Sjo Christina Power, Stenstrøm Anne Dorte, Bojesen Anders Bo, Frølich Jacob Stampe, Bilenberg Niels
1 Child and Adolescent Psychiatric Department, Odense, Mental Health Hospital and University Clinic , Region of Southern Denmark, Odense, Denmark .
2 Clinical Institute, University of Southern Denmark , Odense, Denmark .
J Child Adolesc Psychopharmacol. 2017 Dec;27(10):884-891. doi: 10.1089/cap.2016.0171. Epub 2017 Aug 7.
Mental illness is often accompanied by poor physical health and shorter life expectancy. Second-generation antipsychotics (SGAs) are suspected of increasing cardiovascular risk, possibly through development of metabolic syndrome (MetS), and the risk of adverse outcome is even higher if obesity or metabolic aberration starts in childhood or adolescence.
Drug-naive adolescents were recruited after contact with an outpatient Psychosis Team. Changes relative to baseline in body mass index (BMI), waist circumference (WC), blood pressure (BP), fasting blood glucose (FBG), triglycerides (TG), and high-density lipoprotein (HDL) cholesterol were determined through regular follow-ups.
The sample included 35 SGA-naive patients aged 7-19 (mean: 15.5) with a diagnosis of psychosis. Over 12 months, the overall rate of MetS changed significantly (from 0% to 20% [p < 0.016]). There was a significant increase in BMI (18.4% [p < 0.001]), WC (14.3% [p < 0.001]), TG (25.2% [p = 0.039]), and FBG (3.6% [p = 0.038]), whereas there was a significant decrease in HDL (-11.5% [p < 0.001]). No significant change was found for BP. Compared with the 2014 Danish references BMI-for-age charts, after 12 months the participants' BMI had increased from 0.5 to 1.57 standard deviation (SD) above the 50th percentile for age and gender (p = 0.0001).
To our knowledge, this is the first study to include all the aspects of MetS in a sample of drug-naive adolescents followed over the first 12 months after starting SGA treatment. A significant shift in all parameters (except BP) toward MetS was found, presumably due to SGA use. Therefore, these adolescents will need proper follow-up, consisting of not only monitoring but also preventive measures to diminish these effects of SGA use.
精神疾病常伴有身体健康状况不佳和预期寿命缩短。第二代抗精神病药物（SGA）被怀疑会增加心血管疾病风险，可能是通过引发代谢综合征（MetS），而且如果肥胖或代谢异常始于儿童期或青少年期，不良后果的风险会更高。
在与门诊精神病团队接触后招募未服用过药物的青少年。通过定期随访确定体重指数（BMI）、腰围（WC）、血压（BP）、空腹血糖（FBG）、甘油三酯（TG）和高密度脂蛋白（HDL）胆固醇相对于基线的变化。
样本包括35名年龄在7至19岁（平均15.5岁）、诊断为精神病的未服用过SGA的患者。在12个月期间，MetS的总体发生率有显著变化（从0%升至20%[p < 0.016]）。BMI（18.4%[p < 0.001]）、WC（14.3%[p < 0.001]）、TG（25.2%[p = 0.039]）和FBG（3.6%[p = 0.038]）有显著升高，而HDL有显著下降（-11.5%[p < 0.001]）。未发现BP有显著变化。与2014年丹麦按年龄划分的BMI参考图表相比，12个月后参与者的BMI从第50百分位年龄和性别的标准差（SD）之上0.5升至1.57（p = 0.0001）。
据我们所知，这是第一项在开始SGA治疗后的头12个月对未服用过药物的青少年样本进行随访时涵盖MetS所有方面的研究。发现所有参数（除BP外）都明显朝着MetS方向转变，推测是由于使用SGA所致。因此，这些青少年需要适当的随访，不仅包括监测，还应采取预防措施以减轻使用SGA带来的这些影响。
