Defne ERASLAN, Özgür ÖZTÜRK, BÜLENT KAYAHAN, Nabi ZORLU, Baybars VEZDEDAROĞLU

Şizofreni, atipik antipsikotikler ve obezite

Son yıllarda yeni ilaçların geliştirilmesi ile şizofreni tedavisinde büyük gelişmeler sağlanmış, daha önce sorun yaratan ekstrapiramidal yan etkiler ve negatif belirtiler daha iyi kontrol edilebilmiştir. Ancak, yeni antipsikotiklerin çoğu reseptör profillerindeki farklılıklar nedeniyle metabolik yan etkilere sahiptir. Daha kolay başa çıkılan obezite, atipik antipsikotiklerin yaygın olarak kullanıma girmesiyle ilaç almayan ya da tipik antipsikotik kullanan şizofreni hastalarında ciddi bir soruna dönüşmüştür. Obezite, bu hastaların gerek bedensel sağlıklarını, gerekse yaşam kalitesi ve ilaç uyumlarını etkilemektedir. Bu yazıda, şizofreninin doğal gidişi sırasında hasta ilaç almasa bile ortaya çıkan kilo değişiklikleri üzerinde durulduktan sonra, öncelikle obezitenin meydana geliş düzeneği, özellikle leptin, serotoninerjik, adrenerjik ve dopaminerjik sistemler ve en önemlisi histaminerjik sistem incelenmektedir. Ardından şizofreni hastalarında meydana gelen obezitenin tedavi süresi, doz ve hastayla ilgili etkenler üzerinde durularak, kilo almaya bağlı diyabet ve kardiyak riskler ve obezitenin sosyal ilişkiler ve ilaç uyumu üzerine etkisi değerlendirilmektedir. Son olarak bazı tipik ve atipik antipsikotiklerin ayrı ayrı kilo üzerine olan etkileri incelene-cektir.

Anahtar Kelimeler:

Obezite, Antipsikotik ajanlar, Şizofreni

Schizophrenia, atypical antipsychotics, and obesity

With the development of novel drugs, we have seen a significant improvement in the treatment of schizophrenia and have been able to control negative symptoms and extropyramidal side effects. Unfortunately, most of the novel antipsychotics have metabolic side effects, due to differences in their receptor profiles. Due to the widespread use of atypical antipsychotics, obesity, which was easier to manipulate in patients without medication or who were on typical antipsychotics, has become a major problem. Obesity affects the physical health, quality of life and drug adherence in these patients. In this article, after considering the weight changes that take place in chronic schizophrenia even if the patient is medication-free, we first investigate the possible mechanism and general features of obesity in schizophrenia, focusing of leptin, serotonergic, adrenergic and dopaminergic systems and most importantly, the histaminergic system. We then review relationship of obesity with clinical parameters such as duration of treatment, dosage and other patient related factors, focus on diabetes and cardiac risks related to weight gain, the effect of obesity in social relationships and compliance. Finally, we look at the l the effect of individual antipsychotics, such as chlorpromazine, thioridazine, clozapine, olanzapine, risperidone, quetiapine and ziprasidone on weight gain,

Keywords:

Obesity, Antipsychotic Agents, Schizophrenia,

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