Boston Medical Center, Boston, Massachusetts 02118, USA.
Curr Opin Endocrinol Diabetes Obes. 2010 Oct;17(5):460-6. doi: 10.1097/MED.0b013e32833de61c.
Metabolic syndrome and cardiovascular diseases are important causes of morbidity and mortality among patients with severe mental illnesses. Atypical or second-generation antipsychotics (SGAs) are associated with obesity and other components of metabolic syndrome, particularly abnormal glucose and lipid metabolism. This review aims to provide a summary of recent evidence on metabolic risks associated with SGAs, current recommendations for metabolic monitoring, and efficacy of treatment options currently available.
Studies have identified younger, antipsychotic-naive patients with first-episode psychosis as a population vulnerable to adverse metabolic effects from SGAs. These patients gained more weight and developed evident lipid and glucose abnormalities as soon as 8-12 weeks after treatment initiation. Findings are more striking among children and adolescents. The differential effects of various SGAs are well described, with clozapine and olanzapine associated with the highest metabolic risk. In addition to behavioral therapy, emerging data suggest that pharmacological therapy, most notably metformin, is efficacious in the treatment and possibly prevention of SGA-associated metabolic derangements.
More data have become available on the burden from metabolic complications associated with SGAs. New and effective treatment options are required in the near future to improve cardiovascular health in this susceptible population.
代谢综合征和心血管疾病是严重精神疾病患者发病率和死亡率的重要原因。非典型或第二代抗精神病药物（SGAs）与肥胖和代谢综合征的其他成分有关，特别是葡萄糖和脂质代谢异常。本综述旨在总结最近关于 SGA 相关代谢风险的证据、目前对代谢监测的建议以及现有治疗选择的疗效。
研究发现，首发精神病的年轻、抗精神病药物初治患者是易受 SGA 不良代谢影响的人群。这些患者在治疗开始后 8-12 周体重增加更多，并出现明显的血脂和血糖异常。在儿童和青少年中发现的结果更为明显。各种 SGA 的差异作用得到了很好的描述，氯氮平和奥氮平与最高的代谢风险相关。除行为疗法外，新出现的数据表明，药理学治疗，尤其是二甲双胍，在治疗和可能预防 SGA 相关代谢紊乱方面是有效的。
关于与 SGAs 相关的代谢并发症的负担，已经有更多的数据可用。在不久的将来，需要新的和有效的治疗选择，以改善这一易感人群的心血管健康。
