精神分裂症并发糖尿病的相关因素分析

目的了解住院精神分裂症患者并发糖尿病的相关因素。方法回顾性调查符合CCMD-3诊断标准的住院精神分裂症患者中的糖尿病发病情况以及抗精神病药物的使用情况等相关因素，并观察体重、血糖和血脂的变化。结果在302例精神分裂症患者中，并发糖尿病者为39例（12．91％），其发生与患者的年龄、病程、体重、血脂和阳性糖尿病家族史以及使用抗精神病药物有相关性。结论精神分裂症患者中糖尿病的发生率远高于普通人群，年龄较大、病程较长以及抗精神病药物的长期使用均可增加糖尿病的发生率。     

精神分裂症并发糖尿病的相关因素分析

目的了解住院精神分裂症患者并发糖尿病的相关因素。方法回顾性调查符合CCMD-3诊断标准的住院精神分裂症患者中的糖尿病发病情况以及抗精神病药物的使用情况等相关因素,并观察体重、血糖和血脂的变化。结果在302例精神分裂症患者并发糖尿病者为39例(12.91%),其发生与患者的年龄、病程、体重、血脂和阳性糖尿病家族史以及使用抗精神病药物有相关性。结论精神分裂症患者中糖尿病的发生率远高于普通人群,年龄较大、病程较长以及抗精神病药物的长期使用均可增加糖尿病的发生率。     

住院精神分裂症伴发糖尿病的相关因素分析

目的探讨住院精神分裂症患者伴发糖尿病的相关因素。方法将我院住院精神分裂症患者伴发糖尿病52例作为研究组,52例无糖尿病患者为对照组。比较两者甘油三酯、胆固醇、体重指数（BMI）。结果两组在BMI、胆固醇、总病程、糖尿病家族史、联合用药方面有显著差异（P〈0.05）;两组在年龄、甘油三酯方面差异则无显著性（P〉0.05）。结论精神分裂症伴发糖尿病的影响因素是多方面的,与总病程、联合抗精神病药、糖尿病家族史。BMI及胆固醇相关。     

抗精神病药物与高血糖关系探讨

目的：了解分析目前在我院住院治疗的精神分裂症患者血糖增高情况及其与患者病程，服抗精神病药物等因素关系。方法：调查分析符合CCMD3诊断标准的住院精神分裂症患者中高血糖发生情况，以及分析患者患病病程，糖尿病家族史，抗精神病药物的使用情况等相关因素，并观察患者体重，体重指数，血糖变化。将精神分裂症患者高血糖发生率与脸群患病率进行比较，分析产生高血糖的相关因素。结果：165例精神分裂症住院患者中高血糖发生率16．4％，为普通人群患糖尿病率2．5％的7倍。长期服用抗精神病药物会引起体重、体重指数增加及患者高血糖的发生与病程长短，患者年龄，糖尿病家族史阳性等因素有关。患者的高血糖发生，服非经典与经典抗精神病药物相比较无显著差异。两种以上抗精神病药物联用者高血糖发生率高。结论：精神分裂症患者长期服抗精神病药物引起体重、体重指数增加及其高血糖的发生率远高于一般人群。精神分裂症患者血糖增高可能是长期服抗精神病药物所致的一种延迟性，慢性药物不良反应的表现。应引起临床工作者关注。     

精神分裂症与糖尿病关系的探讨

目的：了解住院精神分裂症患者中糖尿病的发病情况及其与抗精神病药等因素的关系。方法：回顾性调查符合CCMD－2－R诊断标准的住院精神分裂症患者中的糖尿病发病情况以及抗精神病药的使用情况等相关因素,观察体重、血糖和血脂的变化。糖尿病的诊断按照 WHO关于糖尿病的诊断标准（1980年）作出。将精神分裂症患者中的糖尿病发生率与一般人群中的患病率进行比较,并分析影响糖尿病发生的相关因素。结果：在503例精神分裂症住院患者中,糖尿病的发生率为15．1％,为普通人群（2．5％）的6倍（x^2＝18．10,P＜0．01）。抗精神病药物可引起体重的显著增加(t＝5．45,P＜0．01）。糖尿病的发生与精神分裂症的持续病程、长期住院、患者的年龄以及阳性糖尿病家族史等因素有关。氯氮平对糖尿病的影响与其他抗精神药物无显著差异（x^2＝0．38,P＞0．05）。结论：精神分裂症患者中糖尿病的发生率远高于普通人群,抗精神病药物引起的体重增加可能与此有关,临床上应予以关注。     

长期住院精神分裂症患者伴发糖尿病与迟发性运动障碍的研究

目的　本研究旨在探讨长期住院精神分裂症患者伴发糖尿病的危险因素及与迟发性运动障碍的相互关系。方法　对长期住院的精神分裂症患者进行调查。精神分裂症患者符合CCMD - 3诊断标准 ,糖尿病符合1985年WHO糖尿病诊断标准 ,共有 5 9例诊断为糖尿病 ,再选择与之相匹配的 5 9例无糖尿病患者为对照组。对所有入组者使用异常不自主运动量表 (AIMS)评定迟发性运动障碍 (TD)。结果　年龄、总病程、甘油三酯及脂肪肝为长期服用抗精神病药的精神分裂症患者易患糖尿病的危险性因素 ;TD的严重程度与血糖呈线性正相关。结论　对年龄偏大 (5 0岁以上者 )、且病程长的患者应注意尽量控制血脂 ,以防罹患脂肪肝 ,并应密切观察TD的发生 ,从而可减少糖尿病的发生和提高患者的生活质量。     

精神药物的不良反应（三） 长期住院精神分裂症患者伴发代谢综合征情况

目的：了解长期住院精神分裂症患者伴发代谢综合征（MS）的情况。方法：抽样调查住院至少2年以上的长期住院精神分裂症患者,测定患者身高、腰围、体质量及代谢指标,依据世界糖尿病联盟（IDF）规定的诊断标准甄别出MS患者;同时调查与之相关的抗精神病药使用情况。结果：MS发生率为43.4%,女性52.0%高于男性34.9%（χ2=7.420,P〈0.01）;Logistic回归分析发现MS与性别、体质量指数有关;抗精神病药种类与MS发生无显著相关。结论：长期住院接受抗精神病药治疗的精神分裂症患者伴发MS较高。     

730例慢性精神分裂症患者血脂情况调查分析

目的了解慢性精神分裂症患者血脂异常的发生率及影响因素,为制定干预措施提供依据。方法对上海市民政系统三所精神卫生中心目前全部在院的慢性精神分裂症进行调查,选择抗精神病药治疗前无糖尿病、高血压、高血脂等代谢性疾病,病程5年以上,单一抗精神病药治疗至少持续1年以上的慢性精神分裂症患者进行血脂检测,并采用统一的自编调查统计表,内容包括年龄、病程、服药时间、药品种类、剂量、身高、腰围、体重等指标,并对结果进行分析。结果 730例慢性精神分裂症患者血脂异常总发生率为18.4%,胆固醇异常率为4.39%,甘油三酯异常率为12.33%,二者均升高为1.78%,血脂异常发生与非典型抗精神病药、体重指数增加密切相关,并存在性别差异,女〉男。结论慢性精神分裂症患者血脂异常发生率高,与非典型抗精神病药、体重指数密切相关,尤其对女性影响更大,应引起临床医师高度重视,并进行早期干预。     

抗精神病药物对首发精神分裂症患者糖脂代谢和体重的影响

目的比较抗精神病药物对首发精神分裂症患者血糖、血脂及体重的影响,评价不同药物的安全性。方法对门诊／住院首发精神分裂症患者作为期一年药物治疗的随访观察,比较单一使用非典型抗精神病药（维思通、喹硫平、阿立哌唑）和典型抗精神病药（氯丙嗪）患者的空腹血糖、体重指数（BMI）、血脂的变化。结果完成一年随访患者179例,其中出现空腹血糖超标22例（12．3％）,确诊糖尿病1例;新增高甘油三脂48例（26．8％）、高胆固醇31例（17．3％）;单因素相关分析显示,血糖超标与体重指数、年龄、病程及高甘油三脂呈显著性相关,而与用药选择无显著性相关;各组药物对糖脂代谢均有影响,阿立哌唑对精神分裂症患者的体重、血糖、血脂影响最小;Logistic回归分析结果显示体重指数增加、病程长是血糖超标的危险因素。结论抗精神病药物对精神分裂症患者糖脂代谢、体重增加等方面均有不同程度的影响,应预测性评估、定期监测和提早干预。     

503例住院精神分裂症患者共患糖尿病的调查

目的：调查住院精神分裂症患者糖尿病的发生情况及相关因素。方法：对503例住院精神分裂症患者进行病历资料回顾，体格检查及血生化检测。结果：住院精神分裂症患者糖尿病的时点患病率为12．9％，显著高于一般人群的3．21％（OR=4．48，CI=3．43～5．84，P〈0．01）。40—49岁的患者中糖尿病患病率增高明显（14．6％vs．3．02％，OR=5．51，CI=3．49～8．70，P〈0．01）。糖尿病发生与年龄、体质量超重及腹型肥胖有关。糖尿病组患者的病程比非糖尿病患者长（Z=-6．989，P〈0．01），接受目前抗精神病药物治疗时间也比非糖尿病患者长（Z=-4．794，P〈0．01）。氯氮平新发糖尿病患病率高于利培酮组与经典药物组（P〈0．01），利培酮组与经典药物组患病率差异无统计学意义（P〉0．05）。结论：住院精神分裂症患者糖尿病患病率高于一般人群，与患者年龄、体质量超重、病程及抗精神病药治疗时间有关。氯氮平比利培酮及经典药物可能更容易导致糖尿病的发生。     

Antipsychotic metabolic effects: weight gain, diabetes mellitus, and lipid abnormalities.

OBJECTIVE: To review published and nonpublished literature describing changes in weight, glucose homeostasis, and lipid milieu with antipsychotics. METHODS: A Medline search was completed using the words weight gain, diabetes mellitus, cholesterol, triglycerides, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, predictors, prolactin, obesity, and conventional antipsychotics. Publications, including original articles, review articles, letters to the editor, abstracts or posters presented at professional meetings in the last 4 years, and references from published articles, were collected. Manufacturers, including Eli Lilly Canada Inc, JanssenOrtho Inc, Pfizer Canada Inc, AstraZeneca Inc, and Novartis Pharmaceuticals, were contacted to retrieve additional medical information. RESULTS: The topic of antipsychotic-induced weight gain is understudied, and there are relatively few well-controlled studies. Weight gain as a side effect has been described with both conventional and atypical antipsychotics. Moreover, some atypical antipsychotics are associated with de novo diabetes mellitus and increased serum triglyceride levels. Predictors of weight gain may be age, baseline body mass index, appetite stimulation, previous antipsychotic exposure, and antipsychotic treatment duration. CONCLUSION: Significant weight gain is reported with the existing atypical antipsychotics. The weight gain described is highly distressing to patients, may reduce treatment adherence, and may increase the relative risk for diabetes mellitus and hypertriglyceridemia. Physicians employing these agents should routinely monitor weight, fasting blood glucose, and lipid profiles.     

Diabetes mellitus type II--induced by "atypical" neuroleptics?

After the introduction of the so-called "atypical antipsychotics" in the clinical practice hyperglycemia as well as increased triglyceride and cholesterol serum levels were reported in patients treated with some of these agents. The studies and case reports available up to now were reviewed. Some epidemiologic studies show that diabetes mellitus occurs more often in patients treated with atypical antipsychotics if compared to conventional antipsychotics. The available data show that hyperglycemia and diabetes mellitus type II were particularly observed in patients receiving clozapine and olanzapine. Also diabetic ketoacidosis was most frequently reported in patients treated with these drugs. The underlying pathomechanism still remains widely unclear. There is some evidence for an important role of insulin and also leptin. Their secretion seems to be influenced by some atypical antipsychotics. Since overweight is a known risk-factor for diabetes mellitus type II, the weight inducing effect of atypical antipsychotics may also play an important role. Since diabetes mellitus type II often lead to severe diseases, the serum glucose levels should be paid more attention in the treatment with atypical neuroleptics.     

The effects of novel antipsychotics on glucose and lipid levels

BACKGROUND: The novel antipsychotics are extensively used based on their favorable extrapyramidal side effect profiles. However, accumulating evidence suggests that these agents, particularly clozapine and olanzapine, have serious side effects of their own, including weight gain and elevated glucose and triglyceride levels. The goal of this study is to compare the effects of novel antipsychotics clozapine, olanzapine, risperidone, and quetiapine and typical antipsychotics haloperidol and fluphenazine on glucose and lipid levels. METHOD: The charts of 590 patients were retrospectively reviewed. Of those, 215 patients had adequate laboratory data for inclusion. Glucose and lipid level data from 2 1/2 years before and after initiation of the target antipsychotic were included. Covariates, including patients' age, the duration of antipsychotic treatment, other medications that may affect glucose or lipid levels, and the initial laboratory values, were controlled for in the analyses. RESULTS: Glucose levels were increased from baseline for patients treated with clozapine, olanzapine, and haloperidol. There were statistically and clinically significant differences among the medications' effects on lipid profiles (p < .05). Those receiving clozapine and olanzapine demonstrated statistically significant increases in triglyceride levels compared with the other groups. Over one third of patients treated with any of the novel antipsychotics had clinically meaningful triglyceride elevations. CONCLUSION: It has been shown that novel antipsychotics are associated with weight gain. This risk factor along with others, such as elevated glucose and triglyceride levels, compounds the risk for coronary artery disease. Routine monitoring of glucose and lipid levels during treatment with novel antipsychotics should be advocated.     

Antipsychotic medications: metabolic and cardiovascular risk

Individuals with serious mental illness experience excess morbidity and mortality, including an increased prevalence of diabetes mellitus and cardiovascular disease. Cardiovascular disease is the leading cause of death in persons with serious mental illness, and the elevated prevalence of obesity in this population is of particular concern. Obesity is an independent cardiometabolic risk factor that impacts morbidity and mortality and contributes to the development of other cardiometabolic risk factors, such as dyslipidemia and hypertension. In addition, obesity is a major risk factor for type 2 diabetes, with the relative risk of diabetes increasing with body mass index. Increased abdominal fat is strongly associated with insulin resistance, which can lead to impaired glucose regulation. Abdominal obesity, hyperglycemia, hypertension, and dyslipidemia are key components of the metabolic syndrome, a constellation of cardiometabolic risk factors linked by their common association with insulin resistance. Evidence from large clinical samples indicates a high prevalence of metabolic syndrome and all of its components in persons with serious mental illness, particularly in patients with schizophrenia. In addition, psychotropic agents, including some antipsychotic medications, are associated with substantial weight gain, as well as with adiposity-dependent and possibly adiposity-independent changes in insulin sensitivity and lipid metabolism, which increase the risk of diabetes and cardiovascular disease. Among the second-generation antipsychotics, clozapine and olanzapine are associated with the highest risk of substantial weight gain, similar to the weight gain potential associated with low-potency first-generation antipsychotics such as thioridazine or chlorpromazine, as well as with an increased risk of diabetes and dyslipidemia. Various strategies for monitoring cardiometabolic risk factors in patients with mental illness are discussed in this review.     

Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: A five-year naturalistic study

OBJECTIVE: The goal of this 5-year naturalistic study of patients treated with clozapine was to examine the incidence of treatment-emergent diabetes mellitus in relation to other factors, including weight gain, lipid abnormalities, age, clozapine dose, and treatment with valproate.METHOD: Data on age, gender, race, diagnosis, family history of diabetes, and age at clozapine initiation were collected from medical records of 82 outpatients with schizophrenia or schizoaffective disorder. Clozapine dose, data on use of valproate, and laboratory test results were recorded at 6-month intervals.RESULTS: The mean age at the time of clozapine initiation of the 82 patients was 36.4 years; 26.8% of the patients were women, and 91.5% were Caucasian. The mean baseline weight was 175.5 lb, and the mean body mass index was 26.9 kg/m(2). Thirty patients (36.6%) were diagnosed with diabetes during the 5-year follow-up. Weight gain, use of valproate, and total daily dose of clozapine were not significant risk factors for developing diabetes mellitus. Patients experienced significant weight gain that continued until approximately month 46 from initiation of clozapine. There was a nonsignificant increase in total serum cholesterol and a significant increase in serum triglycerides level.CONCLUSIONS: The results support the hypotheses that patients treated with clozapine experience significant weight gain and lipid abnormalities and appear to be at increased risk for developing diabetes.     

Phenomenology of and Risk Factors for New-Onset Diabetes Mellitus and Diabetic Ketoacidosis Associated with Atypical Antipsychotics: An Analysis of 45 Published Cases

Case reports and small retrospective studies suggest that atypical antipsychotic agents may be associated with new-onset Type II diabetes mellitus (DM) or diabetic ketoacidosis (DKA); however, these reports often provide limited or no information on demographic variables such as age, gender, ethnicity, relationship to weight gain, and time course. We analyzed 45 published cases of new-onset DM or DKA for which followed initiation of atypical antipsychotic treatment. Of the 45 patients, 20 had received clozapine, 19 olanzapine, 3 quetiapine, and 3 risperidone. Eighty-seven percent patients were male, and 47% African American. Forty-two percent of these patients presented as DKA, and 50% manifested no weight gain at time of presentation with DM or DKA, although 84% were overweight before antipsychotic therapy. Eighty-four percent presented within 6 months and 59% within 3 months of commencing atypical antipsychotics. The DKA cohort had significantly younger age, less overweight at baseline, and higher proportion of women than did those with DM alone, without significant differences in distribution of ethnicity, weight gain, family history of DM, or duration of exposure to atypical agents. Clinicians should be aware of the potential risks of new-onset DM and DKA in patients taking atypical antipsychotics, and utilize appropriate clinical and laboratory monitoring to prevent serious adverse events.