CLINICAL HANDBOOK OF SCHIZOPHRENIA

13. Co-Occurring Disorders 131test checks blood glucose without regard to eating. This test can be used with an assessmentof symptoms to diagnosis diabetes, but not prediabetes. Positive test results shouldbe confirmed by repeating the fasting plasma glucose test or the oral glucose tolerancetest on a different day.Obesity/OverweightPatients with schizophrenia are at a greater risk for weight gain and obesity due to use ofpsychotropic agents and lifestyle factors. Obesity has been linked to stroke, coronaryheart disease, type II diabetes, hypertension, and arthritis. Weight gain and obesity shouldbe monitored closely at patient visits. Height and weight can be assessed to calculatebody mass index (BMI). Typically a BMI of 25 or greater is considered overweight, with abody mass ≥30 indicating obesity. Waist circumference is also useful to define weightproblems, because excess abdominal fat is associated with glucose intolerance, dyslipidemia,and hypertension. Waist circumferences should not exceed 40 inches in men and35 inches in women.Weight should be assessed frequently throughout treatment to assess any increases ordecreases that may occur. This is especially important after introducing new antipsychoticmedications. Though no specific guidelines are widely accepted, it is not unreasonable toobtain weights at each appointment.Exercise and DietThere are relatively few instruments available for assessing the eating and exercise habitsof people with schizophrenia. The International Physical Activity Questionnaire (IPAQ)has been used with this population; it is simply worded and easily understood by a widevariety of populations. The IPAQ has brief and extended versions. Both versions includeitems about exercise habits; however, the extended version includes questions on inactivitythat are often informative. The Self-Efficacy and Exercise Habits Survey, developed bySallis, Pinski, Grossman, Patterson, and Nader (1998), measures exercise-related selfefficacyand has been shown be both valid and reliable.Pedometers are also a simple, inexpensive, objective measure of activity. Step monitorsare now being used successfully to estimate levels of movement expressed as “stepstaken throughout the day” to document activity. Patients can be given log sheets to completeto indicate activity during the week or month to help clinicians understand their activitylevels. Pedometers may also be used to help patients monitor exercise and fitnessgoals.Eating habits are often to difficult to track. A simple food diary or log may be theeasiest way to indicate eating habits. Logs can be filled out by patients on a daily basisand reviewed by health care providers at appointments. The Diet History Questionnaire(DHQ), a relatively easy to use food frequency instrument developed by the NationalCancer Institute, has good validity for tracking eating habits. Food questionnaires areproblematic because patients often over- or underestimate their food intake during thetime period. This is often why daily food logs may be a more accurate way for cliniciansto assess eating habits.Metabolic SyndromeThis syndrome is closely associated with a generalized metabolic disorder called insulinresistance, in which the body cannot use insulin efficiently. The underlying causes of thesyndrome are physical inactivity, genetic factors, and overweight/obesity. Patients who