이번 연구는 일 대학병원 정신건강의학과에 입원하여 약물치료를 받은 환자들에서 대사증후군의 발생과 체중 및 대사수치의 변화, 이에 정신작용제가 미치는 영향에 대해 알아보고자 하였다.
입원기간 동안 환자들의 중성지방, HDL, LDL, 혈당, 혈압, 키, 체중, 허리둘레를 정기적으로 측정하였고 이를 바탕으로 자료를 수집하여 분석하였으며, 총 146명의 환자가 연구에 포함되었다.
3개월간 입원하여 약물치료를 한 후 신체질량지수가 유의하게 증가하였고, HDL이 유의하게 감소하였다. 대사증후군이 발생한 비율은 12.61%였고, 정신작용제 중에서 quetiapine이 대사증후군을 가장 크게 증가시켰다. 그리고 carbamaze-pine은 허리둘레를 유의하게 증가시켰고, duloxetine과 la-motrigine은 중성지방을 유의하게 증가시켰다. olanzapine, aripiprazole, mirtazapine, duloxetine, valproic acid는 HDL을 유의하게 감소시켰으며, olanzapine, valproic acid는 신체질량지수 또한 유의하게 증가시켰다. fluoxetine은 신체질량지수를 유의하게 감소시켰다.
이번 연구의 결과는 대사증후군이 비교적 짧은 기간 동안 적어도 10명 중 1명이 발생함으로써 조기 진단과 치료의 필요성을 강조하고 있다. 특히 지질수치의 이상이 두드러지므로 치료초기에는 이에 대한 각별한 주의가 요구된다. 또한 일부 정신작용제가 체중 및 대사수치에 이상을 가져올 수 있기 때문에 이를 고려하여 사용해야 한다.
ObjectivezzThis study explored the development of metabolic syndrome, changes in body weight and metabolic syndrome parameters (waist circumference, serum glucose and lipids, blood pressure), and effects of psychotropic agents in psychiatric inpatients being treated with psychotropic agents.
MethodszzIn all, 146 patients who had been admitted to a psychiatric isolated ward for more than 1 month between August 2012 and May 2014 were included in this study. During hospitalization, levels of triglyceride, high density lipoprotein-cholesterol (HDL), low density lipoprotein-cholesterol, and serum glucose, and blood pressure, height, body weight, and waist circumference were regularly measured. For obtaining data on laboratory tests, physical examination and demographic and clinical characteristics, we reviewed patients’ medical records.
ResultszzAfter using psychotropic agents for 3 months, body mass index increased significantly and HDL levels decreased significantly. Of 119 patients without metabolic syndrome at baseline, 15 (12.61%) patients developed a this syndrome after 3 months. Among psychotropic agents, quetiapine most largely increased the number of patients who meet the criteria for metabolic syndrome (17.9%), and this change was significantly larger than that of aripiprazole (p=0.031). Carbamazepine significantly increased waist circumference. Duloxetine and lamotrigine significantly increased triglyceride levels. Olanzapine, aripiprazole, mirtazapine, duloxetine and valproic acid significantly decreased HDL levels. Futher, olanzapine and valproic acid significantly increased body mass index. Fluoxetine significantly decreased body mass index.
ConclusionzzThe results of this study indicate that at least 1 in 10 patients using psychotropic agents develop metabolic syndrome within a relatively short time; this finding emphasizes the importance of early diagnosis and treatment. Because abnormality of lipid parameters was prominent in early phase of treatment, clinicians should monitor these levels carefully. In addition, some psychotropic agents could affect body weight and metabolic syndrome parameters and thus clinicians should be aware of this changes in patients using psychotropic agents. Main limitation of this study is high drop-out rate (74%), and this could make the result underestimate.