Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.
Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
Ir J Psychol Med. 2021 Mar;38(1):49-55. doi: 10.1017/ipm.2020.1. Epub 2020 Feb 20.
Clozapine is the most effective antipsychotic medication, but it has the highest propensity for metabolic side effects. A clozapine clinic was established within an early intervention for psychosis service to facilitate the timely commencement of clozapine and to manage the associated adverse effects. This study describes the changes in the weight, body mass index (BMI), waist circumference and blood pressure after 6 months in young people commenced on clozapine.
This was a prospective cohort study of all young people, aged 15-24 years, commenced on clozapine within an early intervention service in Melbourne, Australia, between 01.04.2016 and 30.06.2018. Continuous data were analyzed with paired t-test and categorical with Wilcoxon signed-rank test.
Twenty-six young people received 6 months of treatment with clozapine, of whom the mean age was 19.8 years (s.d. ±3.1) and 66.7% were male. After 6 months, the mean weight gain was 5.1 kg (s.d. ±10.1 kg) and over half (53.8%) gained clinically significant weight. The proportion of young people classified as either overweight or obese rose from 69.2% to 88.5% (p = 0.006). The proportion of young people with a waist circumference above the recommended parameters increased from 57.9% to 78.9% (p = 0.008). Hypertension was present in 30%, and after 6 months, 45% had hypertension (p = 0.64). Metformin was prescribed to 34.6%, typically to those with the greatest and most rapid weight gain.
Among young people with treatment resistant psychosis, clozapine is associated with significant metabolic side effects in the early stages of commencement. More interventions aimed at attenuating this weight gain are needed.
氯氮平是最有效的抗精神病药物，但它有最高的代谢副作用倾向。在精神病早期干预服务中设立了氯氮平诊所，以方便及时开始氯氮平治疗，并管理相关的不良反应。本研究描述了在澳大利亚墨尔本的早期干预服务中，在开始使用氯氮平的 6 个月内，年轻人的体重、体重指数（BMI）、腰围和血压的变化。
这是一项对所有在 2016 年 4 月 1 日至 2018 年 6 月 30 日期间在澳大利亚墨尔本的早期干预服务中开始使用氯氮平的 15-24 岁年轻人的前瞻性队列研究。连续数据采用配对 t 检验，分类数据采用 Wilcoxon 符号秩检验。
26 名年轻人接受了 6 个月的氯氮平治疗，平均年龄为 19.8 岁（标准差 ±3.1），66.7%为男性。6 个月后，平均体重增加了 5.1 公斤（标准差 ±10.1 公斤），超过一半（53.8%）的人体重增加了临床显著的体重。超重或肥胖的年轻人比例从 69.2%上升到 88.5%（p = 0.006）。腰围超过推荐参数的年轻人比例从 57.9%上升到 78.9%（p = 0.008）。高血压的患病率为 30%，6 个月后，45%的人患有高血压（p = 0.64）。二甲双胍被开给 34.6%的人，通常是那些体重增加最大和最快的人。
在治疗抵抗性精神病的年轻人中，氯氮平在开始治疗的早期阶段与显著的代谢副作用相关。需要更多的干预措施来减轻这种体重增加。
