Smith Emily, Stogios Nicolette, Au Emily, Maksyutynska Kateryna, De Riddhita, Ji Andrew, Erlang Sørensen Mikkel, St John Laura, Lin Hsiang-Yuan, Desarkar Pushpal, Lunsky Yona, Remington Gary, Hahn Margaret, Agarwal Sri Mahavir
Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
Institute of Medical Science, University of Toronto, Toronto, Canada.
Acta Psychiatr Scand. 2022 Sep;146(3):201-214. doi: 10.1111/acps.13484. Epub 2022 Aug 5.
Individuals with intellectual and/or developmental disability (IDD) are often prescribed antipsychotics (APs). However, despite their known propensity to cause metabolic adverse effects, including weight gain, diabetes, and increased risk of cardiovascular events, there is currently a limited body of literature describing the metabolic consequences of AP use in this population.
We searched MEDLINE, EMBASE, PsychINFO, CENTRAL, and CINAHL databases to identify all randomized trials that reported on the metabolic effects of APs in individuals with IDD. Random effects meta-analyses were used to examine weight gain as both a continuous and dichotomous outcome.
Eighteen randomized trials met our inclusion criteria with a total of 1376 patients across a variety of IDDs. AP use was associated with significantly greater weight gain compared with placebo (Continuous: mean difference = 1.10 kg, [0.79, 1.40], p < 0.00001, I = 54%; Dichotomous: odds ratio = 3.94, [2.15, 7.23], p < 0.00001, I = 0). Sub-group analysis revealed no significant effect of AP type. Data regarding the effects of APs on other metabolic outcomes were limited.
This review (PROSPERO # CRD42021255558) demonstrates that AP use is associated with significant weight gain among patients with IDD. Concerningly, most reported studies were in children and adolescents, which sets up an already vulnerable population for adverse medical sequalae at an early age. There was also a lack of long-term studies in adults with IDD. Further studies are required to better understand how AP use affects metabolic parameters in this group of individuals.
智力和/或发育障碍（IDD）患者常被处方使用抗精神病药物（APs）。然而，尽管已知这些药物有导致代谢不良反应的倾向，包括体重增加、糖尿病和心血管事件风险增加，但目前描述该人群使用APs的代谢后果的文献有限。
我们检索了MEDLINE、EMBASE、PsychINFO、CENTRAL和CINAHL数据库，以识别所有报告APs对IDD患者代谢影响的随机试验。采用随机效应荟萃分析来检验体重增加这一连续和二分结果。
18项随机试验符合我们的纳入标准，涉及各种IDD的1376名患者。与安慰剂相比，使用APs与显著更大的体重增加相关（连续：平均差异 = 1.10 kg，[0.79, 1.40]，p < 0.00001，I² = 54%；二分：比值比 = 3.94，[2.15, 7.23]，p < 0.00001，I² = 0）。亚组分析显示AP类型无显著影响。关于APs对其他代谢结果影响的数据有限。
本综述（PROSPERO # CRD42021255558）表明，IDD患者使用APs与显著体重增加相关。令人担忧的是，大多数报告的研究是在儿童和青少年中进行的，这使这个本已脆弱的人群在早年就面临不良医疗后果。在成年IDD患者中也缺乏长期研究。需要进一步研究以更好地了解使用APs如何影响这组个体的代谢参数。
