Lindenmayer J P, Nathan A M, Smith R C
New York University School of Medicine, New York, USA.
J Clin Psychiatry. 2001;62 Suppl 23:30-8.
The available literature suggests that patients with schizophrenia are at risk for diabetes mellitus and taking antipsychotic medication further increases the chance of developing non-insulin-dependent hyperglycemia. Case reports, chart reviews, and some results from clinical drug trials implicate a relationship between glucose levels and treatment with clozapine or olanzapine in patients with schizophrenia, although a few cases of hyperglycemia have also been reported in patients taking risperidone and quetiapine. These studies indicate that hyperglycemia is not dose dependent, is reversible on cessation of treatment with clozapine or olanzapine, and reappears on reintroduction of these therapies. The postulated underlying mechanisms involved in this process in patients with schizophrenia include (1) a decreased sensitivity to insulin that is independent of atypical medication, (2) an increased insulin resistance related to atypical medications, (3) the effects of atypical medications on serotonin receptors, and (4) overuse of insulin due to weight gain. These mechanisms are discussed in detail, and recommendations for the administration of atypical antipsychotics are offered. Overweight, ethnicity, family or personal history of diabetes mellitus or hypertension, and weight gain during the course of treatment have all been identified as risk factors in the development of hyperglycemia in patients with schizophrenia. However, it is difficult to statistically assess the true incidence of diabetes within each type of antipsychotic medication group with the exclusive dependence on available case studies and without proper epidemiologic research.
现有文献表明，精神分裂症患者有患糖尿病的风险，服用抗精神病药物会进一步增加患非胰岛素依赖型高血糖症的几率。病例报告、病历回顾以及一些临床药物试验结果表明，精神分裂症患者的血糖水平与使用氯氮平或奥氮平治疗之间存在关联，不过服用利培酮和喹硫平的患者也有少数高血糖病例的报告。这些研究表明，高血糖与剂量无关，停用氯氮平或奥氮平治疗后可逆转，重新使用这些疗法时又会再次出现。精神分裂症患者这一过程中假定的潜在机制包括：（1）对胰岛素的敏感性降低，与非典型药物无关；（2）与非典型药物相关的胰岛素抵抗增加；（3）非典型药物对5-羟色胺受体的影响；（4）因体重增加导致胰岛素过度使用。将详细讨论这些机制，并给出使用非典型抗精神病药物的建议。超重、种族、糖尿病或高血压家族史或个人史以及治疗过程中的体重增加，均已被确定为精神分裂症患者发生高血糖的危险因素。然而，仅依靠现有病例研究且缺乏适当的流行病学研究，很难从统计学上评估每种抗精神病药物组中糖尿病的真实发病率。
