Hendrick Victoria, Dasher Robert, Gitlin Michael, Parsi Mehrban
Olive View UCLA Medical Center, Sylmar, CA, USA. E-mail:
Ann Clin Psychiatry. 2017 May;29(2):120-124.
Patients taking antipsychotic medications are at high risk for weight gain, which in turn leads to poor health outcomes, nonadherence with treatment, and low self-esteem.
We reviewed published studies of pharmacologic interventions aimed at minimizing antipsychotic-induced weight gain. Treatments initiated prior to onset of weight gain were compared with those that started once weight gain already had occurred.
Although data are limited, adjunctive medications for weight management appear to be more effective when initiated at or near the time when patients are first exposed to antipsychotic medications. Interventions initiated later in the course of treatment-typically after weight gain already has occurred-rarely help patients return to their pretreatment weight. The most commonly used adjunctive intervention has been metformin.
Certain patients benefit from initiating metformin early in their exposure to second-generation antipsychotic agents. In particular, young, healthy patients beginning olanzapine or clozapine probably will experience less weight gain if they concomitantly initiate metformin.
服用抗精神病药物的患者体重增加风险很高，这反过来又会导致健康状况不佳、治疗依从性差和自尊心低落。
我们回顾了旨在尽量减少抗精神病药物引起的体重增加的药物干预的已发表研究。将体重增加开始前启动的治疗与体重增加已经发生后开始的治疗进行了比较。
尽管数据有限，但体重管理辅助药物在患者首次接触抗精神病药物时或接近该时间启动时似乎更有效。在治疗过程后期启动的干预措施——通常是在体重增加已经发生之后——很少能帮助患者恢复到治疗前的体重。最常用的辅助干预措施是二甲双胍。
某些患者在首次接触第二代抗精神病药物时尽早开始使用二甲双胍会受益。特别是，开始使用奥氮平或氯氮平的年轻、健康患者如果同时开始使用二甲双胍，可能体重增加会较少。
