Management of antipsychotic-related weight gain.
Management of antipsychotic-related weight gain.
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DOI：
10.1586/ern.10.85
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发表时间：
2010-07
影响因子：
4.3
通讯作者：
Correll CU
中科院分区：
文献类型：
--
作者：
Maayan L;Correll CU
尽管不同的个体和药物存在差异，但抗精神病药物与明确记录的体重增加和不良代谢影响有关。虽然食欲/卡路里摄取增加以及各种受体、激素和多肽都与此有关，但抗精神病药物导致体重增加以及血糖和血脂异常的生物学机制仍很不清楚。这阻碍了没有心脏代谢影响的抗精神病药物的开发，即使在抗精神病药物幼稚/早期患者中也是如此，以及可以预防或大幅减少心脏代谢不良影响的策略的开发。总的来说，有三种策略可以降低抗精神病药物的心脏代谢风险：1)改用食欲素/代谢不良的抗精神病药物，2)辅助性行为治疗和3)辅助性药物干预。然而，这些战略中的每一种都只是微不足道的有效。在不同的行为干预(N=14，n=746)中，集体治疗和个人治疗、饮食咨询和认知行为治疗似乎具有相同的效果。在15种不同的药理策略(N=35，n=1,629)中，只有二甲双胍、芬氟拉明、西布曲明、托吡酯和瑞波西汀比安慰剂更有效，最多的证据是二甲双胍，但没有任何比较个别药物干预的正面试验。然而，即使在最成功的试验中，风险降低也是有限的。体重没有下降到治疗前的水平，尽管与安慰剂相比具有优势，但体重增加仍然经常发生，特别是在服用抗精神病药物的幼稚患者中，以及当干预措施与抗精神病药物“预防性”共同启动时。未来的研究应侧重于结合治疗方式或药物，并探索新的基于机制的干预措施。
Despite variations across individuals and agents, antipsychotics are associated with clearly documented weight gain and adverse metabolic effects. Although increased appetite/caloric intake and various receptors, hormones and peptides have been implicated, biological mechanisms contributing to the increase in weight and glucose and lipid abnormalities with antipsychotics are largely unknown. This has hampered the creation of antipsychotics that are free of cardiometabolic effects, even in antipsychotic-naïve/early-phase patients, as well as the development of strategies that can prevent or drastically diminish the adverse cardiometabolic effects. In general, three strategies can reduce the cardiometabolic risk of antipsychotics: 1) switching to a less orexigenenic/metabolically adverse antipsychotic, 2) adjunctive behavioral treatments and 3) adjunctive pharmacologic interventions. However each of these strategies has only been modestly effective. Among different behavioral interventions (N=14, n=746), group and individual treatment, dietary counseling and cognitive-behavioral therapy seem to be similarly effective. Among 15 different pharmacologic strategies (N=35 , n=1,629), only metformin, fenfluramine, sibutramine, topiramate and reboxetine were more effective than placebo, with the most evidence being available for metformin, yet without any head-to-head trials comparing individual pharmacologic interventions. Even in the most successful trials, however, the risk reduction was modest. Weight was not decreased to a pre-treatment level, and despite superiority compared to placebo, weight gain still often occurred, particularly in antipsychotic-naïve patients and when interventions were “preventively” co-initiated with antipsychotics. Future research should focus on combining treatment modalities or agents and on exploring novel mechanism-based interventions.
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影响因子：
4.5
作者：
Bai, Ya Mei;Chen, Tzu Ting;Chen, Jen-Yeu
通讯作者：
Chen, Jen-Yeu
影响因子：
4.5
作者：
Alvarez-Jimenez, Mario;Martinez-Garcia, Obdulia;Crespo-Facorro, Benedicto
通讯作者：
Crespo-Facorro, Benedicto
影响因子：
11.3
作者：
Baptista, Trino;Uzcategui, Euderruh;de Baptista, Enma Araujo
通讯作者：
de Baptista, Enma Araujo
影响因子：
4.1
作者：
Afshar, H.;Roohafza, H.;Talaei, M.
通讯作者：
Talaei, M.
影响因子：
5.3
作者：
Alvarez-Jimenez, Mario;Gonzalez-Blanch, Cesar;Crespo-Facorro, Benedicto
通讯作者：
Crespo-Facorro, Benedicto