Schizophrenia is one of the seven most disabling diseases according to World Health Organization. The most potent antipsychotic drugs clozapine and olanzapine are associated with excessive weight gain. Premature deaths in schizophrenia and shorter life expectancy are mainly caused by obesity-related cardiovascular diseases. Obesity itself is associated with brain deterioration, cognitive decline and overall worse quality of life. GLP-1 receptor analogs may be a potent drugs in schizophrenia addressing metabolic disturbances with potential central effects through GLP-1 receptors leading to neuroprotection, plasticity and learning. Studies in this specific field are scarce, so I present here a case-report.
A 49 years-old male was referred to our obesity clinic. He has suffered from schizophrenia since the age of 24, type 2 diabetes since the age 34. The weight gain caused by psychiatric disease was poteantiated by psychiatric medication, currently a long term treatment by risperidone 4 mg daily and olanzapine 5 mg daily. At the initial visit, the patient was very passive in communication, but he filled all questionnaires including 10 days dietary monitoring, where the food was stated precisely with timing, location and in grams. After nutritionist consultation (diet 150 g saccharides, 50 g lipids, 80 g protein, 6000kJ) and physicians´ recommendations done emphasizing the need for physical activity -walking instructions, buying watch for daily step monitoring etc the patient lost 9 kilos in 3 months. He felt generally better, was surprisingly quite talkative, reached every day walk of about 8000 steps. The diabetes control improved from 70 mmol/mol to 57 mmol/l also due to newly prescribed weight-lowering GLP-1 analog semaglutide after 2 months of usage currently on dose 0.5 mg weekly, plus from previous metformin 2 g/day. After 3 months the BMI decreased from 37.6 kg/m2 to 34.8 kg/m2 and waist circumference from 125 cm to 120 cm, respectively.
From my clinical point of view I was a bit sceptic to the adherence of this schizophrenic patient to the weight-reducing programme. On the other hand the primary and secondary obesity prevention in psychiatric patients must be addressed. These patients need deeper clinical focus from all specialists and obesity centers shall meet the needs. Many schizophrenic patients are underestimated in obesity interventions and most of them never get a chance. GLP-1 analogs build new effective perspectives in the treatment of obese schizophrenic patients including potential neuroprotective effects.
22 May 2021 - 26 May 2021