抗精神藥物 (antipsychotics)，包含第一代抗精神藥物 (first-generation antipsychotics, FGAs) 及第二代抗精神藥物 (second-generation antipsychotics, SGAs)，使用在許多成人或兒童相關之精神疾患，例如：思覺失調症 (schizophrenic disorders)、雙極性疾患 (bipolar disorders)、品行疾患 (conductive disorders)、妥瑞氏症候群 (Tourette’s syndrome) 等，都需要藥物以有效控制疾病。1990 年代隨著SGAs 發展及疾病診斷工具進步，越來越多年輕族群使用抗精神藥物。雖然藥物可以有效改善病人的精神症狀，但眾多研究顯示使用SGAs 在數個月就有體重增加與代謝異常的問題，研究指出SGAs 可能增加第二型糖尿病 (type II diabetes mellitus) 的風險，提高代謝症候群 (metabolic syndrome)、心血管疾病 (cardiovascular diseases)，統稱為心血管代謝事件 (cardiometabolic adverse effects) 發生的風險，研究發現，對於兒童與青少年族群的影響可能又比成人更為深遠。根據過去研究顯示，SGAs 的代謝不良作用風險高低順序為：clozapine = olanzapine > quetiapine ≥ risperidone = paliperidone > amisulpride ≥ aripiprazole ≥ ziprasidone， 但是長期的心血管代謝事件安全性則未知，亞洲年輕病患族群的長期評估報告更是付之闕如，有些較新核准的藥品 ( 例如：paliperidone) 的追蹤期間以及歐亞特定藥品 ( 例如：amisulpride 與sulpiride) 的觀察報告都不足。在更多藥品安全性證據刊載前，臨床照顧者及政策決策者在選擇抗精神藥物於年輕族群前需更加謹慎思考。
Among young adults, the use of antipsychotics, including first-generation antipsychotics (FGAs) and particularly second-generation antipsychotics (SGAs), to treat both psychotic disorders and nonpsychotic disorders (e.g., bipolar mania, irritability associated with autistic disorder, and Tourette’s syndrome) increasing. This population also exhibits an increasing antipsychotic use to treat many offlabel indications, including impulsivity, mood dysregulation, aggressive behavior, depression, and anxiety. However, compared with FGAs, SGAs generally increase the risk of cardiometabolic adverse effects, including weight gain, dyslipidemia, type 2 diabetes mellitus, and cardiovascular events (e.g., stroke and myocardial infarction). These cardiometabolic adverse effects of antipsychotics tend to appear faster and to a greater extent in young adults than in older adults. SGAs have been ranked as follows based on their high to low risk of cardiovascular and metabolic adverse effects: clozapine = olanzapine > quetiapine ≥ risperidone = paliperidone > amisulpride ≥ aripiprazole ≥ ziprasidone. However, the currently available safety data of sulpiride and amisulpride—widely used in Asia and Europe—and newer agents, such as paliperidone, in young adults are insufficient. Before additional relevant evidence is published, clinical caregivers and decision makers for this population should be considered.
