Palabras clave
Obesidad
Peso Corporal
Resistencia a la Insulina
Síndrome Metabólico
Cómo citar
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Resumen
Objetivo: Analizar las consecuencias metabólicas asociadas al uso de antipsicóticos en pacientes con obesidad, con énfasis en cambios como aumento de peso, resistencia a la insulina, dislipidemia y riesgo de desarrollar síndrome metabólico, considerando los diferentes perfiles de antipsicóticos y sus implicaciones para la salud metabólica de estos individuos. Métodos: Se trata de una revisión integradora de la literatura, con artículos de 2020 a 2025, en portugués e inglés y con texto completo disponible. La pregunta guía fue: ¿Cuáles son las consecuencias metabólicas asociadas al uso de antipsicóticos en pacientes con obesidad?. La investigación se llevó a cabo en junio de 2025, en las bases de datos: Biblioteca Virtual en Salud (BVS), Servicios de la Biblioteca Nacional de Medicina (PUBMED) y Ciencias de la Salud del Caribe (LILACS), utilizando los Descriptores de Ciencias de la Salud (DeCS) en inglés: Agentes Antipsicóticos, Obesidad, Peso Corporal, Resistencia a la Insulina y Síndrome Metabólico, combinados con el operador booleano “AND”. Resultados: Se analizaron nueve artículos que cumplieron con los criterios de inclusión y exclusión, destacando las principales consecuencias metabólicas: aumento de peso, resistencia a la insulina y riesgo de síndrome metabólico. Consideraciones finales: El estudio refuerza la importancia de la monitorización continua y las estrategias terapéuticas integradas. La heterogeneidad de los estudios limita la generalización de los resultados.
Referencias
ABDULHAQ B, DARDAS LA, SAMI O. Monitoring for the metabolic side effects of second-generation antipsychotic medications: Psychiatrists' views and practices. Perspectives in Psychiatric Care, 2021; 57(3): 1237-1243.
ALHASANI DM, et al. Metabolic Syndrome among Patients Taking Atypical Antipsychotics: A Comparative Cross-Sectional Study at Erada and Mental Health Complex in Taif, Saudi Arabia. Psychopharmacology Bulletin, 2024; 54(4): 35-44.
ALKHOLY R, et al. The impacts of antipsychotic medications on eating-related outcomes: A mixed methods systematic review. PLoS ONE, 2025; 20(2).
ALVAREZ-JIMÉNEZ M, HETRICK SE, GONZÁLEZ-BLANCH C, GLEESON JF, MCGORRY PD. Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry. 2008;193(2):101-107.
BAPTISTA T, et al. Obesity and related metabolic abnormalities during antipsychotic drug administration: mechanisms, management and research perspectives. Pharmacopsychiatry, 2002; 35(6): 205-219.
BAZO-ALVAREZ JC, et al. Efeitos do tratamento prolongado com antipsicóticos no peso corporal: um estudo de coorte baseado na população. Journal of Psychopharmacology, 2020; 34(1): 79-85.
BERNARDO M, et al. Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies. Advances in Therapy, 2021; 38(5): 2491-2512.
CHEN A, et al. Antipsychotics and the microbiota. Current Opinion in Psychiatry, 2020; 33(3): 225-230.
CORFITSEN HT, DRAGO A. Impacto das vias moleculares da biologia do desenvolvimento enriquecidas no ganho de peso induzido por antipsicóticos. Farmacogenética e Genômica, 2020; 30(1): 9-20.
DE R, et al. The impact of weight gain on antipsychotic nonadherence or discontinuation: A systematic review and meta-analysis. Acta Psychiatr Scand, 2025; 151(2): 109-126.
DEUTCH AY. Liraglutide for the Treatment of Antipsychotic Drug-Induced Weight Gain. JAMA Psychiatry, 2017; 74(11): 1172-1173.
DIAS PC, et al. Obesidade e políticas públicas: concepções e estratégias adotadas pelo governo brasileiro. Cadernos de Saúde Pública, 2017; 33(7): e00006016.
ECHEVESTE-NAVARRETE J, et al. Trajectory of the body mass index of children and adolescents attending a reference mental health center. Journal of Pediatric Endocrinology and Metabolism, 2024; 37(6): 559-568.
ELLINGER LK, IPEMA HJ, STACHNIK JM. Efficacy of metformin and topiramate in prevention and treatment of second-generation antipsychotic-induced weight gain. Ann Pharmacother, 2010; 44(4): 668-679.
FRANCISCA H. Antipsicóticos de primeira e segunda geração: impacto ponderal e o papel da abordagem nutricional. 2024.
GAO YN, OLFSON M. National trends in metabolic risk of psychiatric inpatients in the United States during the atypical antipsychotic era. Schizophrenia Research, 2022; 248: 320-328.
GROSU C, et al. Associations between antipsychotics-induced weight gain and brain networks of impulsivity. Transl Psychiatry, 2024; 14(1): 162.
GUPTA S, SONG X. Real-World Analysis of Antipsychotic Drugs' Effect on Weight Gain: An EHR Application. AMIA Annu Symp Proc, 2024; 2023: 961-968.
HEGDE NC, et al. Pharmacological interventions for antipsychotic-induced weight gain in schizophrenia: A network meta-analysis. Gen Hosp Psychiatry, 2024; 90: 12-21.
KRILL RA, KUMRA S. Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management. Adolesc Health Med Ther, 2014; 5: 171-182.
KUJIPER G, MULDER H, EVENHUIS H, VISSER F, HOEKSTRA PJ. Effects of controlled discontinuation of long-term used antipsychotics on weight and metabolic parameters in individuals with intellectual disability. J Clin Psychopharmacol. 2013;33(4):520-524.
KUPPILI PP, NEBHINANI N. Role of Integrated and Multidisciplinary Approach in Combating Metabolic Syndrome in Patients with Severe Mental Illness. Indian J Psychol Med, 2019; 41(5): 466-471.
LIU C, et al. Dietary fiber and probiotics for the treatment of atypical antipsychotic-induced metabolic side effects: study protocol for a randomized, double-blind, placebo-controlled trial. Trials, 2021; 22(1).
LYU N, et al. Trajectories and predictors for the development of clinically significant weight gain in children and adolescents prescribed second generation antipsychotics. Journal of Child & Adolescent Psychopharmacology, 2024; 34(4): 201-209.
MALHOTRA AK, et al. Association between common variants near the melanocortin 4 receptor gene and severe antipsychotic drug-induced weight gain. Archives of General Psychiatry, 2012; 69(9): 904-912.
MIEDLICH SU, LAMBERTI JS. Connecting the dots: Understanding and addressing the metabolic impact of antipsychotic and antidepressant medications. Annals of the New York Academy of Sciences, 2025; 1546(1): 35-57.
MUTWALLI H, et al. Eating cognitions, emotions and behaviour under treatment with second generation antipsychotics: A systematic review and meta-analysis. Journal of Psychiatric Research, 2023; 160: 137-162.
PANIZZUTTI B, et al. Biological Mechanism(s) Underpinning the Association between Antipsychotic Drugs and Weight Gain. J Clin Med, 2021; 10(18): 4095.
TEIXEIRA PJR, ROCHA FL. Efeitos adversos metabólicos de antipsicóticos e estabilizadores de humor. Revista de Psiquiatria do Rio Grande do Sul, 2006; 28(2): 186-196.
TEMPLEMAN LA, REYNOLDS GP, ARRANZ B, SAN L. Polymorphisms of the 5-HT2C receptor and leptin genes are associated with antipsychotic drug-induced weight gain in Caucasian subjects with a first-episode psychosis. Pharmacogenetics and Genomics, 2005; 15(4): 195-200.
WU H, et al. Antipsychotic-Induced Weight Gain: Dose-Response Meta-Analysis of Randomized Controlled Trials. Schizophr Bull, 2022; 48(3): 643-654.
YANG Y, et al. Previous exposure to antipsicotic drug treatment is an effective predictor of metabolic disturbances experienced with current antipsychotic drug treatments. BMC Psychiatry, 2022; 22(1).
YE W, et al. Mechanism and treatments of antipsychotic-induced weight gain. International Journal of Obesity (London), 2023; 47(6): 423-433.
ZHANG JP, et al. Pharmacogenetic associations of antipsychotic drug-related weight gain: a systematic review and meta-analysis. Schizophrenia Bulletin, 2016; 42(6): 1418-1437.
ZIMMERMANN U, et al. Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res, 2003; 37(3): 193-220.