Faulkner Guy, Cohn Tony A
Faculty of Physical Education and Health, University of Toronto, Ontario.
Can J Psychiatry. 2006 Jul;51(8):502-11. doi: 10.1177/070674370605100805.
To provide an overview of pharmacologic and nonpharmacologic strategies for antipsychotic-associated weight gain and metabolic disturbance, to identify important areas for future research, and to make practice recommendations based on current knowledge.
We undertook a selective review of interventions for weight gain and metabolic disturbance in the general population and in individuals treated with antipsychotic medications, focusing on randomized controlled trials in schizophrenia.
Pharmacologic strategies include medication choice, medication dosage and formulation, choice of concomitant psychotropic medications, medication switching, medication addition to effect weight loss or prevent weight gain, and medications to increase insulin sensitivity. Medication choice and medication switching may have the most potent influence on weight and metabolic parameters. Modest short-term weight loss can occur with the addition of selective medications and (or) lifestyle interventions. However, more rigorous and longer-term studies are needed.
Although difficult, the prevention of weight gain and the promotion of weight loss are possible for individuals treated with antipsychotic medications. Further research, including diabetes prevention studies, is required. We suggest a pathway for the management of weight gain and emerging metabolic disturbance.
概述抗精神病药物所致体重增加和代谢紊乱的药物及非药物治疗策略，确定未来研究的重要领域，并根据现有知识提出实践建议。
我们对普通人群以及接受抗精神病药物治疗的个体中体重增加和代谢紊乱的干预措施进行了选择性综述，重点关注精神分裂症的随机对照试验。
药物治疗策略包括药物选择、药物剂量和剂型、联合使用的精神药物选择、药物更换、添加药物以减轻体重或防止体重增加，以及增加胰岛素敏感性的药物。药物选择和药物更换可能对体重和代谢参数影响最大。添加选择性药物和（或）生活方式干预可实现适度的短期体重减轻。然而，需要更严格和长期的研究。
尽管有困难，但对于接受抗精神病药物治疗的个体，预防体重增加和促进体重减轻是可行的。需要进一步研究，包括糖尿病预防研究。我们提出了一条管理体重增加和新出现的代谢紊乱的途径。
