McIntyre R S, McCann S M, Kennedy S H
Centre for Addiction and Mental Health, Clarke Site, Mood and Anxiety Disorders Program, 250 College Street, Toronto, ON M5T 1R8.
Can J Psychiatry. 2001 Apr;46(3):273-81. doi: 10.1177/070674370104600308.
To review published and nonpublished literature describing changes in weight, glucose homeostasis, and lipid milieu with antipsychotics.
A Medline search was completed using the words weight gain, diabetes mellitus, cholesterol, triglycerides, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, predictors, prolactin, obesity, and conventional antipsychotics. Publications, including original articles, review articles, letters to the editor, abstracts or posters presented at professional meetings in the last 4 years, and references from published articles, were collected. Manufacturers, including Eli Lilly Canada Inc, JanssenOrtho Inc, Pfizer Canada Inc, AstraZeneca Inc, and Novartis Pharmaceuticals, were contacted to retrieve additional medical information.
The topic of antipsychotic-induced weight gain is understudied, and there are relatively few well-controlled studies. Weight gain as a side effect has been described with both conventional and atypical antipsychotics. Moreover, some atypical antipsychotics are associated with de novo diabetes mellitus and increased serum triglyceride levels. Predictors of weight gain may be age, baseline body mass index, appetite stimulation, previous antipsychotic exposure, and antipsychotic treatment duration.
Significant weight gain is reported with the existing atypical antipsychotics. The weight gain described is highly distressing to patients, may reduce treatment adherence, and may increase the relative risk for diabetes mellitus and hypertriglyceridemia. Physicians employing these agents should routinely monitor weight, fasting blood glucose, and lipid profiles.
回顾已发表和未发表的描述抗精神病药物引起体重、葡萄糖稳态和脂质环境变化的文献。
使用“体重增加”“糖尿病”“胆固醇”“甘油三酯”“利培酮”“氯氮平”“奥氮平”“喹硫平”“齐拉西酮”“预测因素”“催乳素”“肥胖症”和“传统抗精神病药物”等词汇完成了对医学文献数据库（Medline）的检索。收集了包括原创文章、综述文章、给编辑的信、过去4年在专业会议上发表的摘要或海报以及已发表文章的参考文献等出版物。联系了包括加拿大礼来公司、杨森奥索公司、加拿大辉瑞公司、阿斯利康公司和诺华制药公司在内的制造商，以获取更多医学信息。
抗精神病药物引起体重增加这一主题的研究较少，且对照良好的研究相对较少。传统和非典型抗精神病药物均有体重增加作为副作用的报道。此外，一些非典型抗精神病药物与新发糖尿病和血清甘油三酯水平升高有关。体重增加的预测因素可能是年龄、基线体重指数、食欲刺激、既往抗精神病药物暴露情况以及抗精神病药物治疗持续时间。
现有非典型抗精神病药物均有显著的体重增加报道。所述的体重增加给患者带来极大困扰，可能降低治疗依从性，并可能增加糖尿病和高甘油三酯血症的相对风险。使用这些药物的医生应常规监测体重、空腹血糖和血脂情况。
