老年研究發現非典型抗精神病藥物與體重減輕、體重增加有關


  March 26, 2008 (佛羅里達奧蘭多) — 針對18名接受非典型抗精神病藥物的長期照護年長病患進行的小型病歷回顧發現,61% (n = 11)出現體重減輕,而有33% (n = 6)體重增加。
  
  北卡羅來納大學醫學院的Kimberly B. Rudd醫師等人在美國老年精神醫學會第21屆年會中以海報發表上述結果。
  
  共同作者、北卡羅來納大學醫學院的Micah D. Baxley醫師向 Medscape精神醫學表示,我們發現大部分出現明顯的體重減輕,這和在年輕病患所見的不同;不過,仍有人體重增加;這些病患主要服用risperidone (Risperdal,Janssen藥廠)和olanzapine (Zyprexa,Eli Lilly藥廠),這也是此一族群病患最常用的藥物。
  
  研究團隊寫道,非典型抗精神病藥物已知與發生代謝症候群有關,包括胰島素阻抗與肥胖等諸多風險因素;一篇針對50歲以上精神科住院病患的研究顯示,此一族群有將近70%有代謝症候群;除了治療他們的精神病和雙極性異常,抗精神病藥物通常也用於失智症相關的燥動與精神病,這些藥物用於這些醫療弱勢族群的效果越來越引人關注。
  
  他們目標在研究這些年長之長期照護病患使用非典型抗精神病藥物所造成的體重增加。
  
  他們先對1995至2007年間28名年紀在60歲以上的長期照護病患進行病歷回溯分析。
  
  這段期間總共有18名病患(64%)接受非典型抗精神病藥物,最常見的診斷有失智症(71%)與精神分裂症(21%);這些病患(16名男性、2 名女性)平均年紀為71歲(範圍: 60 – 87歲)且主要都是非裔美國人(12人),住院時的平均身體質量指數(BMI)為32.2 (這表示肥胖)。
  
  最常處方的非典型抗精神病藥物是 risperidone (61%)、olanzapine(55%)、quetiapine (Seroquel,AstraZeneca藥廠) (28%)、ziprasidone(Geodon/Zeldox,Pfizer藥廠) (22%)以及 aripiprazole (Abilify,Bristol-Myers Squibb藥廠) (0.05%)。
  
  10名病患(7名女性和3名男性)未接受任何非典型抗精神病藥物,平均年紀為85.7歲(範圍: 79 – 94歲),也幾乎都是非裔美國人(8人) 且住院時的平均身體質量指數(BMI)為21.9 (在正常範圍)。
  
  總共有43%的病患有心血管疾病,18%在住院前有糖尿病。
  
  處方非典型抗精神病藥物的病患,共有11 人(61%) 體重減輕 (平均14.3磅);這些病患大部分有失智症診斷 (82%)。
  
  處方非典型抗精神病藥物的病患,共有6人(33%)體重增加(平均23磅),這些病患大多接受risperidone (83%) 與olanzapine (66%);抗精神病藥物而體重增加者,大部分(66%)在住院時體重屬於正常BMI。
  
  該研究團隊結論表示,此一回顧的結果反映了年長失智症或者精神病病患以非典型抗精神病藥物治療的研究結果,顯示體重增加或者發生糖尿病的風險沒有提高;仍需要更大樣本的研究來證實此一發現。
  
  北卡羅來納大學醫學院的Shilpa Srinivasan醫師向Medscape精神醫學表示,我們的目標是將此文獻擴大到更大的族群上進行研究,年長者是最弱勢的一群,需要更高度的關注。
  
  美國老年精神醫學會第21屆年會:海報36。2007年3月14-17日。

Atypical Antipsychotics Linked

By Marlene Busko
Medscape Medical News

March 26, 2008 (Orlando, Florida) — A small chart review of 18 elderly long-term-care patients who received atypical antipsychotics found that 61% (n = 11) lost weight and only 33% (n = 6) gained weight.

These findings, by Kimberly B. Rudd, MD, from the University of South Carolina School of Medicine, in Columbia, and colleagues, were presented in a poster here at the American Association for Geriatric Psychiatry 21st Annual Meeting.

"We found predominantly weight loss, in most people, which is a little bit different from what is seen in younger patients," coauthor Micah D. Baxley, MD, from the University of South Carolina School of Medicine, told Medscape Psychiatry. There were still people who gained weight; they were primarily on risperidone (Risperdal, Janssen) and olanzapine (Zyprexa, Eli Lilly) . . . the medications most often prescribed in this population, he added.

Atypical antipsychotics have been linked to the development of metabolic syndrome, a cluster of risk factors including insulin resistance and obesity, the group writes. One study of psychiatric inpatients age 50 years and older reported that nearly 70% of this population had metabolic syndrome, they note. In addition to their use for psychotic and bipolar disorders, antipsychotics are often prescribed for off-label management of agitation and psychosis associated with dementia, raising concerns about the effect of these agents in a medically vulnerable population, the group adds.

They aimed to investigate weight gain with the use of atypical antipsychotics in a population of elderly long-term-care patients.

They performed a retrospective chart review of 28 patients aged 60 years and older who were admitted to a long-term-care center between 1995 and 2007.

A total of 18 patients (64%) received atypical antipsychotics during this period. The most common associated diagnosis was dementia (71%) and schizophrenia (21%). These patients (16 men, 2 women) had a mean age of 71 years (range, 60 – 87 years) and were mainly African Americans (12 patients) and had a mean body-mass index (BMI) on admission of 32.2 (indicating obesity).

The most commonly prescribed atypical antipsychotics were risperidone (61%), olanzapine (55%), quetiapine (Seroquel, AstraZeneca) (28%), ziprasidone (Geodon/Zeldox, Pfizer) (22%), and aripiprazole (Abilify, Bristol-Myers Squibb) (0.05%).

The 10 patients (7 women and 3 men) who did not receive any atypical antipsychotics had a mean age of 85.7 years (range, 79 – 94 years) and were also mainly African American (8 patients) and had a mean BMI on admission of 21.9 (in the normal range).

A total of 43% of patients had cardiovascular disease and 18% had diabetes prior to admission.

A total of 11 patients (61%) prescribed atypical antipsychotics lost weight (mean, 14.3 pounds); most of these patients had a diagnosis of dementia (82%).

A total of 6 patients (33%) receiving atypical antipsychotics gained weight (mean, 23 pounds). These patients had most often received risperidone (83%) and olanzapine (66%). Most patients (66%) who gained weight with atypical antipsychotics had a normal BMI on admission.

"Results of this review reflect recent studies of elderly patients with dementia or psychotic illness treated with atypical antipsychotics, showing no increased risk of weight gain or the development of diabetes mellitus," the group summarizes, adding that further research with larger sample sizes is needed to confirm this finding.

"Our goal is to expand upon this literature looking at a larger population," Shilpa Srinivasan, MD, from the University of South Carolina School of Medicine, told Medscape Psychiatry. The elderly are a particularly vulnerable population deserving of a high level of diligence to care, she added.

American Association for Geriatric Psychiatry 21st Annual Meeting: Poster 36. March 14-17, 2007.

    
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