The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials

Davy Vancampfort; Joseph Firth; Christoph U Correll; Marco Solmi; Dan Siskind; Marc De Hert; Rebekah Carney; Ai Koyanagi; André F Carvalho; Fiona Gaughran; Brendon Stubbs

doi:10.1002/wps.20614

The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials

World Psychiatry. 2019 Feb;18(1):53-66. doi: 10.1002/wps.20614.

Authors

Davy Vancampfort^{1

2}, Joseph Firth^{3

4

5}, Christoph U Correll^{6

7

8}, Marco Solmi⁹, Dan Siskind^{10

11}, Marc De Hert^{2

12}, Rebekah Carney⁴, Ai Koyanagi^{13

14}, André F Carvalho^{15

16}, Fiona Gaughran^{17

18}, Brendon Stubbs^{17

18}

Affiliations

¹ KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
² University Psychiatric Centre KU Leuven, Kortenberg, Belgium.
³ NICM Health Research Institute, Western Sydney University, Westmead, Australia.
⁴ Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
⁵ Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
⁶ Hofstra Northwell School of Medicine Hempstead, New York, NY, USA.
⁷ Department of Psychiatry, Zucker Hillside Hospital, New York, NY, USA.
⁸ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
⁹ Department of Neurosciences, University of Padua, Padua, Italy.
¹⁰ Metro South Addiction and Mental Health Service, Brisbane, Australia.
¹¹ School of Medicine, University of Queensland, Brisbane, Australia.
¹² KU Leuven Department of Neurosciences, Leuven, Belgium.
¹³ Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.
¹⁴ Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
¹⁵ Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
¹⁶ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
¹⁷ South London and Maudsley NHS Foundation Trust, London, UK.
¹⁸ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Abstract

We summarized and compared meta-analyses of pharmacological and non-pharmacological interventions targeting physical health outcomes among people with schizophrenia spectrum disorders. Major databases were searched until June 1, 2018. Of 3,709 search engine hits, 27 meta-analyses were included, representing 128 meta-analyzed trials and 47,231 study participants. While meta-analyses were generally of adequate or high quality, meta-analyzed studies were less so. The most effective weight reduction interventions were individual lifestyle counseling (standardized mean difference, SMD=-0.98) and exercise interventions (SMD=-0.96), followed by psychoeducation (SMD=-0.77), aripiprazole augmentation (SMD=-0.73), topiramate (SMD=-0.72), d-fenfluramine (SMD=-0.54) and metformin (SMD=-0.53). Regarding waist circumference reduction, aripiprazole augmentation (SMD=-1.10) and topiramate (SMD=-0.69) demonstrated the best evidence, followed by dietary interventions (SMD=-0.39). Dietary interventions were the only to significantly improve (diastolic) blood pressure (SMD=-0.39). Switching from olanzapine to quetiapine or aripiprazole (SMD=-0.71) and metformin (SMD=-0.65) demonstrated best efficacy for reducing glucose levels, followed by glucagon-like peptide-1 receptor agonists (SMD=-0.39), dietary interventions (SMD=-0.37) and aripiprazole augmentation (SMD=-0.34), whereas insulin resistance improved the most with metformin (SMD=-0.75) and rosiglitazone (SMD=-0.44). Topiramate had the greatest efficacy for triglycerides (SMD=-0.68) and low-density lipoprotein (LDL)-cholesterol (SMD=-0.80), whereas metformin had the greatest beneficial effects on total cholesterol (SMD=-0.51) and high-density lipoprotein (HDL)-cholesterol (SMD=0.45). Lifestyle interventions yielded small effects for triglycerides, total cholesterol and LDL-cholesterol (SMD=-0.35 to -0.37). Only exercise interventions increased exercise capacity (SMD=1.81). Despite frequent physical comorbidities and premature mortality mainly due to these increased physical health risks, the current evidence for pharmacological and non-pharmacological interventions in people with schizophrenia to prevent and treat these conditions is still limited and more larger trials are urgently needed.

Keywords: Schizophrenia; antipsychotic switching; blood pressure; body weight; cholesterol; dietary interventions; exercise interventions; glucose; insulin; lifestyle counseling; metformin; physical health; psychosis; topiramate; tryglicerides.

Abstract

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