- Last edited on February 16, 2022
Metabolic Syndrome
Primer
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.
Mechanism
- Antipsychotics are thought to cause metabolic syndrome through a variety of etiologies, including histamine (H1) antagonism, increased appetite, and/or the alteration of insulin sensitivity which then directly impairs metabolic regulation.
Antipsychotics
See main article: Introduction to Antipsychotics
Antipsychotics and Risk for Weight Gain
Adapted from: Pringsheim, T. et al. Physical Health and Drug Safety in Individuals with Schizophrenia. Canadian Journal of Psychiatry. 2017;62(9):673-683.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 |
Monitoring
- Patients with first-episode presentation of psychosis should be closely monitored for metabolic side effects.[1]
Antipsychotic Monitoring
Adapted from: Pringsheim, T. et al. (2017) Physical health and drug safety in individuals with schizophrenia. The Canadian Journal of Psychiatry, 62(9), 673-683.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 | ✓ | - | ✓ | ✓ |
Management
Guidelines
Resources
For Patients
Research
References
1)
Correll, Christoph U., et al. Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders baseline results from the RAISE-ETP study. JAMA psychiatry 71.12 (2014) 1350-1363.