Background
Weight-gain, which is associated with antipsychotic treatments, is one of the most important concerns in a psychiatric management. Not only it creates self-esteem issues, but it also leads to serious health problems such as cardiovascular diseases or early death.1 As a matter of fact, there are no effective pharmacological treatments to facilitate weight-loss in psychiatric patients. However, there are some current studies showing Metformin can reduce metabolic rate. As a result, it is considered as a drug of choice in this specific population. Metformin is a biguanide; and its mechanism of action is reducing both hepatic glucose production and intestinal glucose absorption.2 It also improves insulin resistance.2 In addition, Metformin is not metabolized by the liver; it is excreted unchanged in the urine.2 The half-life is from 4 to 6 hours; and the bioavailability is from 50% to 60%.2 Its common side effects include diarrhea, nausea, vomiting, and body weakness.2
Literature search strategy
Literature search was conducted using Embase (1996 to 2014, week 09). Key words which were used includes “antipsychotic”, “metformin”, and “weight gain”. These search terms were combined with Boolean operator “and”. The search was limited to human, English, and randomized clinical trial. After doing this search, 18 articles were retrieved. The selected article was chosen for further evaluation due to its emphasis on primary literature. It related to key concepts in the clinical question. The other articles were excluded because they were not relevant and appropriate to answer to the clinical question. Some of them compared Metformin with other drugs. Some of them emphasized another effect of Metformin besides weight-control. Some o...
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...dy showed the effectiveness of metformin inducing weight loss and improving insulin resistant. However, a larger placebo-controlled multicenter in the west with crossover is needed to support or reject this study.
Works Cited
1. Healthy Weight – It’s not a diet, it’s a lifestyle. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/healthyweight/effects. Updated August 17, 2011. Accessed May 2, 2014.
2. Metformin. In: Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc.; [Updated February 09, 2014; Accessed February 27, 2014]. http://online.lexi.com.ezproxy.mcphs.edu/lco/action/doc/retrieve/docid/patch_f/7260
3. Wang M., Tong J.-H., Zhu G., Liang G.-M., Yan H.-F., Wang X.-Z.. Metformin for treatment of antipsychotic-induced weight gain: A randomized, placebo-controlled study. Schizophr. Res.. 2012;138(1):54-57. doi:10.1016/j.schres.2012.02.021
Smith, M., Segel, J., & Ramsey, D. (2013, 9). Add / adhd medications. Retrieved from http://www.helpguide.org/mental/adhd_medications.htm
Stahl, S. M., & Mignon, L. (2010). Antipsychotics: Treating psychosis, mania and depression (2nd ed.).
Rhee MK., Herrick K., Ziemer DC, et al. Many Americans have pre-diabetes and should be considered for metformin therapy. Diabetes Care. January 2010;33(1):49-54
WebMD LLC. (2012, October 13). Weight Loss & Diet Plans. Retrieved Feburary 5, 2014, from WebMD: http://www.webmd.com/diet/guide/the-truth-about-fad-diets
Clozapine is used on a limited basis because of the risk of agranullocytosis, where white blood cells are destroyed faster than they are produced, causing the individual to be prone to other illnesses. Two other drugs, either one typical and one atypical, or two atypical medications are used and deemed ineffective before clozapine is used due to the this serious side effect, agranullocytosis. Even thought this risk happens to be small, 1% to 2%, the drug is normally viewed in the psychiatric field as a method of last resort.(Kentridge, 1995) The most common explanation for what occurs in the brain of a schizophrenic is the dopamine hypothesis, where certain areas of the brain have excessive activity at certain dopamine receptors.(Kalat, 2004) This theory will be a reoccurring theme when explaining how clozapine interacts with the body.
-Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005. Web.
Many providers will not necessarily follow the prescribing guidelines when initiating treatments that consist of second generations antipsychotics. The prescribing guidelines are typically reinforced after a psychiatric consultation. Nurses initial admission assessment can help determine patients at increased risk for becoming overweight, obese, pre-diabetic, diabetic, hypertensive, or dyslipidemic.
Obesity remains an extremely serious issue worldwide. Once considered a problem for wealthier counties, overweight and obesity are now dramatically increasing in low and middle income countries (WHO, 2011). In American, the rates of obesity continue to soar. CDC (2009) recognizes obesity as a risk factor for diabetes, heart disease, high blood pressure, and other health problems. According to NHANES over two-thirds of the US are overweight or obese, and over one-third are obese (CDC, 2009). Treatment for this illness varies; it may include the incorporation of diet, exercise, behavior modification, medication, and surgery. Since there is no single cause of all overweight and obesity, there is no single way to prevent or treat overweight and obesity that will help everyone (CDC, 2009).
Ross, C. E. (1999). Overweight and depression. Journal of Health and Social Behavior, 35(1), 63-79.
Schizophrenia is a devastating and costly mental disorder that affects 1% of population worldwide. Patients manifest clusters of positive, negative and cognitive symptoms in early twenties and are often left with life-long severe mental disability and social stigma. Cognitive deficits in patients with schizophrenia are considered core symptoms of this disorder, and can manifest at the initial stage (Elvevåg and Goldberg, 2000). Atypical antipsychotics ameliorate positive symptoms but may only modestly improve cognitive symptoms (Richelson, 2010). In addition to this, some of the typical antipsychotics are even have deteriorative effects on cognitive symptoms (Heaton and Crowley 1981). To find the appropriate treatments for cognitive deficits of schizophrenia, it is important to know the underlying pathophysiology.
Price, L. O., Charney, D. S., Goodman, W. K., Krystal, J. H., Woods, A. N. & Heninger, G. R. Clinical data on the role of serotonin in the mechanism of action of antidepressant drugs. Journal Clinical Psychiatry, April 1990, 51: 44-50. (cited as 5)
Centers for Disease Control and Prevention. (2011). healthy weight- it’s not a diet, it’s a lifestyle! Retrieved March 6, 2011, from http://www.cdc.gov/healthyweight/index.html
Many people think that eating healthy means depriving yourself of your favorite foods or even foods that are unhealthy. When in actuality, depriving yourself of certain foods can have a negative effect on your health and a negative effect on you. Living a healthy lifestyle is about moderation, not completely cutting yourself off from foods you enjoy. Whilst
But, food might not only sustain life, it can also give particular disease if you had the wrong selection. Knowledge about food nutrition and proper selection is too pricey to disregard. The key to have a better and healthy lifestyle is to consume a variety of foods at the right amount to meet your body’s calorie needs. Eating with a healthy meal plan will show you how much you need from each food group I gave you above to sustain your body with the daily nutrients intake that promote not only good health but longer lives. I suggest you will make your own food plan to help your fitness grooming easy to
First, I will address the root issue of many people’s eating habits, and then I will expand on why and how to develop a healthier lifestyle.