Addressing cardiometabolic risk during treatment with antipsychotic medications.

J Amiel, C Mangurian, J Newcomer 


Antipsychotic medications can improve psychiatric symptoms and clinical outcomes for people suffering from serious mental illness, but can also produce side effects that range in severity from mildly unpleasant to significant safety concerns. In particular, some antipsychotic medications are associated with metabolic adverse effects that can significantly influence risk for morbidity and mortality with long-term use. In people with severe and persistent mental illness (SPMI), who have major barriers to accessing medical care, metabolic risk factors like obesity, hyperglycemia and hypertension are under-recognized and under-treated. Compared with the general population, treated patients with SPMI have been observed to be twice as likely to meet Adult Treatment Panel III (ATP-III) criteria for the metabolic syndrome, a collection of risk factors for diabetes mellitus and cardiovascular disease (CVD), including coronary heart disease (CHD), stroke and peripheral vascular disease (Table 1) (1, 2). In fact, people with SPMI in public sector treatment settings in the United States have life expectancies 25 to 30 years shorter than the general population and most often die of CVD (3).

The metabolic adverse event profiles of currently available antipsychotic medications have been well-described (4). In this review, we will focus on evidence regarding the variety of risk-reduction interventions available to clinicians and evaluate the evidence supporting their clinical utility, with a particular emphasis on weight-loss strategies.

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