Managing Metabolic Abnormalities in the Psychiatrically Ill: A Clinical Guide for Psychiatrists

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Patients with mental and substance use disorders have shown higher rates of morbidity and mortality from medical illnesses than the general population, and physicians are also increasingly aware of adverse effects of psychiatric medications on metabolic and cardiovascular health. In light of these problems, this book addresses an important unmet need of patients with mental disorders — namely, the lack of integration of general medical care with psychiatric care and the related problem of barriers to collaboration and communication among health care providers. Managing Metabolic Abnormalities in the Psychiatrically Ill is the first book to provide a current review of the relationships among psychiatric illnesses, metabolic abnormalities, and treatment, focusing on how clinicians can tailor care to those doubly-afflicted patients.

The book integrates research findings into practical clinical guidelines that spell out what psychiatrists need to know when their patients with mental illness suffer from — or are at risk of developing — obesity, diabetes, cardiovascular disease, or the metabolic syndrome. The contributors address those risks that need to be considered in the overall context of treatment, background risks of medical illnesses associated with specific psychiatric disorders themselves, and the means of applying these data to treatment recommendations, monitoring, and clinical practice. Among the specific topics addressed are: • Potential effects of psychotropics on appetite, body weight, and metabolic parameters in obese patients, and the potential effects of anti-obesity agents on psychotic, manic, and depressive syndromes• Increased risk of type 2 diabetes among individuals with psychotic and mood disorders due to neurobiological changes and behavioral effects associated with these disorders• Greater risk for cardiovascular disease among the mentally ill, stressing the importance of mental health providers understanding cardiovascular risk classification and modification strategies• An association between dysregulation of glucose and lipid metabolism and the related risk of type 2 diabetes during treatment with any of the eight second-generation antipsychotics currently available in the United States• Guidance in choice of medications and appropriate monitoring strategies for hyperlipidemia, along with recognition of which antipsychotics pose the greatest risk and an understanding of the common dyslipidemia patterns seen with their use

Chapters include key clinical concepts, quick-reference tables, and extensive references, and a final chapter provides an assessment tool for evaluating patients' metabolic risk. Together, the chapters in this book constitute an authoritative clinical guide that enables psychiatrists to better integrate the treatment of patients' mental disorders with their metabolic conditions.

American Psychiatric Publishing

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Editorial Reviews

Doody's Review Service
Reviewer: Robert Hung, MD, MPH (Rush University Medical Center)
Description: This is a compilation of topical reviews addressing the unique relationship between metabolic derangements and severe mental illnesses (SMI) such as schizophrenia and bipolar disorder.
Purpose: The purpose is to synthesize existing clinical research and to translate it into a meaningful approach to care for psychiatric patients with metabolic conditions such as obesity or hyperglycemia. The book comes at a crucial time when many patients with SMI have cardiovascular comorbidities, and treatments with psychiatric medications are inducing metabolic conditions.
Audience: Written for psychiatrists and mental health providers, the book is especially relevant for those who only intermittently screen for metabolic conditions (i.e., fasting glucose or lipid panel) or rarely seek guidance on treatment options to prevent metabolic complications.
Features: The book opens with a review of diabetes and metabolic syndrome. The next three chapters summarize the extensive amount of research on SMI as it relates to obesity, diabetes, and cardiovascular disease. The subsequent chapters focus on antipsychotic medications and their effect on weight, glucose metabolism, and serum lipids. The final chapter offers a clinical strategy to assess and monitor metabolic parameters in psychiatric patients.
Assessment: The authors use tables to summarize the numerous studies. Algorithms are presented for the treatment of obesity, risk stratification of cardiovascular risk, and choosing an antipsychotic. Proposed etiologic links between SMI, cardiovascular disease, and diabetes are expounded. The chapters are well written, but the litany of studies distracts the reader from the main goal of obtaining clinical recommendations. More synthesis of the research and less emphasis on the biologic mechanisms leading to metabolic problems would benefit practicing clinicians. The final chapter is a superb synthesis of clinical guidelines and can stand alone as the pearl of the book.
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Product Details

  • ISBN-13: 9781585622412
  • Publisher: American Psychiatric Publishing, Incorporated
  • Publication date: 12/28/2006
  • Edition description: New Edition
  • Pages: 326
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.65 (d)

Meet the Author

Richard A. Bermudes, M.D., is Assistant Clinical Professor in the Department of Psychiatry and Behavioral Sciences at the University of California, Davis Medical Center in Sacramento, California.

Paul E. Keck Jr., M.D., is President and CEO of the Craig and Frances Lindner Center of HOPE and Lindner Professor of Psychiatry and Neuroscience and Executive Vice Chairman of the Department of Psychiatry at the University of Cincinnati College of Medicine in Cincinnati, Ohio.

Susan L. McElroy, M.D., is Professor of Psychiatry and Neuroscience at the Psychopharmacology Research Program in the Department of Psychiatry at the University of Cincinnati College of Medicine in Cincinnati, Ohio.

American Psychiatric Publishing

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Table of Contents

Contributors. Preface. Diabetes: an overview. The metabolic syndrome. Severe mental illness and obesity. Severe mental illness and diabetes mellitus. Cardiovascular disease. Antipsychotic-associated weight gain: a synthesis and clinical recommendations. Glucose metabolism: effects of atypical antipsychotics. Serum lipids: effects of antipsychotics. Metabolic risk assessment, monitoring, and interventions: translating what we have learned into practice. Index.

American Psychiatric Publishing

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