{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:03:38Z","timestamp":1789671818865,"version":"4.0.1"},"reference-count":45,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000245","name":"Michael Smith Health Research BC","doi-asserted-by":"publisher","award":["HPI-2025-04674"],"award-info":[{"award-number":["HPI-2025-04674"]}],"id":[{"id":"10.13039\/501100000245","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Individuals with schizophrenia and concurrent substance use disorders (SUDs) face a high risk of rapid weight gain during residential treatment, driven by inpatient environmental factors, baseline metabolic vulnerability, and metabolically active psychotropic medications. Clozapine, commonly indicated for treatment-resistant psychosis, is frequently associated with early and substantial weight gain. This study examined whether adjunctive metformin or aripiprazole attenuated weight gain in individuals taking clozapine in a naturalistic residential setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included adults prescribed clozapine during admission to a 105-bed provincial concurrent disorders facility in British Columbia, Canada (2021\u20132024). Adults with \u226590-day admissions and available therapeutic drug monitoring were included. Monthly weights were extracted from electronic records and linked to serum concentrations and medication exposure. Linear mixed-effects models with random intercepts and slopes assessed predictors of weight trajectories, with fixed effects including age, sex, baseline weight, norclozapine concentration, opioid agonist therapy (OAT), augmenting antipsychotic defined daily dose, and adjunctive metformin and aripiprazole. Interaction terms between time and adjunctive agents evaluated effects on weight trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty individuals contributed 306 matched serum concentration\u2013weight observations. The cohort was predominantly male with schizophrenia and comorbid SUDs. Higher baseline weight and greater time between admission and blood draw were associated with increased weight. In adjusted models, norclozapine concentration and OAT were associated with higher weight. Metformin was associated with attenuation of weight gain over time (time \u00d7 metformin: B\u2009=\u2009\u22122.63, 95% CI \u22124.49 to \u22120.76), whereas aripiprazole was not (B\u2009=\u2009\u22120.38, 95% CI \u22122.58 to 1.82).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Metformin was associated with attenuation of weight gain trajectory in this population, whereas aripiprazole showed no clear effect. These findings highlight substantial metabolic vulnerability in inpatient concurrent disorders settings and support early preventive metabolic interventions during clozapine treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/07067437261486956","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:14:18Z","timestamp":1789496058000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Metformin, but Not Aripiprazole, Was Associated With Attenuation of Weight Gain in Clozapine-Treated Inpatients With Concurrent Disorders: A Repeated Measures Cohort Analysis: La metformine, mais non l\u2019aripiprazole, a \u00e9t\u00e9 associ\u00e9e \u00e0 une att\u00e9nuation du gain de poids chez les patients hospitalis\u00e9s trait\u00e9s par la clozapine et pr\u00e9sentant des troubles concomitants : une analyse de cohorte \u00e0 mesures r\u00e9p\u00e9t\u00e9es"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4163-8241","authenticated-orcid":false,"given":"Reza","family":"Rafizadeh","sequence":"first","affiliation":[{"name":"University of British Columbia"},{"name":"Psychiatry, Red Fish Healing Centre for Mental Health and Addiction, Coquitlam, British Columbia, Canada"},{"name":"Psychiatry, Lower Mainland Pharmacy Services, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Frankow","sequence":"additional","affiliation":[{"name":"Psychiatry, Lower Mainland Pharmacy Services, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijaykumar","family":"Seethapathy","sequence":"additional","affiliation":[{"name":"University of British Columbia"},{"name":"Psychiatry, Red Fish Healing Centre for Mental Health and Addiction, Coquitlam, British Columbia, 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