmented reality” built into the game.
Dr. Elmaghraby and his coauthor Suzanne Geier Jasberg, MD, an attending psychiatrist with PrairieCare Medical Group in Minneapolis, described their findings in a poster at the International Congress on Schizophrenia Research.
The Pokémon Go game appeared in the summer of 2016, and during that time, many of the young patients attending a first-episode psychosis clinic began talking about playing it, Dr. Elmaghraby said in an interview.
“They have the negative symptoms – they’re socially isolated, withdrawing from friends and families, and don’t engage with society,” she said. But the game requires users to travel around the real world in search of Pokémon characters.
“People who hadn’t left the house in many days were getting multiple steps per day by going out in the environment and engaging with other people,” she said.
The poster focuses on the 22-year-old male, who had the disorganized type of schizophrenia with auditory and visual hallucinations. He also had residual dyskinetic movements related to a previous stint on risperidone.
His thought processes were improving, but he’d had trouble leaving the house for 6 months. Then, the game coaxed him into a new phase.
“He demonstrated remarkable improvement in his negative symptoms, most notably motivation,” the clinicians wrote. “The game seemed to have a unique ability to motivate this young person to engage more robustly in social interactions.”
They also noticed that several patients, including the young man, engaged in a peculiar behavior: They turned off the “augmented reality” in the game.
Normally, Pokémon Go players keep the augmented reality feature on, allowing them to see Pokémon characters as if they’re actually nearby. Smartphone screens create the illusion by blending their live camera view of the world with images of the characters. (Think about how Dick Van Dyke appears to dance with animated penguins in “Mary Poppins,” and you’ll get the idea.)
In this augmented reality, your smartphone screen may makes it appear as if a Pokémon character is on top of the coffee cup at your desk, said report coauthor Dr. Jasberg. This feature adds to the immediacy and fun of the game.
But players can turn off this feature, eliminating the view of the world through the smartphone camera. Instead of appearing as if they’re nearby in the real world, the characters simply show up on a green screen, Dr. Jasberg said. (Players still have to go places to find them.)
The patients couldn’t explain why they preferred to turn off the feature, which is easily done, Dr. Elmaghraby said. However, they indicated that it’s not in order to preserve battery life, she said.
Dr. Elmaghraby speculates that their choices may have something to do with their underlying sensory processing dysfunction.
The clinicians hope to study how the brains of patients with schizophrenia work when they play the game with the augmented reality turned off and on. And they’re intrigued by how such games as Pokémon Go might encourage people to move and become socially engaged.
There’s been fairly little published research into the effects of the Pokémon Go craze, possibly because it erupted so recently. Several studies have examined its effects on exercise, with one analysis of college students suggesting that it especially boosted activity levels in the formerly sedentary (Int J Health Geogr. 2017 Feb 22;16[1]:8). Another study of young adults found that the increase of activity in players was moderate and vanished after 6 weeks (BMJ. 2016 Dec 13;355:i6270).
For now, Dr. Jasberg encouraged clinicians to be aware of Pokémon Go and understand that it’s a low-risk intervention. The clinicians didn’t notice any negative impacts, although it’s possible that parents may have gotten zinged by a distinctly modern phenomenon – overtaxed smartphone data plans.
The authors reported no relevant disclosures.
San Diego – A 22-year-old Minnesota patient with schizophrenia tried to “catch ’em all” during last year’s Pokémon Go craze, and he ended up landing something even more important: motivation to get outside and meet people.
That’s the word from clinicians who report that the game dramatically transformed the young man’s life, coaxing him to leave his house, chat with other players, and even stop worrying so much about his movement disorder.
Could Pokémon Go become a treatment for people with mental illness who need motivation to leave their homes? It’s not clear, and the decline of the Pokémon Go phenomenon may make it difficult for researchers to find out, at least until another version sweeps the nation.
The Minnesota clinicians want to study the idea; they also want to know why it seems – based on a tiny sample – that patients with schizophrenia may have trouble tolerating the “augmented reality” built into the game.
Dr. Elmaghraby and his coauthor Suzanne Geier Jasberg, MD, an attending psychiatrist with PrairieCare Medical Group in Minneapolis, described their findings in a poster at the International Congress on Schizophrenia Research.
The Pokémon Go game appeared in the summer of 2016, and during that time, many of the young patients attending a first-episode psychosis clinic began talking about playing it, Dr. Elmaghraby said in an interview.
“They have the negative symptoms – they’re socially isolated, withdrawing from friends and families, and don’t engage with society,” she said. But the game requires users to travel around the real world in search of Pokémon characters.
“People who hadn’t left the house in many days were getting multiple steps per day by going out in the environment and engaging with other people,” she said.
The poster focuses on the 22-year-old male, who had the disorganized type of schizophrenia with auditory and visual hallucinations. He also had residual dyskinetic movements related to a previous stint on risperidone.
His thought processes were improving, but he’d had trouble leaving the house for 6 months. Then, the game coaxed him into a new phase.
“He demonstrated remarkable improvement in his negative symptoms, most notably motivation,” the clinicians wrote. “The game seemed to have a unique ability to motivate this young person to engage more robustly in social interactions.”
They also noticed that several patients, including the young man, engaged in a peculiar behavior: They turned off the “augmented reality” in the game.
Normally, Pokémon Go players keep the augmented reality feature on, allowing them to see Pokémon characters as if they’re actually nearby. Smartphone screens create the illusion by blending their live camera view of the world with images of the characters. (Think about how Dick Van Dyke appears to dance with animated penguins in “Mary Poppins,” and you’ll get the idea.)
In this augmented reality, your smartphone screen may makes it appear as if a Pokémon character is on top of the coffee cup at your desk, said report coauthor Dr. Jasberg. This feature adds to the immediacy and fun of the game.
But players can turn off this feature, eliminating the view of the world through the smartphone camera. Instead of appearing as if they’re nearby in the real world, the characters simply show up on a green screen, Dr. Jasberg said. (Players still have to go places to find them.)
The patients couldn’t explain why they preferred to turn off the feature, which is easily done, Dr. Elmaghraby said. However, they indicated that it’s not in order to preserve battery life, she said.
Dr. Elmaghraby speculates that their choices may have something to do with their underlying sensory processing dysfunction.
The clinicians hope to study how the brains of patients with schizophrenia work when they play the game with the augmented reality turned off and on. And they’re intrigued by how such games as Pokémon Go might encourage people to move and become socially engaged.
There’s been fairly little published research into the effects of the Pokémon Go craze, possibly because it erupted so recently. Several studies have examined its effects on exercise, with one analysis of college students suggesting that it especially boosted activity levels in the formerly sedentary (Int J Health Geogr. 2017 Feb 22;16[1]:8). Another study of young adults found that the increase of activity in players was moderate and vanished after 6 weeks (BMJ. 2016 Dec 13;355:i6270).
For now, Dr. Jasberg encouraged clinicians to be aware of Pokémon Go and understand that it’s a low-risk intervention. The clinicians didn’t notice any negative impacts, although it’s possible that parents may have gotten zinged by a distinctly modern phenomenon – overtaxed smartphone data plans.
The authors reported no relevant disclosures.
San Diego – A 22-year-old Minnesota patient with schizophrenia tried to “catch ’em all” during last year’s Pokémon Go craze, and he ended up landing something even more important: motivation to get outside and meet people.
That’s the word from clinicians who report that the game dramatically transformed the young man’s life, coaxing him to leave his house, chat with other players, and even stop worrying so much about his movement disorder.
Could Pokémon Go become a treatment for people with mental illness who need motivation to leave their homes? It’s not clear, and the decline of the Pokémon Go phenomenon may make it difficult for researchers to find out, at least until another version sweeps the nation.
The Minnesota clinicians want to study the idea; they also want to know why it seems – based on a tiny sample – that patients with schizophrenia may have trouble tolerating the “augmented reality” built into the game.
Dr. Elmaghraby and his coauthor Suzanne Geier Jasberg, MD, an attending psychiatrist with PrairieCare Medical Group in Minneapolis, described their findings in a poster at the International Congress on Schizophrenia Research.
The Pokémon Go game appeared in the summer of 2016, and during that time, many of the young patients attending a first-episode psychosis clinic began talking about playing it, Dr. Elmaghraby said in an interview.
“They have the negative symptoms – they’re socially isolated, withdrawing from friends and families, and don’t engage with society,” she said. But the game requires users to travel around the real world in search of Pokémon characters.
“People who hadn’t left the house in many days were getting multiple steps per day by going out in the environment and engaging with other people,” she said.
The poster focuses on the 22-year-old male, who had the disorganized type of schizophrenia with auditory and visual hallucinations. He also had residual dyskinetic movements related to a previous stint on risperidone.
His thought processes were improving, but he’d had trouble leaving the house for 6 months. Then, the game coaxed him into a new phase.
“He demonstrated remarkable improvement in his negative symptoms, most notably motivation,” the clinicians wrote. “The game seemed to have a unique ability to motivate this young person to engage more robustly in social interactions.”
They also noticed that several patients, including the young man, engaged in a peculiar behavior: They turned off the “augmented reality” in the game.
Normally, Pokémon Go players keep the augmented reality feature on, allowing them to see Pokémon characters as if they’re actually nearby. Smartphone screens create the illusion by blending their live camera view of the world with images of the characters. (Think about how Dick Van Dyke appears to dance with animated penguins in “Mary Poppins,” and you’ll get the idea.)
In this augmented reality, your smartphone screen may makes it appear as if a Pokémon character is on top of the coffee cup at your desk, said report coauthor Dr. Jasberg. This feature adds to the immediacy and fun of the game.
But players can turn off this feature, eliminating the view of the world through the smartphone camera. Instead of appearing as if they’re nearby in the real world, the characters simply show up on a green screen, Dr. Jasberg said. (Players still have to go places to find them.)
The patients couldn’t explain why they preferred to turn off the feature, which is easily done, Dr. Elmaghraby said. However, they indicated that it’s not in order to preserve battery life, she said.
Dr. Elmaghraby speculates that their choices may have something to do with their underlying sensory processing dysfunction.
The clinicians hope to study how the brains of patients with schizophrenia work when they play the game with the augmented reality turned off and on. And they’re intrigued by how such games as Pokémon Go might encourage people to move and become socially engaged.
There’s been fairly little published research into the effects of the Pokémon Go craze, possibly because it erupted so recently. Several studies have examined its effects on exercise, with one analysis of college students suggesting that it especially boosted activity levels in the formerly sedentary (Int J Health Geogr. 2017 Feb 22;16[1]:8). Another study of young adults found that the increase of activity in players was moderate and vanished after 6 weeks (BMJ. 2016 Dec 13;355:i6270).
For now, Dr. Jasberg encouraged clinicians to be aware of Pokémon Go and understand that it’s a low-risk intervention. The clinicians didn’t notice any negative impacts, although it’s possible that parents may have gotten zinged by a distinctly modern phenomenon – overtaxed smartphone data plans.
The authors reported no relevant disclosures.
AT THE ICSR BIENNIAL MEETING
