Changes in body mass and metabolic profiles in patients with first-episode schizophrenia treated for 12 months with a first-generation antipsychotic

Objectives: To assess changes in body mass and metabolic profiles in patients with first-episode schizophrenia receiving standardised, assured treatment and to identify predictors and moderators of the effects. Methods: We investigated the changes in body mass, fasting blood glucose and lipids in 107 largely antipsychotic naïve, first-episode schizophrenia patients who were treated according to a standard algorithm with long-acting injectable flupenthixol decanoate over 12 months. Results: Eighty-three (78%) participants completed the 12 months of treatment, and 104 (97%) received 100% of the prescribed injections during their participation. There were significant increases in BMI ( P<. .0001), waist circumference ( P= 0.0006) and triglycerides ( P= 0.03) and decrease in HDL ( P= 0.005), while systolic ( P= 0.7) and diastolic blood pressure ( P= 0.8), LDL ( P= 0.1), cholesterol ( P= 0.3), and glucose ( P= 0.9) values did not change over time. The triglyceride: HDL ratio increased by 91%. Change in BMI was only correlated with change in triglycerides ( P= .008). The only significant predictor of BMI increase was non-substance abuse ( P= .002). Conclusions: The risks of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics. This is a global problem, and developing communities may be particularly susceptible.