Obesity may affect pregnancy more than asthma

Last Updated: 2006-07-06 16:03:03 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Complications of pregnancy in obese women with asthma may have more to do with obesity than with asthma, researchers report in the medical journal Obstetrics and Gynecology.

Lead investigator Dr. Israel Hendler told Reuters Health that his team hypothesized that "since obesity and asthma go together, the adverse outcomes shown in asthmatic women during pregnancy are due to the obese state and not to the asthma status."

Asthmatic women, he continued, "have more cesarean deliveries and more preeclampsia, because they are more obese and not because of their asthma status. We also showed that obese women have more asthma exacerbations during pregnancy."

Hendler of Hutzel Hospital-Wayne State University, Detroit, and a multicenter team studied data on about 1,700 asthmatic women and more than 800 pregnant women without asthma, the "control" group.

Some 30.7 percent of the asthmatic women were obese, compared with 25.5 percent of controls. Obese women, regardless of asthma status were 60 percent more likely to undergo cesarean delivery. These women were also 70 percent more likely to develop preeclampsia or high blood pressure and more than four times more likely to develop pregnancy-related diabetes.

There were no significant differences in rates of asthma improvement between obese and non-obese women (20.6 percent versus 23.6 percent). There were also no significant differences in rates of asthma deterioration (33.3 percent versus 28.8 percent). However, obese women were 30 percent more likely to have asthma exacerbations.

Given these findings, the researchers conclude that further study is needed on "the effects of excess weight gain and weight reduction on the course of asthma during pregnancy."

SOURCE: Obstetrics and Gynecology, July 2006.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Clozapine cuts aggression in schizophrenics

Last Updated: 2006-07-06 16:10:33 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - The drug clozapine is more effective than olanzapine or haloperidol at reducing aggressive behavior in violent patients with schizophrenia, new research shows. This ability to curb aggressiveness seems to be separate from the drug's antipsychotic effect.

Schizophrenia is a severe psychiatric disorder in which patients experience distorted thinking, hallucinations and abnormal emotions. The disease is classified as a psychotic disorder, meaning that patients are often not completely in touch with reality. Therefore, the disease is treated with antipsychotic drugs, including the newer, "atypical" drugs clozapine and olanzapine as well as the older drug haloperidol.

"There had been evidence in the literature that the atypical antipsychotics have some specific anti-aggressive effects," but a lot of the supporting data came from studies that didn't focus on violent patients, lead author Dr. Menahem I. Krakowski, from the Nathan Kline Institute for Psychiatric Research in Orangeburg, New York, told Reuters Health.

The study, which is reported in the Archives of General Psychiatry, involved 110 patients at state psychiatric facilities who were randomly selected to receive clozapine, olanzapine or haloperidol for 12 weeks.

To be eligible for the study, the subjects had to have a documented episode of physically assaulting another person while hospitalized and display persistence of their aggression in the form of other aggressive events.

In terms of reducing both overall and physical aggression, clozapine was significantly better than olanzapine, which, in turn, was significantly better than haloperidol. By contrast, the agents were comparable in their ability to improve psychiatric symptoms.

"Clozapine was better than the other drugs at reducing physical assaults, threats, and insults and in preventing patients from destroying property and throwing objects," Krakowski said.

While clozapine is the most effective drug, Krakowski warned that the drug also has some important side effects and regular blood monitoring is critical. For this reason, olanzapine might be a better initial choice, he added, unless the patient has hard-to-control aggressive behavior.

SOURCE: Archives of General Psychiatry, June 2006.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.