Heavy Hitters: Understanding and Treating Antipsychotic Induced Metabolic Syndrome: Sponsored by the Cardiac Psychiatry SIG and the Integrative Medicine SIG

Abstract:

Schizophrenia and other psychiatric disorders are associated with increased morbidity and mortality, with notable disparities in life expectancy, including from cardiovascular disease and from oncologic diseases. As consultation-liaison psychiatrists (CLP), we are often called to care for people at the intersections of psychiatric and non-psychiatric illnesses. Often, our treatment recommendations include use of medications such as mirtazapine or the use of atypical antipsychotics where there are known side effects of weight gain, risk of dysregulated glucose metabolism, and dyslipidemia. Efforts to mitigate the risk of these medications can include prescription of other agents such as metformin, or more recently, utilization of GLP-1 agonists such as semaglutide or tirzepatide, or combination agents like olanzapine-samidorphan; however, there is an essential role for integrative approaches including optimizing nutrition, lifestyle coaching, and importantly, addressing the structural barriers that may promote worsening health outcomes for our patients including structural racism and structural inequities in access to safe housing, green spaces, and healthful nutrition. In this presentation, we will discuss the role of CLP in promoting overall wellbeing in patients receiving psychotropic medications that increase their risk for cardiometabolic sequelae.


Dr. Lou (15 minutes) , a cardiologist, will frame the conceptualization of metabolic syndrome across the lifespan and how metformin and GLP-1 agonists can target this.


Dr. Rajagopalan (15 minutes) will elucidate how psychiatrists caring for children, adolescents, and emerging adults can participate in risk stratification, assessment, and management of metabolic syndrome across care settings.


Dr. DeSimone (15 minutes) will discuss the bidirectional relationship between common psychiatric conditions such as MDD, ADHD, and cognitive impairment and diet and nutrition. Dr. DeSimone will highlight how nutritional status can influence illness development, and how illness can perpetuate nutritional and metabolic sequelae.


Dr. Camacho (15 minutes) will close by discussing practical strategies the CLP can utilize to integrate assessment and management of structural barriers to management of metabolic sequelae of psychiatric treatment, and how to create treatment plans that include the full complement of lifestyle, therapy, and medication recommendations for our patients across the lifespan.


We will close with 10 minutes of questions and answers with our panel.