使用Paliperidone治療精神分裂症病人所產生的代謝副作用

Metabolic Effects of Paliperidone in a Patient with Schizophrenia

目的：使用第二代抗精神病劑治療精神分裂症具較佳療效。然而，它所產生運動障礙 和代謝相關副作用是被廣泛擔憂的。較少報告提及第二代抗精神病劑paliperidone 所產生 的相關副作用，已知較常發生的藥物副作用包含錐體外症狀、頭痛、失眠、嗜睡和體重增 加。本文提出一位精神分裂症病人以paliperidone 治療後關於代謝副作用的臨床發現。病例報告：一位33 歲男性病人於一年多前開始患有精神病症狀，此病人的精神病正性症狀，在 paliperidone 適當治療劑量和治療時程後，治療反應良好。但是，病人於治療一年期間體重 由69.5 公斤增至96.4 公斤，且有高血脂和高尿酸血症之其他代謝副作用。病人主訴因代謝 副作用而影響服藥順從性。結論：精神科醫師需要密切注意paliperidone 治療後所產生的代 謝副作用，並且應盡力預防或減少發生的可能性。

Objective: Second-generation antipsychotic (SGA) drugs have a favorable therapeutic benefi cial profi le in patients with schizophrenia. But, we have more concerns about their adverse events in metabolic effects, which are less studied in paliperidone, an SGA. Its reported side effects include extrapyramidal symptoms, headache, insomnia, and somnolence as well as weight gain. Here, we report a patient with schizophrenia who was treated with paliperidone and developed metabolic effects. Case Report: More than one year ago, 33-year-old male patient with schizophrenia had psychotic symptoms and received paliperidone. He responded well to paliperidone and he was maintained with at adequate dosage and duration. His body weight was increased from 69.5 kg to 96.4 kg after one-year treatment. His other metabolic effects included dyslipidemia and hyperuricemia. But he had poor drug compliance after development of metabolic effects. Conclusion: Psychiatrists should be cautious about the possibility of having paliperidone-induced metabolic effects. Efforts on psychoeducation should be made to prevent or minimize the adverse effects.