Bae Heewon, Lee Ji Hyun, Je Sungsuk, Lee Seung-Hoon, Choi Hayun
Veterans Medical Research Institute, Veteran Health Service Medical Center, Seoul, Republic of Korea.
Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea.
Psychiatry Investig. 2024 Feb;21(2):111-122. doi: 10.30773/pi.2023.0301. Epub 2024 Feb 22.
Second-generation antipsychotics (SGAs) have revolutionized the treatment of psychiatric disorders, but are associated with significant metabolic risks, including diabetes and hyperglycemic crises. This review explores the complex interplay between antipsychotics, diabetes, and hyperglycemic crises, highlighting the mechanisms underlying SGA-induced diabetes.
We present the case of a patient with schizophrenia who was taking antipsychotic medication and was admitted to the emergency room due to the sudden onset of diabetic ketoacidosis (DKA) without any history of diabetes. We extensively searched databases, including Elsevier, PubMed, IEEE, SpringerLink, and Google Scholar, for papers on the effects of antipsychotic drugs on DKA from 2002 to 2021. We focused on DKA, hyperglycemia, and atypical antipsychotics, and retrieved 117 papers. After full-text review, 32 papers were included in this comprehensive review.
DKA was significantly more frequent in patients taking SGAs. Antipsychotics can induce insulin resistance either directly or through the onset of obesity. Antipsychotics can reduce insulin secretion from pancreatic β-cells, which is associated with absolute insulin deficiency.
As the use of antipsychotics continues to increase, understanding their risks and mechanisms is crucial for clinicians to enable informed treatment decisions and prevent potentially life-threatening complications.
第二代抗精神病药物（SGAs）彻底改变了精神疾病的治疗方式，但与显著的代谢风险相关，包括糖尿病和高血糖危象。本综述探讨了抗精神病药物、糖尿病和高血糖危象之间的复杂相互作用，重点阐述了SGA诱发糖尿病的潜在机制。
我们报告了一例精神分裂症患者的病例，该患者正在服用抗精神病药物，因突发糖尿病酮症酸中毒（DKA）且无糖尿病病史而被送入急诊室。我们广泛检索了包括爱思唯尔、PubMed、IEEE、SpringerLink和谷歌学术在内的数据库，以查找2002年至2021年期间关于抗精神病药物对DKA影响的论文。我们重点关注DKA、高血糖和非典型抗精神病药物，并检索到117篇论文。经过全文审查，32篇论文被纳入本综述。
服用SGAs的患者中DKA的发生率显著更高。抗精神病药物可直接或通过引发肥胖导致胰岛素抵抗。抗精神病药物可减少胰腺β细胞的胰岛素分泌，这与绝对胰岛素缺乏有关。
随着抗精神病药物的使用持续增加，了解其风险和机制对于临床医生做出明智的治疗决策以及预防潜在的危及生命的并发症至关重要。
