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• W1972080797 abstract "Des psychiatres, des diabétologues et des pharmaciens des cinq centres universitaires et d’hôpitaux belges, impliqués dans le traitement de la schizophrénie, se sont réunis en vue d’effectuer une revue critique des informations les plus récentes traitant du risque d’apparition et de développement des troubles métaboliques induits par les antipsychotiques de seconde génération. Les membres du consensus ont formulé des recommandations de bonne pratique clinique psychiatrique. Certains SGA sont associés à un risque plus élevé de troubles métaboliques ; dès lors avant d’entreprendre un traitement, tous les facteurs de risques métaboliques doivent être considérés. Lors du choix, il y a lieu de soigneusement soupeser à efficacité égale, à la fois le risque d’induction d’un trouble métabolique et les risques de facteurs métaboliques intrinsèques au patient. Il y a lieu de privilégier le SGA aux facteurs de risques métaboliques moindres. Les stades précoces du diabète, de l’obésité, des dyslipémies doivent être décelés durant les premiers mois du traitement et si nécessaire traités. Un arrêt du SGA impliqué ainsi qu’un switch vers un SGA à risque moindre font partie de nos recommandations. Le psychiatre doit informer et créer une collaboration avec son patient, sa famille et les autres soignants. The current literature supports that schizophrenia (and bipolar disorders) appear to be associated with a higher prevalence of type 2 diabetes. Because of the silent nature of diabetes mellitus, and the fact that schizophrenic patients are not screened comprehensively for the disease, the true prevalence of hyperglycemia and diabetes may be substantially underestimated (4-8). Notably, it has been suggested that schizophrenia as such carries an increased risk, as certain characteristics of schizophrenic patients such as unhealthy life style promote the diabetes risk. This risk may be increased by antipsychotic drug treatment, as was already suggested for first-generation antipsychotics (FGA) (21). The amount of literature on the association of SGA and metabolic disorders is much larger however, although well-controlled prospective data are sparse. Reports comprise abnormal glucose regulation, exacerbation of existing type 1 and 2 diabetes, new-onset pseudo-type 1 or type 2 diabetes, diabetic ketoacidosis, coma and death. In large-scale studies (mostly retrospective), reviews and meta-analyses, the association was not found for all drugs (31-34). According to recent reviews, the risk of developing diabetes was highest for clozapine and olanzapine, followed by quétiapine and risperidone. The hierarchy of liability of weight gain, or differential effects on insulin resistance was also in the described order. Apart from disturbances in glucose metabolism, further frequent metabolic abnormalities in schizophrenic patients on SGA include features of the metabolic syndrom (1-6). Antipsychotics such as clozapine and olanzapine have also been associated with hypertriglyceridemia (9), while agents such as haloperidol, risperidone and ziprasidone were associated with reductions in plasma triglycerides (6). Amisulpride, aripiprazole and ziprasidone seem to carry the lowest risk for weight gain, diabetes and effects on insulin resistance. As a consequence, there is a shift in attention toward physical health monitoring in patients with mental health disorders (21-24) The APA and ADA as well a British working group (29) have recently published the findings on SGA and metabolic abnormalities in a joint statement (table I) (6)." @default.
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• W1972080797 title "Troubles métaboliques associés aux antipsychotiques atypiques : consensus belge sur la conduite à tenir" @default.
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