University Psychiatric Center, Catholic University Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium. marc.de.hert@ uc-kortenberg.be
Nat Rev Endocrinol. 2011 Oct 18;8(2):114-26. doi: 10.1038/nrendo.2011.156.
Antipsychotic medications can induce cardiovascular and metabolic abnormalities (such as obesity, hyperglycemia, dyslipidemia and the metabolic syndrome) that are associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease. Controversy remains about the contribution of individual antipsychotic drugs to this increased risk and whether they cause sudden cardiac death through prolongation of the corrected QT interval. Although some drug receptor-binding affinities correlate with specific cardiovascular and metabolic abnormalities, the exact pharmacological mechanisms underlying these associations remain unclear. Antipsychotic agents with prominent metabolic adverse effects might cause abnormalities in glucose and lipid metabolism via both obesity-related and obesity-unrelated molecular mechanisms. Despite existing guidelines and recommendations, many antipsychotic-drug-treated patients are not assessed for even the most easily measurable metabolic and cardiac risk factors, such as obesity and blood pressure. Subsequently, concerns have been raised over the use of these medications, especially pronounced in vulnerable pediatric patients, among whom their use has increased markedly in the past decade and seems to have especially orexigenic effects. This Review outlines the metabolic and cardiovascular risks of various antipsychotic medications in adults and children, defines the disparities in health care and finally makes recommendations for screening and monitoring of patients taking these agents.
抗精神病药物可引起心血管和代谢异常（如肥胖、高血糖、血脂异常和代谢综合征），从而增加 2 型糖尿病和心血管疾病的风险。关于个别抗精神病药物对这种风险的贡献以及它们是否通过延长校正 QT 间期导致心脏性猝死，仍存在争议。尽管一些药物受体结合亲和力与特定的心血管和代谢异常相关，但这些关联的确切药理学机制尚不清楚。具有明显代谢不良影响的抗精神病药物可能通过与肥胖相关和与肥胖无关的分子机制引起葡萄糖和脂质代谢异常。尽管存在现有指南和建议，但许多接受抗精神病药物治疗的患者甚至没有评估最容易测量的代谢和心脏危险因素，如肥胖和血压。因此，人们对这些药物的使用提出了担忧，尤其是在易受伤害的儿科患者中，在过去十年中，这些患者使用这些药物的情况明显增加，而且似乎具有更强的食欲刺激作用。本综述概述了各种抗精神病药物在成人和儿童中的代谢和心血管风险，定义了医疗保健方面的差异，最后为接受这些药物治疗的患者提出了筛查和监测建议。
