Goltz Jeffrey, Ivanov Iliyan, Rice Timothy R
Zucker Hillside Hospital, Glen Oaks, NY, USA.
Mount Sinai Health System, New York, NY, USA.
Int J Dev Disabil. 2019 Jul 14;67(3):159-167. doi: 10.1080/20473869.2019.1638583.
The purpose of this review was to understand the impact of second generation antipsychotic (SGA)-induced weight gain on youth with autism spectrum disorders (ASDs), including the clinical evidence, mechanisms, monitoring guidelines, and treatments. To achieve this, multiple MEDLINE/PUBMED and Google database searches were performed and analyzed articles from January 2001 to April 2018. Existing evidences indicates youth with ASDs may be more prone to SGA-induced weight gain than youth with other psychiatric illnesses. The mechanism by which such weight gain occurs is unclear, but is likely multifactorial. Guidelines have been developed to monitor SGA-induced weight gain, though the existing guidelines have had limited adherence by clinicians. The available randomized control trials that have analyzed the benefit of metformin in youth suffering from SGA-induced weight gain have produced conflicting results, but the data looking specifically at youth with ASD have been positive. Increasing data on use of topiramate, melatonin, and zonisamide to treat SGA-induced weight gain in youth also exists and warrants further study. However, overall, the current understanding of the effect of SGA-induced weight gain on youth with ASD and the therapeutic use of medications like metformin is limited, but the existing literature provides useful guidelines for future research. The clinical algorithms for monitoring and managing SGA-induced weight gain have shown promise; however, their utility in routine clinical practice requires further investigation.
本综述的目的是了解第二代抗精神病药物（SGA）所致体重增加对自闭症谱系障碍（ASD）青少年的影响，包括临床证据、机制、监测指南及治疗方法。为此，我们对MEDLINE/PUBMED以及谷歌数据库进行了多次检索，并分析了2001年1月至2018年4月期间的相关文章。现有证据表明，与患有其他精神疾病的青少年相比，ASD青少年可能更容易出现SGA所致体重增加。体重增加的发生机制尚不清楚，但可能是多因素的。虽然已经制定了监测SGA所致体重增加的指南，但临床医生对现有指南的遵循程度有限。分析二甲双胍对SGA所致体重增加青少年益处的现有随机对照试验结果相互矛盾，但专门针对ASD青少年的数据是积极的。关于使用托吡酯、褪黑素和唑尼沙胺治疗青少年SGA所致体重增加的数据也在增加，值得进一步研究。然而，总体而言，目前对SGA所致体重增加对ASD青少年的影响以及二甲双胍等药物的治疗用途的了解有限，但现有文献为未来研究提供了有用的指南。监测和管理SGA所致体重增加的临床算法已显示出前景；然而，它们在常规临床实践中的效用需要进一步研究。
