Chang Shen-Chieh, Goh Kah Kheng, Lu Mong-Liang
Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
World J Psychiatry. 2021 Oct 19;11(10):696-710. doi: 10.5498/wjp.v11.i10.696.
Metabolic disturbances and obesity are major cardiovascular risk factors in patients with schizophrenia, resulting in a higher mortality rate and shorter life expectancy compared with those in the general population. Although schizophrenia and metabolic disturbances may share certain genetic or pathobiological risks, antipsychotics, particularly those of second generation, may further increase the risk of weight gain and metabolic disturbances in patients with schizophrenia. This review included articles on weight gain and metabolic disturbances related to antipsychotics and their mechanisms, monitoring guidelines, and interventions. Nearly all antipsychotics are associated with weight gain, but the degree of the weight gain varies considerably. Although certain neurotransmitter receptor-binding affinities and hormones are correlated with weight gain and specific metabolic abnormalities, the precise mechanisms underlying antipsychotic-induced weight gain and metabolic disturbances remain unclear. Emerging evidence indicates the role of genetic polymorphisms associated with antipsychotic-induced weight gain and antipsychotic-induced metabolic disturbances. Although many guidelines for screening and monitoring antipsychotic-induced metabolic disturbances have been developed, they are not routinely implemented in clinical care. Numerous studies have also investigated strategies for managing antipsychotic-induced metabolic disturbances. Thus, patients and their caregivers must be educated and motivated to pursue a healthier life through smoking cessation and dietary and physical activity programs. If lifestyle intervention fails, switching to another antipsychotic drug with a lower metabolic risk or adding adjunctive medication to mitigate weight gain should be considered. Antipsychotic medications are essential for schizophrenia treatment, hence clinicians should monitor and manage the resulting weight gain and metabolic disturbances.
代谢紊乱和肥胖是精神分裂症患者主要的心血管危险因素，与普通人群相比，这会导致更高的死亡率和更短的预期寿命。尽管精神分裂症和代谢紊乱可能存在某些共同的遗传或病理生物学风险，但抗精神病药物，尤其是第二代抗精神病药物，可能会进一步增加精神分裂症患者体重增加和代谢紊乱的风险。本综述纳入了有关抗精神病药物所致体重增加和代谢紊乱及其机制、监测指南和干预措施的文章。几乎所有抗精神病药物都与体重增加有关，但体重增加的程度差异很大。尽管某些神经递质受体结合亲和力和激素与体重增加及特定代谢异常相关，但抗精神病药物所致体重增加和代谢紊乱的确切机制仍不清楚。新出现的证据表明基因多态性在抗精神病药物所致体重增加和抗精神病药物所致代谢紊乱中起作用。尽管已经制定了许多抗精神病药物所致代谢紊乱的筛查和监测指南，但它们在临床护理中并未得到常规实施。许多研究还探讨了管理抗精神病药物所致代谢紊乱的策略。因此，必须对患者及其护理人员进行教育并激励他们通过戒烟、饮食和体育活动计划来追求更健康的生活。如果生活方式干预失败，应考虑换用另一种代谢风险较低的抗精神病药物或加用辅助药物以减轻体重增加。抗精神病药物对精神分裂症治疗至关重要，因此临床医生应监测并管理由此导致的体重增加和代谢紊乱。
