Attenuation of Antipsychotic-Induced Weight Gain With Early Behavioral Intervention in Drug-Naive First-Episode Psychosis Patients: A Randomized Controlled Trial

Background: The purpose of this study was tocompare an early behavioral intervention (EBI) with nonstructuredstandard physical care (routine care intervention [RCI]) inpreventing antipsychotic-induced weight gain in drug-naivefirst-episode psychosis patients.

Method: Sixty-one patients with aDSM-IV-diagnosed psychotic disorder were first randomly assignedto 3 different antipsychotic treatments (risperidone [N = 23],olanzapine [N = 18], and haloperidol [N = 21]) and subsequentlyrandomly assigned to the intervention condition (EBI, N = 35) or RCI (N = 27). EBI was specifically designed to teach strategies toenhance control over factors associated withantipsychotic-induced weight gain and consisted of 8 flexibleintervention modules that incorporated behavioral interventions,nutrition, and exercise. In the RCI group, patients were informedabout potential weight gain and advised to increase theirexercise and limit food intake. Body weight and body mass indexwere measured at baseline and then weekly for 3 months. Inaddition to change in weight and body mass index, a third outcomemeasure was the proportion of patients who had gained more than7% of their body weight at 3 months. Participating patients werereferred between August 2002 and September 2004.

Results: All 61 participants completed thestudy. Patients in the EBI group gained significantly less weight(mean = 4.1 kg, SD = 4.0) than those allocated to the RCI group(mean = 6.9 kg, SD = 4.5) (p < .01) during the 3-month follow-upperiod. Similar findings were obtained when both groups werecompared on treatment-induced change in body mass index, whichwas significantly less in the EBI group than in the RCI group(1.40 vs. 2.39 kg/m²) (p < .01). Accordingly,significantly fewer patients in the EBI group (N = 11; 39.3%) thanin the RCI group (N = 26; 78.8%) (p < .002) increased theirbaseline weight by more than 7%, the cutoff for clinicallymeaningful weight gain.

Conclusions: EBI was effective in attenuatingantipsychotic-induced weight gain in a drug-naive first-episodepsychosis cohort. Patients displayed good adherence to this typeof preventive intervention.