Casey Daniel E
UHN 80 Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA.
Am J Med. 2005 Apr;118 Suppl 2:15S-22S. doi: 10.1016/j.amjmed.2005.01.046.
Individuals with psychiatric disorders tend to have excessive morbidity. They typically have high rates of respiratory illnesses, infectious diseases, substance abuse (including smoking), obesity, diabetes mellitus, and cardiovascular disease (CVD). Persons with schizophrenia and affective disorders also have a high prevalence of risk factors for CVD, such as diabetes and obesity, which are on the order of 1.5 to 2.0 times higher than in the general population; this translates into increased mortality rates due to CVD. The use of certain psychotropics results in metabolic sequelae, such as obesity, dyslipidemia, glucose dysregulation, and the metabolic syndrome. These sequelae exacerbate the already elevated risk of CVD and diabetes in this group of people. Therefore, the use of psychotropic agents that result in, for example, excessive weight gain not only add another complication for physicians managing a patient with schizophrenia but also may have serious prognostic and cost implications with respect to treatment-related diabetes and coronary disease incidence. The recent American Diabetes Association (ADA) Consensus Panel concluded that some agents are associated with greater diabetes risk than others. The current review describes the prevalence of the metabolic syndrome in people with affective disorders and schizophrenic populations, its prognostic relevance, and its exacerbation among patients treated with particular psychotropic agents, including certain atypical antipsychotics, selective serotonin reuptake inhibitors, and mood stabilizers. The costs associated with the treatment of the metabolic syndrome, diabetes, and coronary heart disease in populations with schizophrenia are also described.
患有精神疾病的个体往往发病率过高。他们通常呼吸系统疾病、传染病、药物滥用（包括吸烟）、肥胖、糖尿病和心血管疾病（CVD）的发生率较高。患有精神分裂症和情感障碍的人患CVD的危险因素患病率也很高，如糖尿病和肥胖，比一般人群高出1.5至2.0倍；这导致CVD死亡率上升。使用某些精神药物会导致代谢后遗症，如肥胖、血脂异常、血糖调节异常和代谢综合征。这些后遗症加剧了这组人群中原本就较高的CVD和糖尿病风险。因此，使用会导致例如体重过度增加的精神药物，不仅给治疗精神分裂症患者的医生增加了另一项并发症，而且对于与治疗相关的糖尿病和冠心病发病率可能具有严重的预后和成本影响。最近美国糖尿病协会（ADA）共识小组得出结论，某些药物比其他药物具有更高的糖尿病风险。本综述描述了情感障碍和精神分裂症人群中代谢综合征的患病率、其预后相关性以及在接受特定精神药物治疗的患者中（包括某些非典型抗精神病药物、选择性5-羟色胺再摄取抑制剂和心境稳定剂）代谢综合征的加剧情况。还描述了精神分裂症人群中与代谢综合征、糖尿病和冠心病治疗相关的成本。
