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, ANNEXE, vol.5, 2011.

, Grade scientifique des recommandations de l'« Evidence Based Medicine, Haute Autorité de Santé (HAS) ANNEXE, vol.6

, Prise de poids significative > ou = à 7% lors d'un traitement par AP2, Newcomer et al, 2005.

, Résumé des différents récepteurs et association d'effets secondaires, Nasrallah et al (195) ANNEXE 8

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, Ces nouvelles thérapeutiques ont permis une réduction des effets extrapyramidaux iatrogènes, au détriment d'une incidence plus importante de l'obésité, du diabete de type 2 (DT2) dans une population dont la pathologie mentale semble déjà prédisposer à une vulnérabilité métabolique. Il est important que le clinicien considère spécifiquement les effets métaboliques lors de l, Depuis les années 80, les antipsychotiques de seconde génération ou atypiques (AP2)

, Des stratégies thérapeutiques individuelles préventives et curatives de la prise de poids (adiposité et insulinorésistance) et du DT2 pour réduire les risques de morbi-mortalité et d'inobservance médicamenteuse existent

A. Travers-une-synthèse-de-la-littérature, Le risque de DT2 est hétérogène pour les différents AP2 par des mécanismes indirects (prise pondérale) et directs sur l'insulinosécrétion. La mise en place de RHD doit être systématique lors de la prescription d'un AP2. L'introduction d'olanzapine ou de clozapine, les patients à haut risque d'évolution vers un DT2, une prise de poids rapide de plus de 7 %, un IMC supérieur à 25 kg/m2, nous avons ciblé deux objectifs : (i) explorer les liens entre la prescription d'AP2 et le diagnostic de DT2, (ii) étudier les stratégies thérapeutiques pharmacologiques et non pharmacologiques préventives et curatives du DT2 chez les patients souffrant de schizophrénie et traités par un AP2

, En cas d'echec, d'inefficacité ou d'impossibilité du switch pharmacologique, l'adjonction de topiramate ou de metformine sont les deux traitements adjuvants recommandés. L'aripiprazole est aussi une stratégie efficace en association avec l'olanzapine et la clozapine

, These new therapies have led to a reduction in iatrogenic extrapyramidal effects, to the detriment of a greater incidence of obesity, diabetes mellitus (DM) and acidocetotic comas that emerge in a population whose mental pathology already seems predisposed to metabolic vulnerability. For the clinician, it is important to consider metabolic effects with SGA prescription in schizophrenia. Adopting individual preventive and curative therapeutic strategies for weight gain (adiposity and insulinoresistance) and DM to reduce the risk of morbi-morbimortality and drug non-compliance are provided. Through a synthesis of the literature, two main objectives are considered: (i) the association between SGA prescription and DM. diagnosis, (ii) The pharmacological and non-pharmacological preventive and curative therapeutic strategies of DT2 in patients with schizophrenia and treated with an SGA. The risk of DM is heterogeneous for the different SGA by indirect mechanisms (weight gain) and direct on insulinosecretion. The implementation of HDR must be systematic when prescribing an SGA. The introduction of olanzapine or clozapine, patients with high risk of progression to DM, 7% rapid weight gain, BMI greater than 25 kg/m2 are indications for a 6 months structured intervention, « diabetes mellitus » -« strategy » -« schizophrenia