Weiden Peter J
State University of New York (SUNY) Downstate Medical Center and King's County Hospital, Brooklyn, N.Y., USA.
J Clin Psychiatry. 2007;68 Suppl 4:34-9.
Patients taking antipsychotic medications for psychiatric disorders also have many risk factors for medical comorbidities and early death. While these risk factors were present before the arrival of the newer antipsychotic medications, the overall risk factor burden is exacerbated for those high-risk patients whose antipsychotic therapy causes or aggravates obesity or dyslipidemia. Therefore, there is an urgent need for effective interventions to address problems related to the additional iatrogenic burden from weight gain and dyslipidemias caused by antipsychotic medications. For patients with schizophrenia, complete discontinuation of antipsychotic therapy is not advisable and, therefore, pharmacologic options are narrowed to dose adjustments, adding adjunctive agents to induce weight loss, discontinuation of other adjunctive agents associated with weight gain, or changing the antipsychotic medication ("switching"). This article reviews the evidence showing that relative to other possible treatment options, switching to an antipsychotic with a lower propensity to induce weight gain or dyslipidemia can be effective for reversing the weight gain and dyslipidemia caused by previous antipsychotic treatment.
服用抗精神病药物治疗精神疾病的患者也有许多患内科合并症和过早死亡的风险因素。虽然这些风险因素在新型抗精神病药物出现之前就已存在，但对于那些抗精神病治疗导致或加重肥胖或血脂异常的高危患者来说，总体风险因素负担会加剧。因此，迫切需要有效的干预措施来解决与抗精神病药物引起的体重增加和血脂异常所带来的额外医源性负担相关的问题。对于精神分裂症患者，完全停用抗精神病治疗并不可取，因此，药物治疗选择局限于调整剂量、添加辅助药物以诱导体重减轻、停用其他与体重增加相关的辅助药物或更换抗精神病药物（“换药”）。本文综述了相关证据，表明相对于其他可能的治疗选择，换用一种导致体重增加或血脂异常倾向较低的抗精神病药物可有效逆转先前抗精神病治疗引起的体重增加和血脂异常。
