Correll Christoph U
Dr. Correll is with the The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, and the Albert Einstein College of Medicine, Bronx, NY.
J Am Acad Child Adolesc Psychiatry. 2007 Jun;46(6):687-700. doi: 10.1097/chi.0b013e318040b25f.
To review weight and metabolic effects of mood-stabilizing treatments in pediatric bipolar disorder.
Systematic PubMed/Medline search of studies reporting on change in weight and/or glucose/lipid values with mood-stabilizing drugs in at least nine pediatric patients with bipolar disorder.
Nineteen studies, including 24 medication trials in 684 patients (mean age, 12.3 +/- 2.9 years) were included. Youngsters received lithium, antiepileptics, or their combinations (n = 459), or second-generation antipsychotics, alone or combined with lithium or divalproex (n = 225), for 4 to 48 (mean, 15.4 +/- 12.7) weeks. Weight increase was significant/clinically relevant in 18 (75.0%) trials. Weight loss was significant with topiramate (2 studies, 38 subjects) and present with aripiprazole (1 study, 14 subjects). In trials lasting < or =12 weeks, weight gain was greater with second-generation antipsychotics plus mood stabilizers (5.5 +/- 1.8 kg) compared to mood-stabilizer monotherapy (1.2 +/- 1.9 kg, p <.05, Cohen's d = 2.33) or mood-stabilizer cotreatment (2.1 +/- 1.3 kg, p <.05, Cohen's d = 2.17), but not compared to antipsychotic monotherapy (3.4 +/- 1.3 kg, p >.05, Cohen's d = 1.34). Nonfasting glucose/lipid changes were nonsignificant in two second-generation antipsychotic trials (n = 61, 8.9%).
Data are sparse regarding body composition effects and lacking for fasting metabolic effects of mood stabilizers in pediatric bipolar disorder. Combining antipsychotics with mood stabilizers seems to lead to greater weight gain than treatment with one or two mood stabilizers.
回顾心境稳定剂治疗儿童双相情感障碍对体重及代谢的影响。
通过PubMed/Medline系统检索研究，这些研究报告了至少9例儿童双相情感障碍患者使用心境稳定剂后体重和/或血糖/血脂值的变化。
纳入19项研究，包括对684例患者（平均年龄12.3±2.9岁）进行的24项药物试验。青少年接受锂盐、抗癫痫药物或其联合用药（n = 459），或第二代抗精神病药物，单独使用或与锂盐或丙戊酸联合使用（n = 225），治疗4至48周（平均15.4±12.7周）。18项（75.0%）试验中体重增加显著/具有临床相关性。托吡酯治疗导致体重显著减轻（2项研究，38例受试者），阿立哌唑治疗也出现体重减轻（1项研究，14例受试者）。在持续时间≤12周的试验中，与心境稳定剂单药治疗（1.2±1.9 kg，p<.05，Cohen's d = 2.33）或心境稳定剂联合治疗（2.1±1.3 kg，p<.05，Cohen's d = 2.17）相比，第二代抗精神病药物加心境稳定剂导致体重增加更多（5.5±1.8 kg），但与抗精神病药物单药治疗（3.4±1.3 kg，p>.05，Cohen's d = 1.34）相比无差异。两项第二代抗精神病药物试验（n = 61，8.9%）中，非空腹血糖/血脂变化不显著。
关于心境稳定剂对儿童双相情感障碍身体成分影响的数据稀少，且缺乏对空腹代谢影响的数据。与使用一种或两种心境稳定剂治疗相比，抗精神病药物与心境稳定剂联合使用似乎导致体重增加更多。
