Nagasaki Schizophrenia Study : Outcome of a 15-year Follow-up of an Incident Cohort

The Nagasaki World Health Organization (WHO) Collaborating Center for Research and Training in Mental Health conducted the WHO Coordinated Multi-Center Study of the Long-term Course and Outcome of Schizophrenia as a part of the International Study on Schizophrenia (ISoS). The study used 107 patients who were initially diagnosed as having ICD-9 schizophrenia for the WHO Collaborative Study on the Determinants of Outcome of Severe Mental Disorders (DOSMeD). Subjects were first collected in 1979-1980 for an incidence study of schizophrenia in Nagasaki. In this 15-yearfollow- up study, 7 subjects died, 43 subjects were lost to follow-up and 57 were successfully traced. Among the 7 death cases, 4 suicides were confirmed and 1 was suspected. During the 15-year period, 25 (44%) of the 57 living subjects displayed continuous psychotic course type schizophrenia. During the last 2 years, 14 (25%) were not psychotic ; 31 (54%) were continuously psychotic. Global Assessment of Functioning Scale for Symptomatology (GAF-S) indicated symptomatological outcomes : 16 (28%) had severe symptoms (GAF-S70). Social outcome was evaluated using the Global Assessment of Functioning Scale for Disability (GAF-D): 28 (49%) showed poor adjustment (GAF-D70). The overall time trend was almost evenly divided in thirds : 20 (35%) were getting better, 18 (32%) were the same and 19 (33%) were worse. The present study showed that the outcome of schizophrenia is not always poor, although some patients display a continuous course and poor outcome

Glucagon-like peptide-1 receptor agonists as an effective therapeutic agent for diabetes mellitus and obesity in patients with schizophrenia under treatment with second-generation antipsychotics

Objectives: Cases of schizophrenia are commonly complicated with obesity and diabetes mellitus partially caused by excessive eating associated with the use of second-generation antipsychotics (SGAs). We aimed to study the efficacy of glucagon-like peptide-1 in patients with schizophrenia under treatment with SGAs. Methods: Diabetic patients with schizophrenia were included if their HbA1c levels increased more than 1% and/or their weight increased more than 3 kg after treatment with SGAs. Patients who developed diabetes after treatment with SGAs were also included. The participants were treated with GLP-1 receptor agonists for one year, and their changes in weight and HbA1c and any adverse events were evaluated. Results: Seven patients were treated with GLP-1 receptor agonists; their mean age was 46.1 yrs old (range; 26 to 59), mean body weight was 85.3 kg (65.5 to 96.8), and mean BMI was 33.8 (27 to 38.7). Five of them showed improvement in their HbA1c levels of 1.2% (0.1 to 3.4, p=0.089) with a weight loss of 3.7 kg (-9.6 to +3.5, p=0.14) on average. The adverse effects observed were all gastrointestinal, but were not severe enough to cause termination of the GLP-1 receptor agonist treatment. The GLP-1 receptor agonist was not effective in one patient, and another patient terminated the treatment in a few months. Conclusions: Although the number of patients studied was small, GLP-1 receptor agonists seem to be effective for treating diabetes and bringing about weight loss in patients with schizophrenia under treatment with SGAs