Review Article
Metabolic Issues in Patients with Severe Mental Illness
Abstract
This article reviews the epidemiology of weight gain and diabetes mellitus in general and in patients with severe mental illness in particular. Body mass index is defined, and possible predictors for weight gain in patients receiving antipsychotic medications are also enumerated. Information on risk of association with type 2 diabetes mellitus is described, as well as information on dyslipidemias within the rubric of the metabolic syndrome. Recent consensus panel reports and their recommendations for ongoing patient monitoring are reviewed. The issue of switching antipsychotic medication in the context of a developing metabolic disorder is discussed with regard to appropriately balancing risk and benefits. Collaborative treatment between a psychiatrist and an endocrinologist is encouraged. The primary care physician may be required to fulfill both roles.
Key Points
* The seriously mentally ill patient may fundamentally be at higher risk for metabolic problems.
* Second-generation antipsychotic medications have been associated with an increase in weight, but this varies from agent to agent and from patient to patient.
* Recent evidence points to schizophrenia and bipolar disorder as being independent diabetes risk factors, even in the absence of treatment with antipsychotic medication.
* When a problem is identified and it persists despite efforts at nutritional and other lifestyle interventions, deciding whether or not to switch antipsychotic medication can be a significant clinical dilemma.
* Second-generation antipsychotic agents that have a more favorable weight-gain profile will have an increasingly important role, but their use, like all treatments, will also be dependent on an individual's therapeutic response.
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