Rojnic Kuzman Martina, Bosnjak Kuharic Dina, Kekin Ivana, Makaric Porin, Madzarac Zoran, Koricancic Makar Ana, Kudlek Mikulic Suzan, Bajic Zarko, Bistrovic Petra, Bonacin Dora, Vogrinc Zeljka
Department of Psychiatry, University Hospital Centre Zagreb, Zagreb, Croatia.
Zagreb School of Medicine, University of Zagreb, Zagreb, Croatia.
Front Psychiatry. 2018 Oct 16;9:488. doi: 10.3389/fpsyt.2018.00488. eCollection 2018.
Antipsychotic-induced weight gain and metabolic abnormalities are one of the major challenges in the treatment of psychosis, contributing to the morbidity, mortality and treatment non-adherence. Different approaches were used to counteract these side effects but showed only limited or short-term effects. This study aims to analyse the effects of a long-term multimodal treatment program for first episode psychosis on antipsychotic-induced metabolic changes. We enrolled 71 patients with first episode psychosis treated at the Zagreb University Hospital Centre from 2016 until 2018. Participants were assigned to one of the two groups: day hospital program vs. treatment as usual (TAU). Outcomes were: body weight, blood glucose, lipids and cholesterol, psychopathology and global level of functioning during the 18-months follow-up. Although the TAU group gained more weight and had higher increase of blood glucose, while the day hospital group had a higher increase in total cholesterol at 18th month follow-up, after the adjustment for age, gender and baseline measures, the type of treatment was not significantly associated with any of the primary outcome measures. Patients' psychopathology measures significantly decreased and their functional level significantly increased at month 18th in both groups. While both types of treatment were effective in reducing psychopathology and restoring the patients' level of functioning, both were relatively ineffective in counteracting antipsychotic-induced metabolic abnormalities and antipsychotic-induced weight gain.
抗精神病药物引起的体重增加和代谢异常是精神病治疗中的主要挑战之一，会导致发病率、死亡率以及治疗依从性问题。人们采用了不同方法来对抗这些副作用，但效果有限或只是短期有效。本研究旨在分析针对首发精神病的长期多模式治疗方案对抗精神病药物引起的代谢变化的影响。我们纳入了2016年至2018年在萨格勒布大学医院中心接受治疗的71例首发精神病患者。参与者被分为两组之一：日间医院项目组与常规治疗组（TAU）。观察指标包括：18个月随访期间的体重、血糖、血脂和胆固醇、精神病理学以及整体功能水平。尽管在第18个月随访时，常规治疗组体重增加更多且血糖升高幅度更大，而日间医院组总胆固醇升高幅度更大，但在对年龄、性别和基线指标进行调整后，治疗类型与任何主要观察指标均无显著关联。两组患者的精神病理学指标在第18个月时均显著下降，功能水平均显著提高。虽然两种治疗方式在减轻精神病理学症状和恢复患者功能水平方面均有效，但在对抗抗精神病药物引起的代谢异常和抗精神病药物引起的体重增加方面相对无效。
