Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada.
Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada.
Nutrients. 2020 Dec 18;12(12):3883. doi: 10.3390/nu12123883.
Disturbed eating behaviours have been widely reported in psychotic disorders since the early 19th century. There is also evidence that antipsychotic (AP) treatment may induce binge eating or other related compulsive eating behaviours. It is therefore possible that abnormal eating patterns may contribute to the significant weight gain and other metabolic disturbances observed in patients with psychosis. In this scoping review, we aimed to explore the underlying psychopathological and neurobiological mechanisms of disrupted eating behaviours in psychosis spectrum disorders and the role of APs in this relationship. A systematic search identified 35 studies that met our eligibility criteria and were included in our qualitative synthesis. Synthesizing evidence from self-report questionnaires and food surveys, we found that patients with psychosis exhibit increased appetite and craving for fatty food, as well as increased caloric intake and snacking, which may be associated with increased disinhibition. Limited evidence from neuroimaging studies suggested that AP-naïve first episode patients exhibit similar neural processing of food to healthy controls, while chronic AP exposure may lead to decreased activity in satiety areas and increased activity in areas associated with reward anticipation. Overall, this review supports the notion that AP use can lead to disturbed eating patterns in patients, which may contribute to AP-induced weight gain. However, intrinsic illness-related effects on eating behaviors remain less well elucidated, and many confounding factors as well as variability in study designs limits interpretation of existing literature in this field and precludes firm conclusions from being made.
自 19 世纪初以来，精神障碍患者中就广泛报道了饮食行为障碍。也有证据表明，抗精神病药物（AP）治疗可能会引起暴食或其他相关的强迫性进食行为。因此，异常的饮食模式可能是导致精神病患者体重显著增加和其他代谢紊乱的原因之一。在本次范围综述中，我们旨在探讨精神分裂症谱系障碍中饮食行为障碍的潜在心理病理学和神经生物学机制，以及抗精神病药物在这种关系中的作用。系统检索确定了符合纳入标准的 35 项研究，并纳入了我们的定性综合分析。综合自我报告问卷和食物调查的证据，我们发现，精神病患者表现出食欲增加和对高脂肪食物的渴望，以及卡路里摄入量增加和吃零食增加，这可能与抑制力下降有关。来自神经影像学研究的有限证据表明，首次发作的抗精神病药物初治患者对食物的神经处理与健康对照组相似，而慢性抗精神病药物暴露可能导致饱腹感区域的活动减少和与奖励预期相关的区域的活动增加。总的来说，该综述支持这样一种观点，即抗精神病药物的使用会导致患者出现饮食紊乱，这可能是抗精神病药物引起体重增加的原因。然而，与疾病相关的内在因素对饮食行为的影响仍不太清楚，许多混杂因素以及研究设计的变异性限制了对该领域现有文献的解释，也无法得出确定的结论。
