Krill Rebecca A, Kumra Sanjiv
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
Adolesc Health Med Ther. 2014 Sep 26;5:171-82. doi: 10.2147/AHMT.S49807. eCollection 2014.
To review the metabolic consequences of second-generation antipsychotics in youth and current monitoring and intervention guidelines for optimal treatment.
Second-generation antipsychotics have largely replaced the use of first-generation antipsychotics in treating psychotic disorders in youth. In addition, there has been a dramatic increase in using these medications to treat a variety of nonpsychotic disorders. These medications have significant metabolic side effects, including weight gain. This raises concern, given the problem of pediatric obesity.
A review of current literature looking at prescribing practices and possible reasons for the increased use of second-generation antipsychotics in children and adolescents was conducted. Review of the mechanisms for why youth may be particularly vulnerable to the metabolic consequences (particularly weight gain) was similarly completed. In addition, data supporting the efficacy, rationale, and unique side-effect profile of each individual second-generation drug were evaluated to help inform providers on when and what to prescribe, along with current monitoring practices. The current evidence base for possible interventions regarding the management of antipsychotic-induced weight gain was also evaluated.
On the basis of the literature review, there are several speculated reasons for the increase in prescriptions of second-generation antipsychotics. The choice of antipsychotic for youth should be based upon the disorder being treated along with the unique side-effect profile for the most commonly used second-generation antipsychotics. Monitoring strategies are also individualized to each antipsychotic. The current interventions recommended for antipsychotic-induced weight gain include lifestyle management, switching medication to a drug with a lower propensity for weight gain, and pharmacologic (particularly metformin) treatment.
回顾第二代抗精神病药物在青少年中的代谢影响以及当前优化治疗的监测和干预指南。
第二代抗精神病药物在很大程度上已取代第一代抗精神病药物用于治疗青少年精神病性障碍。此外，使用这些药物治疗各种非精神病性障碍的情况也急剧增加。这些药物具有显著的代谢副作用，包括体重增加。鉴于儿童肥胖问题，这引发了人们的关注。
对当前文献进行综述，探讨儿童和青少年中第二代抗精神病药物处方实践及使用增加的可能原因。同样完成了对青少年为何可能特别易受代谢影响（尤其是体重增加）机制的综述。此外，评估了支持每种第二代药物疗效、理论依据和独特副作用特征的数据，以帮助医疗服务提供者了解何时及开具何种药物处方，以及当前的监测实践。还评估了关于抗精神病药物所致体重增加管理的可能干预措施的现有证据基础。
基于文献综述，第二代抗精神病药物处方增加有多种推测原因。为青少年选择抗精神病药物应基于所治疗的疾病以及最常用第二代抗精神病药物的独特副作用特征。监测策略也因每种抗精神病药物而异。目前推荐用于抗精神病药物所致体重增加的干预措施包括生活方式管理、换用体重增加倾向较低的药物以及药物治疗（尤其是二甲双胍）。
