Şizofreni Hastalarında Obezite ve Yeme Bozukluğunu Etkileyen Etmenlerin Değerlendirilmesi

Bu çalışmada şizofreni hastalarında obezite ve yeme bozukluğu gelişimini etkileyen bazı risk faktörlerinin değerlendirilmesi amaçlanmıştır. Çalışmaya Manisa Ruh Sağlığı ve Hastalıkları Hastanesinde ayaktan tedavi gören, 18-60 yaş arası 160 şizofreni hastası (76 kadın, 84 erkek) ve kontrol grubu olarak 206 sağlıklı birey (103 kadın, 103 erkek) dahil edilmiştir. Katılımcılara yüz yüze görüşme yöntemi ile anket uygulanmış, sosyo-demografik özellikleri belirlenmiş ve antropometrik ölçümleri alınmıştır. Yeme bozukluğu riskinin değerlendirilmesinde Yeme Tutum Testi-26 kullanılmıştır. Bireylerde obezite ve yeme bozukluğu riski ikili (binary) lojistik regresyon modelleri kullanılarak değerlendirilmiştir. Kadın olgularda beden kütle indeksinin (BKİ) 28,3±5,97 kg/m2, erkekler olgularda 27,8±5,18 kg/m2 olduğu, kontrol grubunda ise bu değerlerin kadınlarda 25,1±4,61 kg/m2, erkeklerde 25,7±3,71 kg olduğu belirlenmiştir. Kadın olguların %30,9’unun fazla kilolu, %21,9’unun obez, erkek olguların %51,2’sinin fazla kilolu, %23,8’inin obez olduğu saptanmıştır. Olguların sağlıklı bireylere göre fazla kilolu veya obez olma olasılığının 3,48 kat [OR=3,48 (2,23-5,43)], antipsikotik kullananların ise 3,8 kat [OR=3,80 (2,34-6,19)] daha fazla olduğu bulunmuştur. Olguların %18,8’inde yeme bozukluğu riski görülürken kontrol grubundaki bireylerde bu oran %7,8 olarak belirlenmiştir (P=0,001). Her iki grupta da kadınlarda yeme bozukluğu riskine sahip bireylerin oranı daha fazladır. Olgularda yeme bozukluğu riski görülme olasılığının sağlıklı bireylere göre 2,64 kat [OR=2,64 (1,31-5,28], kadınlarda görülme olasılığının erkeklere göre 2,30 kat [OR=2,30 (1,17-4,52] ve antipsikotik kullananlarda 2,74 kat [OR=2,74 (1,44-5,23] daha fazla olduğu saptanmıştır. Şizofreni hastalarında obezite ve yeme bozukluğu gelişme riskinin yüksek olduğu bilinmektedir. Bu olumsuz etkenler hastalarda metabolik sendrom prevalansının ve kardiyovasküler hastalık nedenli mortalitenin artmasına neden olmaktadır. Bu hastalarda obezite ve yeme bozukluğu arasındaki ilişkilerin altında yatan psikolojik, psikopatolojik, genetik ve nörofizyolojik mekanizmaların anlaşılmasına yönelik uzunlamasına araştırmalar yapılmalıdır.

Anahtar Kelimeler:

Şizofreni, Obezite, Yeme bozukluğu, Beden kütle indeksi, Antipsikotik

Evaluation of Factors Affecting Obesity and Eating Disorders in Patients with Schizophrenia

The aim of this study was to evaluate some risk factors affecting the development of obesity and eating disorders in schizophrenia patients. The study included 160 schizophrenia patients (76 females, 84 males) aged between 18-60 years who were receiving outpatient treatment in Manisa Mental Health and Diseases Hospital and 206 healthy individuals (103 females, 103 males) as the control group. A questionnaire was applied to the participants by face-to-face interview method, socio-demographic characteristics were determined and anthropometric measurements were taken. Eating Attitude Test-26 was used to assess the risk of eating disorder. Obesity and eating disorder risk in individuals were evaluated using binary logistic regression models. It was determined that the body mass index (BMI) was 28.3±5.97 kg/m2 in female cases and 27.8±5.18 kg/m2 in male cases, and these values were 25.1±4.61 kg/m2 in females and 25.7±3.71 kg/m2 in males in the control group. It was found that 30.9% of the female cases were overweight and 21.9% were obese. 51.2% of the male cases were overweight and 23.8% were obese. It was found that the probability of being overweight or obese was 3.48 times [OR=3.48 (2.23-5.43)] and the probability of being overweight or obese was 3.8 times [OR=3.80 (2.34-6.19)] higher in antipsychotic users compared to healthy individuals. While 18.8% of the cases had an eating disorder risk, this rate was 7.8% in the control group (P=0.001). In both groups, the rate of individuals with eating disorder risk was higher in females. It was found that the probability of having an eating disorder risk was 2.64 times [OR=2.64 (1.31-5.28)] higher in cases than in healthy individuals, 2.30 times [OR=2.30 (1.17-4.52)] higher in female than in male and 2.74 times [OR=2.74 (1.44-5.23)] higher in antipsychotic users. It is known that schizophrenia patients have a high risk of developing obesity and eating disorders. These unfavorable factors lead to an increase in the prevalence of metabolic syndrome and mortality due to cardiovascular disease. Longitudinal studies should be conducted to understand the psychological, psychopathological, genetic and neurophysiological mechanisms underlying the relationship between obesity and eating disorders in these patients.

Keywords:

Schizophrenia, Obesity, Eating disorders, Body mass index, Antipsychotics,

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Bak M, Drukker M, Cortenraad S, Vandenberk E, Guloksuz S. 2021. Antipsychotics result in more weight gain in antipsychotic naive patients than in patients after antipsychotic switch and weight gain is irrespective of psychiatric diagnosis: A meta-analysis. PloS One, 16(2): e0244944. DOI: 10.1371/journal.pone.0244944.
Binbay T, Ulaş H, Elbi H, Alptekin K. 2011. Türkiye’de psikoz epidemiyolojisi: Yaygınlık tahminleri ve başvuru oranları üzerine sistematik bir gözden geçirme. Turk Psikiyatri Derg, 22(1): 40-52.
Brink M, Green A, Bojesen AB, Lamberti JS, Conwell Y, Andersen K. 2019. Excess medical comorbidity and mortality across the lifespan in schizophrenia: A nationwide Danish register study. Schizophrenia Res, 206: 347-354. DOI: 10.1016/j.schres.2018.10.020.
Chouinard VA, Pingali SM, Chouinard G, Henderson DC, Mallya SG, Cypess AM, Cohen BM, Öngür D. 2016. Factors associated with overweight and obesity in schizophrenia, schizoaffective and bipolar disorders. Psychiatry Res, 237: 304-310. DOI: 10.1016/j.psychres.2016.01.024.
Dipasquale S, Pariante CM, Dazzan P, Aguglia E, McGuire P, Mondelli V. 2013. The dietary pattern of patients with schizophrenia: a systematic review. J Psychiatric Res, 47(2): 197-207. DOı: 10.1016/j.jpsychires.2012.10.005.
Döngel BD, Demirkol ME, Tamam L. 2018. Şizofreni hastalarında fiziksel hastalık eş tanılarının değerlendirilmesi. Cukurova Medic J, 43(4): 892-902.
Elman I, Borsook D, Lukas SE. 2006. Food intake and reward mechanisms in patients with schizophrenia: implications for metabolic disturbances and treatment with second-generation antipsychotic agents. Neuropsychopharmacol, 31(10): 2091-2120. DOI: 10.1038/sj.npp.1301051.
Ergüney-Okumuş FE, Sertel-Berk HÖ. 2020. Yeme tutum testi kısa formunun (YTT-26) üniversite örnekleminde Türkçeye uyarlanması ve psikometrik özelliklerinin değerlendirilmesi. Psikol Çal, 40(1): 57-78.
Ertekin H, Uysal S, Aydın M, İlhan B, Ertekin YH. 2020. Correlation between vaspin and PANSS scores in schizophrenia patients with obesity. Int J Psychiatry Medic, 55(4): 264-280. DOI: 10.1177/0091217420905463.
Fawzi MH, Fawzi MM. 2012. Disordered eating attitudes in Egyptian antipsychotic naive patients with schizophrenia. Compreh Psychiatry, 53(3): 259-268. DOI. 10.1016/j.comppsych.2011.04.064.
Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. 2019. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. American J Clinl Nutrit, 109(5): 1402-1413. DOI: 10.1093/ajcn/nqy342.
Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. 1982. The eating attitudes test: psychometric features and clinical correlates. Psychol Medic, 12(4): 871-878. DOI: 10.1017/s0033291700049163.
Gurpegui M, Martínez-Ortega JM, Gutiérrez-Rojas L, Rivero J, Rojas C, Jurado D. 2012. Overweight and obesity in patients with bipolar disorder or schizophrenia compared with a non-psychiatric sample. Prog Neuro-psychopharmacol Biol Psychiatry, 37(1): 169-175.
Holt RI, Peveler RC. 2009. Obesity, serious mental illness and antipsychotic drugs. Diabetes Obesity Metabol, 11(7): 665-679. DOI: 10.1111/j.1463-1326.2009.01038.x.
Khosravi M. 2020. Biopsychosocial factors associated with disordered eating behaviors in schizophrenia. Ann General Psychiatry, 19(1): 67. DOI: 10.1186/s12991-020-00314-2.
Kim M, Yang SJ, Kim HH, Jo A, Jhon M, Lee JY, Ryu SH, Kim JM, Kweon YR, Kim SW. 2023. Effects of dietary habits on general and abdominal obesity in community-dwelling patients with schizophrenia. Clin Psychopharmacol Neurosci, 21(1): 68-76. DOI: 10.9758/cpn.2023.21.1.68.
Kluge M, Schuld A, Himmerich H, Dalal M, Schacht A, Wehmeier PM, Hinze-Selch D, Kraus T, Dittmann RW, Pollmächer T. 2007. Clozapine and olanzapine are associated with food craving and binge eating: results from a randomized double-blind study. j Clin Psychopharmacol, 27(6): 662-666. DOI: 10.1097/jcp.0b013e31815a8872.
Kouidrat Y, Amad A, Lalau JD, Loas G. 2014. Eating disorders in schizophrenia: implications for research and management. Schizophrenia Res Treat, 2014: 791573.
Kouidrat Y, Amad A, Stubbs B, Louhou R, Renard N, Diouf M, Lalau JD, Loas G. 2018. Disordered eating behaviors as a potential obesogenic factor in schizophrenia. Psychiatry Res, 269: 450-454. DOI: 10.1016/j.psychres.2018.08.083.
Küçükerdönmez Ö, Urhan M, Altın M, Hacıraifoğlu Ö, Yıldız B. 2019. Assessment of the relationship between food addiction and nutritional status in schizophrenic patients. Nutrit Neurosci, 22(6): 392-400. DOI. 10.1080/1028415X.2017.1392429.
Malaspina D, Walsh-Messinger J, Brunner A, Rahman N, Corcoran C, Kimhy D, Goetz RR, Goldman SB. 2019. Features of schizophrenia following premorbid eating disorders. Psychiatry Res, 278: 275-280. DOI: 10.1016/j.psychres.2019.06.035.
Manu P, Dima L, Shulman M, Vancampfort D, De Hert M, Correll CU. 2015. Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management. Acta Psychiatrica Scandinavica, 132(2): 97-108. DOI: 10.1111/acps.12445.
Mazereel V, Detraux J, Vancampfort D, van Winkel R, De Hert M. 2020. Impact of psychotropic medication effects on obesity and the metabolic syndrome in people with serious mental illness. Front Endocrinol, 11: 573479. DOI: 10.3389/fendo.2020.573479.
McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L, Meltzer HY, Hsiao J, Scott Stroup T, Lieberman JA. 2005. Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Res, 80(1): 19-32. DOI: 10.1016/j.schres.2005.07.014.
Mueller-Stierlin AS, Peisser A, Cornet S, Jaeckle S, Lehle J, Moerkl S, Teasdale SB. 2022. Exploration of perceived determinants of disordered eating behaviors in people with mental illness-A qualitative study. Int J Environ Res Pub Health, 20(1): 442. DOI: 10.3390/ijerph20010442.
Mukherjee S, Skrede S, Milbank E, Andriantsitohaina R, López M, Fernø J. 2022. Understanding the effects of antipsychotics on appetite control. Front Nutrit, 8: 815456. DOI: 10.3389/fnut.2021.815456.
Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. 2015. Premature Mortality among adults with schizophrenia in the United States. JAMA Psychiatry, 72(12): 1172-1181. DOI: 10.1001/jamapsychiatry.2015.1737.
Osuji PN, Onu JU. 2019. Feeding behaviors among incident cases of schizophrenia in a psychiatric hospital: Association with dimensions of psychopathology and social support. Clin Nutrit ESPEN, 34: 125-129. DOI: 10.1016/j.clnesp.2019.08.001.
Owen MJ, Sawa A, Mortensen PB. 2016. Schizophrenia. Lancet, 388(10039): 86-97. DOI: 10.1016/S0140-6736(15)01121-6.
Roerig JL, Steffen KJ, Mitchell JE. 2011. Atypical antipsychotic-induced weight gain: insights into mechanisms of action. CNS Drugs, 25(12): 1035-1059.
Sankaranarayanan A, Johnson K, Mammen SJ, Wilding HE, Vasani D, Murali V, Mitchison D, Castle DJ, Hay P. 2021. Disordered eating among people with schizophrenia spectrum disorders: A systematic review. Nutrients, 13(11): 3820DOI: 10.3390/nu13113820.
Sentissi O, Viala A, Bourdel MC, Kaminski F, Bellisle F, Olié JP, Poirier MF. 2009. Impact of antipsychotic treatments on the motivation to eat: preliminary results in 153 schizophrenic patients. Int Clin Psychopharmacol, 24(5): 257-264. DOI: 10.1097/YIC.0b013e32832b6bf6.
Srebnik D, Comtois K, Stevenson J, Hoff H, Snowden M, Russo J, Ries R. 2003. Eating disorder symptoms among adults with severe and persistent mental illness. Eating Disord, 11(1): 27-38. DOI: 10.1080/10640260390167465.
Teff KL, Kim SF. 2011. Atypical antipsychotics and the neural regulation of food intake and peripheral metabolism. Physiol Behav, 104(4): 590-598. DOI: 10.1016/j.physbeh.2011.05.033.
Tian Y, Liu D, Wang D, Wang J, Xu H, Dai Q, Andriescue EC, Wu HE, Xiu M, Chen D, Wang L, Chen Y, Yang R, Wu A, Wei CW, Zhang X. 2020. Obesity in Chinese patients with chronic schizophrenia: Prevalence, clinical correlates and relationship with cognitive deficits. Schizophrenia Res, 215: 270-276. DOI: 10.1016/j.schres.2019.10.017.
Treasure J, Duarte TA, Schmidt U. 2020. Eating disorders. Lancet 95(10227): 899-911. DOI: 10.1016/S0140-6736(20)30059-3. van Os J, Kapur S. 2009. Schizophrenia. Lancet, 374(9690): 635-645. DOI: 10.1016/S0140-6736(09)60995-8.
van Strien T, Konttinen H, Homberg JR, Engels RC, Winkens LH. 2016. Emotional eating as a mediator between depression and weight gain. Appetite, 100: 216-224. DOI: 10.1016/j.appet.2016.02.034.
van Zonneveld SM, Haarman BCM, van den Oever EJ, Nuninga JO, Sommer IEC. 2022. Unhealthy diet in schizophrenia spectrum disorders. Curr Opin Psychiatry, 35(3): 177-185. DOI: 10.1097/YCO.0000000000000791.
Vancampfort D, Stubbs B, Mitchell AJ, De Hert M, Wampers M, Ward PB, Rosenbaum S, Correll CU. 2015. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry, 14(3): 339-347. DOI: 10.1002/wps.20252.
Veeraraghavan V. 2021. Obesogenic behavior and binge eating disorder in an elderly female with schizophrenia. J Obesity Metab Syndrome, 30(2): 184-187. DOI: 10.7570/jomes20096.
Wang J, Zhang Y, Yang Y, Liu Z, Xia L, Li W, Li Z, Xie X, Deng W, Zhang K, Liu H. 2021. The prevalence and independent influencing factors of obesity and underweight in patients with schizophrenia: a multicentre cross-sectional study. Eating Weight Disord, 26(5): 1365-1374. DOI: 10.1007/s40519-020-00920-9.