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。     

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。     

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。     

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。     

精神分裂症患者伴发代谢综合征的患病率调查

目的调查国内精神分裂症患者中代谢综合征的患病率及分析可能的相关影响因素。方法对住院的精神分裂症患者进行问卷调查和实验室测定,代谢综合征的诊断标准采用2004年中华医学会糖尿病分会代谢综合征标准。结果符合入组条件者共完成602例。精神分裂症患者中代谢综合征患病率为35．5％。与代谢综合征患病风险相关的危险因素包括年龄、性别、抗精神病药物种类及精神分裂症的病程（P〈0．05）。Logistic回归分析结果显示,女性精神分裂症患者罹患代谢综合征的相对危险度明显高于男性。年龄的相对危险度为12．27（95％CI2．238-32．557）。抗精神病药物种类与代谢综合征的患病风险有关（P=0．047〈0．05）。结论与普通人群相比,精神分裂症患者具有较高的代谢综合征发病风险,可能的危险因素包括女性、高龄、病程长及服用氯氮平药物等。     

精神分裂症长期住院患者躯体疾病调查

目的：分析精神分裂症长期住院患者躯体疾病情况。方法：对精神分裂症长期住院患者215例进行心电图、血糖、血常规、血钾、血压等检验，并与一般人群进行比较。结果：伴有冠心病、糖尿病和肺结核均以精神分裂症长期住院患者显著较一般人群为多（P均〈0．01），高血压病显著较少（P〈0．05）。结论：应注意长期住院精神分裂症患者用药情况和躯体情况。     

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。     

精神分裂症患者QTc问期延长的影响因素

目的 调查精神分裂症患者心电图QTc间期延长及相关影响因素。方法 对服用稳定剂量抗精神病药的522例住院精神分裂症患者进行横断面调查,收集人口学资料,测定空腹血糖等生化指标,并进行心电图检查,以QTc≥440ms作为QTc间期延长标准,分析QTc间期延长状况及其相关因素。结果 QTc间期延长发生率12．8％,女性（22．7％）高于男性（7．8％）,差异有统计学意义（P〈0．01）,心电图窦性心动过速和传导阻滞患者QTc间期延长风险分别是心电图正常患者的2．6和3．1倍（P〈0．05）。结论 抗精神病药治疗期间QTc间期延长发生率存在性别差异,女性QTc间期延长的风险可能更高。     

精神分裂症患者伴发糖尿病的相关因素分析

目的 为了解住院精神分裂症患者伴发糖尿病的相关因素。方法 回顾性调查住院精神分裂症患者发生糖尿病与精神药物、体重、血糖及血脂等的相关性。结果 在1472例精神分裂症患者中伴发糖尿病者共162例(11．0％)，其发生与患者的年龄、病程、体重、甘油三酯、胆固醇及服用抗精神病药有相关性，而与性别无关。结论 患者年龄越大、病程越长糖尿病的发生率越高，长期使用抗精神病药可能会导致糖尿病，尤以氯氮平为甚。     

住院精神分裂症患者药物使用现况调查

目的调查2013年5月在上海交通大学医学院附属精神卫生中心住院的精神分裂症患者药物使用情况。方法本次研究为横断面研究,以2013年5月22日为时点调查日,对我院802例精神分裂症住院患者使用自制调查表进行药物使用的现况调查。结果（1）单一使用抗精神病药物患者比例为43．45％。（2）抗精神病药物使用频度前5位：氯氮平421例（52．56％）,奥氮平225例（28．09％）,利培酮196例（24．47％）,阿立派唑158例（19．73％）,奎硫平126例（15．73％）。（3）精神分裂症患者中合并糖尿病的比例为21．70％,且年龄因素、是否使用氯氮平治疗与糖尿病的发生有相关性。（4）精神分裂症患者中合并高血压的比例为33．04％,且年龄因素与高血压的发生有相关性。结论我院单一用药比例低,氯氮平的使用率高,抗精神病药物的治疗仍需进一步规范。精神分裂症患者中合并糖尿病、高血压的比例高,年龄因素可增加糖尿病、高血压的发生率,服用氯氮平可增加糖尿病的发生率。     

Diabetes, tardive dyskinesia, parkinsonism, and akathisia in schizophrenia: a retrospective study applying 1998 diabetes health care guidelines to antipsychotic use.

BACKGROUND: This study examines the links among diabetes, tardive dyskinesia (TD), and other extrapyramidal symptoms (EPS) in schizophrenia outpatients treated with typical and atypical antipsychotics. OBJECTIVES: Using a retrospective chart review, we compared 30 schizophrenia patients with diabetes mellitus (DM) with 30 schizophrenia patients, matched for age and sex, with no DM. We compared prevalence and severity of parkinsonism, akathisia, TD, dystonia, and antipsychotic type (that is, typical vs atypical). RESULTS: We found no statistically significant differences between the DM group and the non-DM group prevalence and severity of EPS, including TD. CONCLUSION: We did not find DM and TD association to be significant in the era of atypical antipsychotics, possibly because of their antidyskinetic effect.     

Differential trends in prevalence of diabetes and unrelated general medical illness for schizophrenia patients before and after the atypical antipsychotic era

OBJECTIVE: To estimate the net growth in the risk of type 2 diabetes mellitus (DM) in the population of patients with schizophrenia that may be attributable to the increased use of the class of atypical antipsychotics (A-APDs), adjusting for community trends in DM risk. METHODS: Using data from the National Hospital Discharge Survey, we perform trend analyses for prevalence of DM and general illness unrelated to insulin resistance in patients with schizophrenia, as well as in individuals without known mental illness, during three time periods: 1) prior to any A-APDs introduction (1979-1989); 2) short-term after their introduction (1990-1995), and long-term following their introduction (1996-2001). RESULTS: Trends in DM and general illness risks were comparable among inpatients with schizophrenia and those without mental illness during the pre-A-APD era and the short-term post-A-APDs era. During 1996-2001, the net difference in DM prevalence grew at an increasing rate (0.7% per year, p<0.001). By 2001, over a base DM prevalence of 10% in patients with schizophrenia, 3.1 percentage points (p=0.016) could be attributed to the use of A-APDs. There was no significant net growth in the prevalence of general illness during this period for these patients. This growth was most pronounced among African-American females and middle aged (35-49 years old) patients. This increased risk of DM translates into additional direct medical costs of $800 million per year. CONCLUSIONS: The introduction of A-APDs, after a lag period, is associated with increased risk of DM. This needs to be considered in light of the advantages of these drugs in efficacy and tolerability. Long-term studies are necessary to identify the effect of individual A-APDs on DM risk.     

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.     

Olanzapine-induced diabetes in a seven-year-old boy

The atypical antipsychotics have been recognized to induce diabetes mellitus and ketoacidosis in the adult psychiatric population. This report notes the onset of weight gain, diabetes, and apparent ketosis in a prepubertal boy diagnosed with bipolar disorder and treated with olanzapine. The hyperglycemia rapidly normalized after discontinuation of the olanzapine. Within 2 years, the diabetes recurred. In spite of the normalization of blood-glucose levels, urine ketone tests remained positive and were explained by the fact that patients taking valproic acid may have a false-positive urine test for ketones. Regular monitoring of glucose should be considered in children and adolescents who gain weight while treated with atypical antipsychotics.     

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.