Cordes J, Sinha-Röder A, Kahl K G, Malevani J, Thuenker J, Lange-Asschenfeldt C, Hauner H, Agelink M W, Klimke A
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Heinrich-Heine-Universität, Düsseldorf.
Fortschr Neurol Psychiatr. 2008 Dec;76(12):703-14. doi: 10.1055/s-2008-1038279. Epub 2008 Oct 15.
Extensive, selective literature review of 2500 articles from the last years (up to December 2007) predominantly from Medline and Cochrane, using as search terms "antipsychotic or schizophrenia or individual drug names (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone)" and the terms "BMI, weight gain, metabolic syndrome, diabetes, lipid(s), cholesterol, triglycerides" was conducted. Regardless of the advantages ascribed to atypical antipsychotics and the special effectiveness of clozapine in patients resistant to therapy and at risk for suicide, the probability of weight gain is considerably increased for some of these substances. Patients with schizophrenia have a considerably reduced life expectancy associated with an increased prevalence of cardiovascular risk factors. There is a lack of practical guidelines integrated into clinical psychiatric care for the management of cardiovascular risk factors. The monitoring of patients treated with atypics, which has been recommended in the APA/ADA Consensus Paper in light of these facts, is insufficiently established in clinical practice. A regular monitoring can convey self control and motivation to the patient. In the case of corresponding risk constellations further decisions regarding indication and therapy have to be considered. Especially patients with a high cardiovascular risk profile are highly recommended to participate in a weight-management program for prevention purposes. Such a special program should include elements of dietetic treatment and behaviour and exercise therapy. First controlled studies suggest an effective prevention of weight gain and metabolic changes when applying such a structured program. The practice oriented step by step concept presented here is meant to provide points of reference for the implementation of required medical and psychoeducative measures facilitating the management of weight and further cardiovascular risk factors in the context of psychiatric care in patients with schizophrenia.
对过去几年（截至2007年12月）主要来自医学文献数据库（Medline）和考克兰系统评价数据库（Cochrane）的2500篇文章进行了广泛、有选择性的文献综述，搜索词为“抗精神病药或精神分裂症或个别药物名称（氨磺必利、阿立哌唑、氯氮平、奥氮平、喹硫平、利培酮、齐拉西酮）”以及“体重指数、体重增加、代谢综合征、糖尿病、脂质、胆固醇、甘油三酯”。尽管非典型抗精神病药具有诸多优势，且氯氮平对难治性及有自杀风险的患者有特殊疗效，但其中一些药物导致体重增加的可能性显著增加。精神分裂症患者的预期寿命大幅缩短，心血管危险因素的患病率却有所上升。临床精神科护理中缺乏用于管理心血管危险因素的实用指南。鉴于这些事实，美国精神病学协会/美国糖尿病协会共识文件中建议对使用非典型药物治疗的患者进行监测，但在临床实践中这一监测措施尚未充分确立。定期监测可以增强患者的自我控制能力和积极性。对于相应的风险情况，必须考虑有关用药指征和治疗的进一步决策。尤其强烈建议心血管风险较高的患者参加体重管理项目以进行预防。这样一个特殊项目应包括饮食治疗、行为和运动疗法等内容。首批对照研究表明，实施这样一个结构化项目可有效预防体重增加和代谢变化。这里提出的以实践为导向的逐步实施理念旨在为实施必要的医学和心理教育措施提供参考，以便在精神分裂症患者的精神科护理中更好地管理体重及其他心血管危险因素。
