Has Clozapine link to Schizophrenia patient's weight gain?

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TABLE OF CONTENTS

CHAPTER 1 INTRODUCTION1

1.1Purpose of the Chapter1

1.2Background1

1.3Rationale5

1.4Research Question6

1.5Aim6

1.6Objectives6

CHAPTER 2 METHODS8

2.1 Purpose of the Chapter8

2.2 Literature Review8

2.3 Critical Appraisal Tools8

2.4 Literature Search9

2.5 Inclusion and Exclusion-Criteria11

2.6 Outcome of the Literature Research11

REFERENCES13

CHAPTER 1 INTRODUCTION

Purpose of the Chapter

This chapter introduces the concept of Clozapine and links it to Schizophrenia Patients Weight Gain. The rationale for this topic, the research question, aims and objectives of this literature review will be presented.

Background

Schizophrenia is a chronic, severe, and disabling brain disorder that affects about 1% of people worldwide. The disorder is characterized by a mixture of symptoms affecting an individual's attention, concentration, cognition, perception and mood. These chronic symptoms lead to deterioration of psychosocial functioning. Symptoms are clinically divided into positive symptoms (e.g., delusions and hallucinations) and negative symptoms (e.g. avoidance, anhedonia, and social withdrawal). The development of symptoms is thought to be based on underlying genetic factors that create defective connectivity between distinct brain regions in utero or in early life (Zanarini Parachini 2004 907). Maturational processes during adolescence (such as myelination, synaptogenesis and synaptic pruning) and in early adulthood, e.g., refinement of the neural circuitry, that occur together with hormonal changes and environmental stressors may result in the exacerbation of symptoms. However, the exact etiology and pathology of schizophrenia remains unknown (Ryan Keeling 2004 75).

Schizoaffective disorder (SAD) is defined as "the presence of psychotic symptoms in the absence of mood changes for at least two weeks in a patient who has a mood disorder." The diagnosis is used when an individual does not fit diagnostic standards for either schizophrenia or "affective" (mood) disorders such as major depression disorder (MDD) and bipolar disorder (manic depression). SAD patients are characterized by continuation of delusions or hallucinations after the mood has stabilized and are accompanied by other symptoms of schizophrenia such as catatonia, paranoia, bizarre behaviour, or thought disorders. About one in every two hundred people (1/2 percent) develops SAD at some time during his or her life. Schizophrenia along with SAD, is one of the most common serious psychiatric disorders (Seeman 2004 1333). More hospital beds are occupied by persons with these disorders than any other psychiatric disorder. As both SCZ and SAD have significant psychotic components, tend to co-aggregate in familie, and patients are exposed to similar treatment regimens, we will group persons with these two mental illnesses together in one group as the cases for our study.

Patients with schizophrenia exhibit considerable variability in therapeutic and metabolic (i.e. weight gain) responses to clozapine, an atypical antipsychotic medication. Although the development of conventional antipsychotic medications represented a major breakthrough in the treatment of schizophrenia, a refractory subgroup of 10 to 20% of schizophrenic patients have a poor response to conventional antipsychotics and approximately 50% of schizophrenic patients demonstrate only a partial response to these medications (Lieberman et al 2005 1223). Further, many patients experience adverse side effects (e.g., extra-pyramidal symptoms) and thus have difficulty tolerating conventional neuroleptic medications. Hence, there has been a great interest in ...