Can Fam Physician. 2018 Sep;64(9):660-662.
A 10-year-old male patient presented to my clinic with irritability associated with autism spectrum disorder, and previous therapeutic efforts had not been successful. Treatment with quetiapine has considerably reduced irritability and improved his quality of life; however, the patient's mother has stated that her child's clothes are no longer fitting because his waist size has increased substantially, and that he has gained 5 kg since treatment initiation 8 weeks ago. Should second-generation antipsychotic (SGA) treatment be stopped or continued, and how can these side effects be best mitigated in a family practice setting? Use of SGAs in pediatric patients has increased in recent years, which has brought to light a number of worrisome metabolic side effects that occur in children. Owing to the efficacy of treatment, SGAs must often be continued despite side effects. Even if the drug has been prescribed elsewhere, family physicians should closely monitor these patients following the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children guidelines. When starting an SGA, patients and their families should be educated on the importance of healthy eating and physical activity to preemptively mitigate potential side effects. Recent studies have also shown adjunctive metformin to have a potential role in reducing weight gain.
一位 10 岁男性患者因自闭症谱系障碍伴发的烦躁不安就诊于我的诊所，先前的治疗尝试均未成功。喹硫平治疗显著减轻了他的烦躁不安症状，提高了他的生活质量；然而，患儿的母亲表示，孩子的衣服不再合身，因为他的腰围明显增大，且自 8 周前开始治疗以来体重增加了 5 公斤。是否应该停止或继续第二代抗精神病药物（SGA）治疗，在家庭医疗环境中如何最好地减轻这些副作用？近年来，儿科患者中 SGA 的使用有所增加，这凸显了儿童中出现的一些令人担忧的代谢副作用。由于治疗效果，尽管存在副作用，SGAs 通常仍需继续使用。即使药物是在其他地方开的处方，家庭医生也应根据加拿大儿童抗精神病药监测有效性和安全性联盟的指南密切监测这些患者。开始使用 SGA 时，应向患者及其家属教育健康饮食和身体活动的重要性，以预先减轻潜在的副作用。最近的研究还表明，二甲双胍辅助治疗可能在减轻体重增加方面具有一定作用。
