Ganguli Rohan
University of Pittsburgh School of Medicine; Services and Research for Recovery in Serious Mental Illness, University of Pittsburgh Medical Center; and the Western Psychiatric Institute and Clinic, Pittsburgh, Pa, USA.
J Clin Psychiatry. 2007;68 Suppl 4:19-25.
Compared with the general population, individuals with schizophrenia demonstrate an increased prevalence of obesity. While most antipsychotics are associated with weight gain, certain second-generation antipsychotics (SGAs) appear to be especially problematic. Weight gain and obesity are highly distressing to these patients, can reduce treatment adherence, and may increase the relative risk of serious medical conditions and all-cause premature mortality. The selection of an antipsychotic on the basis of its effectiveness and relative side effect profile is recognized as an important initial consideration in the treatment of schizophrenia. However, less is known regarding the efficacy of dietary, pharmacologic, and behavioral therapy in reducing antipsychotic-related weight gain and obesity. Behavioral therapy, in particular, is understudied, and there are relatively few controlled trials of its effectiveness in reducing SGA-induced weight gain. Although weight loss resulting from behavioral therapy has been observed mostly as a result of effective short-term interventions, controlled behavioral studies do exist to suggest that weight can be controlled long term. In addition, a small pilot study in patients with schizophrenia or schizoaffective disorder recently demonstrated that behavioral therapy that utilizes stepped interventions, involving body weight self-monitoring, diet, and exercise, can prevent weight gain in patients initiating treatment with SGAs. Additional studies of behavioral therapy for long-term weight control in patients with schizophrenia and other forms of severe mental illness are warranted.
与普通人群相比，精神分裂症患者肥胖的患病率更高。虽然大多数抗精神病药物都与体重增加有关，但某些第二代抗精神病药物（SGA）似乎问题尤为突出。体重增加和肥胖给这些患者带来极大困扰，会降低治疗依从性，并可能增加患严重疾病和全因过早死亡的相对风险。根据抗精神病药物的疗效和相对副作用情况进行选择，被认为是精神分裂症治疗中重要的初始考虑因素。然而，关于饮食、药物和行为疗法在减少抗精神病药物相关体重增加和肥胖方面的疗效，人们了解较少。特别是行为疗法，研究不足，关于其减少SGA引起体重增加有效性的对照试验相对较少。虽然行为疗法导致的体重减轻大多是有效的短期干预结果，但确实存在对照行为研究表明体重可以长期得到控制。此外，最近一项针对精神分裂症或分裂情感性障碍患者的小型试点研究表明，采用逐步干预措施（包括体重自我监测、饮食和运动）的行为疗法，可以预防开始使用SGA治疗患者体重增加。有必要对行为疗法在精神分裂症和其他严重精神疾病患者长期体重控制方面进行更多研究。
