Psychiatria pre prax 1/2014

Metabolic syndrome in the context of psychiatric disorders and psychotropic treatment

Review of the available data suggests that metabolic syndrome is fairly prevalent in patients with schizophrenia. The prevalence rate is similar to other severe mental illness like bipolar disorder and other psychotic disorder and is much higher than that seen in general population or healthy controls. Since the introduction of atypical antipsychotics, there has been increasing concern about the contribution of antipsychotic medication to the prevalence of the metabolic syndrome. Identification, prevention, and modification of the cardiovascular risk factors should be one of the important therapeutic objectives in the management of patient with severe mental disorders. Mental health providers worldwide are slowly adopting metabolic monitoring as a standard of care in patients receiving antipsychotics, often without a clear understanding of which parameters best correlate with insulin resistance, or other metabolic and cardiovascular risk factors. There is clearly a need for clinicians to employ multiple strategies to minimize metabolic risk, including using metabolically more neutral medications, promoting healthier lifestyle habits, developing expertise in switching antipsychotics for metabolic reasons, using other pharmacological strategies reducing metabolic changes, and, most importantly, practicing good preventive care through regular monitoring of relevant metabolic parameters.

Keywords: metabolic syndrome, atypical antipsychotics, diabetes, dyslipidaemia, insulin resistance, cardiovascular risk factors.