M E TA B O L I C

RISK

For Patients Taking

Antipsychotics
 The participant will be able to name 6 different atypical
1 antipsychotics that are commonly used in psychiatric
treatment, as well as 4 indications for use.

The participant will identify the defining symptoms of

2 metabolic syndrome.

OBJECTIVES
The participant will state the appropriate monitoring of
3 patients taking atypical antipsychotics according to 2004
ADA guidelines.

The participant will describe appropriate patient

4 counseling strategies to ensure compliance with
monitoring.
 Common Common
indications medications
• Schizophrenia • Aripiprazole
• Major (Abilify)
depression with • Risperidone
SECOND or without (Risperdal)
G E N E R AT I O N psychosis • Olanzapine
( AT Y P I C A L ) • Bipolar disorder (Zyprexa)
A N T I P S YC H O T I C S • Anger/irritability • Ziprasidone
associated with (Geodon)
autism spectrum • Quetiapine
disorders (Seroquel)
• Lurasidone
(Latuda)
METABOLIC SYNDROME/INSULIN
RESISTANCE
 META BOL IC SYN D ROME/IN SUL IN
RESISTA N CE (A N Y 3 OF TH E F OL L OW IN G)

Increased
Increased Increased
body
triglycerides blood glucose
weight/BMI

High blood High

pressure cholesterol
 METABOLIC S YNDROME LEADS TO:

Cardiovascular Metabolic
complications complications
• Atherosclerosis • Type II diabetes
• Stroke mellitus
• Cardiac arrest
 • Increased in many patients with mental
health disorders WITHOUT treatment
with antipsychotics
• As much as 1.5-3.0 times higher in
drug-naïve patients with
META BOL IC schizophrenia and affective disorders
compared to general population
SYN D ROME • Relationship between specific second-
generation antipsychotics and both
RISK diabetes and obesity
• Rapid weight gain when first trialed
on medication
• Different SGAs have much different
risks
 MONITORING RECOMMENDED BY THE
AMERICAN DIAB ETES AS S OCIATION AND
AMERICAN P S YCHIATRIC AS S OCIATION

R E C O M M E N DAT I O N S
BY T HE AM E R I C AN
DIABETES
A S S O C I AT I O N A N D
Baseline • Weight and height
AMERICAN monitoring
P S YC H I AT R I C
A S S O C I AT I O N
• Personal and family
history of obesity,
diabetes, dyslipidemia,
hypertension, or
cardiovascular disease
(with BMI)
• Waist circumference
• Blood pressure
• Fasting plasma glucose
• Fasting lipid profile

R E C O M M E N DAT I O N S
BY T HE AM E R I C AN
DIABETES
A S S O C I AT I O N A N D
Follow-up
AMERICAN monitoring • Blood pressure, fasting
P S YC H I AT R I C
A S S O C I AT I O N
• Personal and family
history annually
• Weight at 4, 8, and 12
weeks after initiation
and then quarterly
• Waist circumference
annually
plasma glucose, fasting
lipid profile at 12 weeks
• Fasting plasma glucose
annually
• Fasting lipid profile
every 5 years
 ADA/ APA REC OMMENDED MONITORING

Baseline 4 weeks 8 weeks 12 weeks Quarterly Annually Every 5 years

Personal/family history X X

Weight (BMI) X X X X X

Waist circumference X X

Blood pressure X X X

Fasting plasma glucose X X X

Fasting lipid profile X X X

 Fasting blood glucose (complete
metabolic panel)

Fasting triglycerides and

BAS ELINE cholesterol (lipid panel)
MONITORING
FOR AMERIC AN Hemoglobin A1c
PS YC HIATRIC
C ARE Prolactin

Complete blood count with

platelets and differential
 Weight

Height
OTHER Blood pressure
PA R A M E T E R S
TO MONITOR
R E G U L A R LY Abdominal circumference

Family history

Personal history
 FOLLOW-UP MONITORING

Labs every 6-12 months Weight/Height monthly

Monitor compliance with

Blood pressure monthly medication at every visit
COUNSELING PATIENTS
C OUNS ELING PATIENT S

Specific drug
used

Smoking
Length of
treatment
(Short-term

Risk
vs. Long-
term)
Personal
habits Physical
(Lifestyle) inactivity

Current
Unhealthy
weight and
BMI eating habits
 PATIENT
HANDOUT • Gives info on
• Why medications are used
• Possible side effects
• Best way to monitor for side effects
• Things to monitor at home
• Best way to treat & prevent side effects