Metabolic Syndrome caused by Antipsychotic Agents

• Antipsychotic medications are widely prescribed and carry a variable propensity to cause weight gain and its attendant sequelae – hyperglycaemia, hypertension and hyperlipidaemia.
• These metabolic risks, along with smoking and poor lifestyle habits, occur between two and five times more often in patients with psychosis than in the general population. 
• Early detection and intervention for cardiometabolic risks, and a judicious tailoring of the use of antipsychotic medications can help to improve long-term outcomes in these patients
• For patients with schizophrenia or bipolar disorder as well as diabetes, the chances of premature death are significantly higher compared to matched persons with diabetes alone.
• Clearly the illness and its treatment may be contributing to the development of metabolic risk

Causative Agents

• if there is a family history of diabetes or cardiovascular disease, if the person is from a high-risk ethnic background or is young, the choice of antipsychotic should consider potential metabolic consequences of the prescription
• Additionally, many commonly prescribed psychotropics (including valproate, lithium, mirtazepine, tricyclic antidepressants and some selective serotonin reuptake inhibitors) that are used in combination with antipsychotics may themselves lead to considerable weight gain

Pharmacotherapeutic Interventions
Switching Agents

• very difficult to find an optimal antipsychotic drug for the individual
• if their psychiatric history supports continuing their current medication, it may be wise to enhance the lifestyle modification as much as possible

Drugs for Metabolic Illness

• The use of standard pharmaceutical approaches for psychiatric patients is similar to those for patients without mental illness. Sadly for those with mental illness, the likelihood of receiving adequate and appropriate pharmaceutical therapies, such as statins, is significantly less than for those without mental illness
• A randomized, controlled trial of 128 first-episode schizophrenia patients found that metformin 750 mg/day in combination with lifestyle modifications was superior to lifestyle modifications or metformin 750 mg/day alone at reducing body mass index, insulin resistance index, and waist circumference
• In a meta-analysis of 32 randomized, double-blind, placebo-controlled studies examining 15 different medications used to attenuate weight gain, metformin had the greatest average weight loss 

Reference:

1. http://www.cenpaticoaz.com/files/2014/07/PG-Metabolic-Syndrome-2014-05-28
2. Assessment and Management of Atypical Antipsychotic-Induced Metabolic Abnormalities. http://www.uspharmacist.com/content/d/feature/c/23859/