Hyperglycemia associated with the use of atypical antipsychotics.
Hyperglycemia associated with the use of atypical antipsychotics.
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发表时间：
2001-01
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通讯作者：
J. Lindenmayer;Ann-Marie Nathan;Robert C. Smith
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作者：
J. Lindenmayer;Ann-Marie Nathan;Robert C. Smith
现有文献表明，精神分裂症患者有患糖尿病的风险，服用抗精神病药物进一步增加了发展为非胰岛素依赖型高血糖的机会。病例报告、图表回顾和临床药物试验的一些结果表明，精神分裂症患者的血糖水平与氯氮平或奥氮平的治疗之间存在关系，尽管服用利培酮和奎硫平的患者也有少数高血糖病例的报道。这些研究表明，高血糖不是剂量依赖性的，停止使用氯氮平或奥氮平治疗后是可逆的，并在重新引入这些治疗时再次出现。精神分裂症患者参与这一过程的潜在机制包括(1)独立于非典型药物的胰岛素敏感性降低，(2)与非典型药物相关的胰岛素抵抗增加，(3)非典型药物对5-羟色胺受体的影响，以及(4)由于体重增加而过度使用胰岛素。详细讨论了这些机制，并对非典型抗精神病药物的管理提出了建议。超重、种族、糖尿病或高血压家族或个人病史，以及在治疗过程中体重增加，都被确定为精神分裂症患者发生高血糖的危险因素。然而，在完全依赖现有病例研究和没有适当的流行病学研究的情况下，很难在统计上评估每种类型的抗精神病药物组中糖尿病的真实发病率。
The available literature suggests that patients with schizophrenia are at risk for diabetes mellitus and taking antipsychotic medication further increases the chance of developing non-insulin-dependent hyperglycemia. Case reports, chart reviews, and some results from clinical drug trials implicate a relationship between glucose levels and treatment with clozapine or olanzapine in patients with schizophrenia, although a few cases of hyperglycemia have also been reported in patients taking risperidone and quetiapine. These studies indicate that hyperglycemia is not dose dependent, is reversible on cessation of treatment with clozapine or olanzapine, and reappears on reintroduction of these therapies. The postulated underlying mechanisms involved in this process in patients with schizophrenia include (1) a decreased sensitivity to insulin that is independent of atypical medication, (2) an increased insulin resistance related to atypical medications, (3) the effects of atypical medications on serotonin receptors, and (4) overuse of insulin due to weight gain. These mechanisms are discussed in detail, and recommendations for the administration of atypical antipsychotics are offered. Overweight, ethnicity, family or personal history of diabetes mellitus or hypertension, and weight gain during the course of treatment have all been identified as risk factors in the development of hyperglycemia in patients with schizophrenia. However, it is difficult to statistically assess the true incidence of diabetes within each type of antipsychotic medication group with the exclusive dependence on available case studies and without proper epidemiologic research.