Sernyak Michael J
Yale University School of Medicine and Veterans Affairs Connecticut Healthcare System, West Haven, Conn, USA.
J Clin Psychiatry. 2007;68 Suppl 4:14-8.
It has long been known that psychiatric patients experience increased morbidity and mortality associated with a range of physical disorders. Lifestyle, inadequate health care, and a variety of other factors all contribute to the poor physical health of people with severe mental illness. Second-generation antipsychotics have gained widespread acceptance for the management of patients with schizophrenia and other forms of severe mental illness. While demonstrating several advantages over first-generation antipsychotics, second-generation antipsychotics have been found to cause or exacerbate several metabolic disorders, including diabetes, obesity, dyslipidemia, and metabolic syndrome. These disorders are closely linked and consistently associated with the development of cardiovascular disease, with varying prevalence rates depending on the second-generation antipsychotic used. As a result, several authoritative guidelines have been developed for the monitoring and management of metabolic disturbances in schizophrenia and other forms of severe mental illness. Specifically, the guidelines and recommendations generated from the Mount Sinai Conference on Medical Monitoring and the American Diabetes Association/American Psychiatric Association Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes call for a more integrated and cooperative approach between primary care physicians and mental health care providers to improve the quality of health care for people with severe mental illness. By routinely performing physical health monitoring, referrals, and/or treatment for patients with schizophrenia and other forms of severe mental illness, mental health care providers can take a lead role in transforming the current system of fragmented mental and physical health services into a system focused on early intervention, wellness, and recovery.
长期以来，人们一直知道精神科患者因一系列身体疾病而出现发病率和死亡率上升的情况。生活方式、医疗保健不足以及各种其他因素都导致了重度精神疾病患者身体健康状况不佳。第二代抗精神病药物已被广泛用于治疗精神分裂症和其他形式的重度精神疾病患者。虽然第二代抗精神病药物相对于第一代抗精神病药物显示出若干优势，但已发现它们会引发或加剧多种代谢紊乱，包括糖尿病、肥胖症、血脂异常和代谢综合征。这些紊乱密切相关，并始终与心血管疾病的发生有关，其患病率因所使用的第二代抗精神病药物而异。因此，已经制定了若干权威指南，用于监测和管理精神分裂症及其他形式重度精神疾病中的代谢紊乱。具体而言，西奈山医学监测会议以及美国糖尿病协会/美国精神病学协会抗精神病药物与肥胖症和糖尿病共识发展会议所产生的指南和建议要求初级保健医生和精神卫生保健提供者采取更综合、合作的方法，以提高重度精神疾病患者的医疗保健质量。通过对精神分裂症及其他形式重度精神疾病患者进行常规的身体健康监测、转诊和/或治疗，精神卫生保健提供者可以在将当前分散的精神和身体健康服务系统转变为一个注重早期干预、健康和康复的系统方面发挥主导作用。
