Systemic metabolic effects associated with antipsychotic agents

Atypical antipsychotic medications used to treat schizophrenia and bipolar disorders are widely acknowledged to offer efficacy with a lower risk of neurologic (extrapyramidal) side effects compared with conventional agents.

To varying degrees, however, the atypicals are associated with metabolic effects, particularly with respect to weight gain, hyperglycemia, dyslipidemia, and type 2 diabetes.

These issues, along with insights into how clinicians make treatment choices in practice, are reviewed in Recognizing and managing psychotic and mood disorders in primary care, a CME activity developed through the joint sponsorship of the University of Cincinnati and Dowden Health Media. It was edited and peer reviewed by The Journal of Family Practice. This CME activity is supported by an educational grant from AstraZeneca.

The expert faculty consists of Henry A. Nasrallah, MD, Donald W. Black, MD, Joseph F. Goldberg, MD, David J. Muzina, MD, and Stephen F. Pariser, MD.

Practical pearls

The medical literature suggests that people with psychiatric illnesses may be predisposed toward metabolic disorders even before drug treatment, although it is difficult to predict which patients will be affected and how pharmacologic treatment might affect this process.
Obesity and diabetes are 1.5 to 2 times more prevalent in patients with schizophrenia and mood disorders compared with the general public. Rates of these diseases are higher even in individuals with schizophrenia who have no history of antipsychotic drug use.
Clinicians should be aware that antipsychotic agents may directly affect glucose homeostasis; case reports note that some patients develop hyperglycemia after therapy is initiated and that the effects may be reduced after therapy discontinuation.
Risk of diabetes is increased in individuals with obesity or smoking addiction, a common feature in individuals with mood disorders.