Metabolic Syndrome is a group of conditions (including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) that occur together. This increases the risk of heart disease, stroke and diabetes. Of psychotropic medications, the risk is greatest with antipsychotics.
| Category | Risk of Weight Gain (%) | Antipsychotic |
|---|---|---|
| Lower | <12 | Aripiprazole, asenapine, and ziprasidone |
| Intermediate | 10-24 | Lurasidone, other first generation antipsychotics, paliperidone, perphenazine, quetiapine, and risperidone |
| Higher | >24 | Chlorpromazine, clozapine, and olanzapine |
| Initiation | 1 month after initiation | 3 months after initiation | Then annually | |
|---|---|---|---|---|
| Electrolytes, Cr, LFTs, TSH | ✓ | As clinically indicated | As clinically indicated | As clinically indicated |
| Fasting plasma glucose | ✓ | As clinically indicated | ✓ | ✓ |
| HbA1c | ✓ | - | ✓ | ✓ |
| Lipid panel (total cholesterol, LDL, HDL, triglycerides) | ✓ | As clinically indicated | ✓ | ✓ |
| Body mass (BMI) | ✓ | ✓ | ✓ | ✓ |
| Blood pressure (BP) | ✓ | As clinically indicated | ✓ | ✓ |
| Extrapyramidal symptom (EPS) exam | ✓ | ✓ | ✓ | ✓ |
| Endocrine function history (gynecomastia, galactorrhea, libido) | ✓ | - | ✓ | ✓ |
| Prolactin | If clinically indicated | If clinically indicated | If clinically indicated | If clinically indicated |
| ECG (QT monitoring) | If clinically indicated (some clinicians will order this routinely as a baseline) | - | If on multiple QTc-prolonging medications (or if clinically indicated) | As clinically indicated, or yearly |
| Smoking history | ✓ | - | ✓ | ✓ |