Department of Psychiatry, New York University School of Medicine, NY, USA.
Clin Drug Investig. 2011;31(7):455-82. doi: 10.2165/11589060-000000000-00000.
Antipsychotic therapy forms the cornerstone of treatment for people with severe mental illness. Second-generation (atypical) antipsychotics are associated with a significantly lower incidence of extrapyramidal symptoms than the typical, first-generation agents; however, changes in metabolic variables -- including impaired glucose metabolism, diabetes mellitus, weight gain and dyslipidaemia -- have been reported during treatment with second-generation antipsychotics. Understanding any potential link between antipsychotic treatment and the incidence of these events is complicated by the increasing prevalence of obesity and diabetes occurring in the general population and the increased risk of diabetes and changes in metabolic variables in people with schizophrenia. While relative risk estimates are inconsistent, the association between atypical antipsychotics and increases in glucose level appears to fall on a continuum, with olanzapine appearing to have a greater association than some other atypical antipsychotics. The PubMed database was used to search for publications that included any information on measures of changes in weight, body mass index (BMI) and/or metabolic variables in randomized studies of olanzapine published between 1992 and 2010. In long-term (≥48 weeks) studies of olanzapine, the mean weight gain was 5.6 kg (last observation carried forward; median exposure 573 days). The proportions of patients who gained at least 7%, 15% or 25% of their baseline weight with long-term exposure were 64%, 32% and 12%, respectively. Some studies have suggested that weight gain early during the course of olanzapine treatment may predict clinically significant weight gain following long-term exposure to the drug. Changes in metabolic variables, such as elevated indices of glucose metabolism and triglyceride level, have also been observed during treatment with olanzapine. Consensus guidelines emphasize the importance of appropriate baseline screening and ongoing monitoring of weight gain and metabolic variables for people receiving all antipsychotic treatments. Long-term weight management programmes have been shown to reduce weight gain in some patients.
抗精神病药物治疗是严重精神疾病患者治疗的基石。第二代（非典型）抗精神病药物与典型第一代药物相比，锥体外系症状的发生率明显降低；然而，在使用第二代抗精神病药物治疗期间，已经报道了代谢变量的变化，包括葡萄糖代谢受损、糖尿病、体重增加和血脂异常。由于肥胖和糖尿病在普通人群中的发病率不断增加，以及精神分裂症患者发生糖尿病和代谢变量变化的风险增加，理解抗精神病药物治疗与这些事件的发生率之间的任何潜在联系变得复杂。虽然相对风险估计不一致，但非典型抗精神病药物与血糖升高之间的关联似乎呈连续变化，奥氮平的关联似乎比其他一些非典型抗精神病药物更大。使用 PubMed 数据库搜索了 1992 年至 2010 年期间发表的关于奥氮平随机研究中体重、体重指数（BMI）和/或代谢变量变化测量的任何信息的出版物。在奥氮平的长期（≥48 周）研究中，平均体重增加了 5.6kg（最后一次观察到的向前推进；中位数暴露 573 天）。长期暴露后体重增加至少 7%、15%或 25%的患者比例分别为 64%、32%和 12%。一些研究表明，奥氮平治疗早期的体重增加可能预示着长期暴露于该药物后体重的显著增加。在奥氮平治疗期间，还观察到代谢变量的变化，如葡萄糖代谢和甘油三酯水平升高的指数。共识指南强调了对接受所有抗精神病药物治疗的患者进行适当的基线筛查和体重增加及代谢变量的持续监测的重要性。长期体重管理计划已被证明可以减少一些患者的体重增加。
