Lambert Tim J R, Chapman Leon H
Office for Psychiatric Evaluation and Educational Newmedia, University of Melbourne, Royal Melbourne Hospital, VIC.
Med J Aust. 2004 Nov 15;181(10):544-8. doi: 10.5694/j.1326-5377.2004.tb06443.x.
Psychotic illness and its treatment are associated with an increased rate of diabetes and worsening blood sugar control, Australia. The newer, second-generation antipsychotic agents are more likely to produce this effect than the first-generation agents, but both contribute to the problem. The effect is usually related to insulin resistance through weight gain, but other mechanisms may exist. Diabetic ketoacidosis is rare. Management of psychosis takes priority over concerns about the potential metabolic sequelae of treatment, but the prevalence of the latter requires that all patients taking antipsychotic agents be actively screened and treated. Patients treated with antipsychotic agents need baseline and regular checks, including weight, blood glucose and lipid levels and blood pressure. Management of psychosis with its attendant medical problems requires a multidisciplinary approach, with primary health practitioners playing a central role. Mortality and medical morbidity is higher in those with psychosis than expected; preventive measures, combined with early detection and treatment of hyperglycaemia and other metabolic problems, is a key public health issue.
精神病性疾病及其治疗与糖尿病发病率上升和血糖控制恶化有关。较新的第二代抗精神病药物比较第一代药物更易产生这种效应，但两者都会导致这一问题。这种效应通常与体重增加引起的胰岛素抵抗有关，但可能还存在其他机制。糖尿病酮症酸中毒较为罕见。精神病的治疗优先于对治疗潜在代谢后遗症的担忧，但后者的患病率要求对所有服用抗精神病药物的患者进行积极筛查和治疗。接受抗精神病药物治疗的患者需要进行基线检查和定期检查，包括体重、血糖、血脂水平和血压。伴有相关医疗问题的精神病管理需要多学科方法，初级保健从业者发挥核心作用。患有精神病的人群的死亡率和医疗发病率高于预期；预防措施，以及高血糖和其他代谢问题的早期发现和治疗，是一个关键的公共卫生问题。
