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Managing Metabolic Abnormalities in the Psychiatrically Ill

A Clinical Guide for Psychiatrists

Edited by Richard A. Bermudes, M.D., Paul E. Keck, Jr., M.D., and Susan L. McElroy, M.D.

  • ISBN 978-1-58562-241-2
  • Item #62241

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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.


  • Contributors
  • Preface
  • Chapter 1. Diabetes: An Overview
  • Chapter 2. The Metabolic Syndrome
  • Chapter 3. Severe Mental Illness and Obesity
  • Chapter 4. Severe Mental Illness and Diabetes Mellitus
  • Chapter 5. Cardiovascular Disease
  • Chapter 6. Antipsychotic-Associated Weight Gain: A Synthesis and Clinical Recommendations
  • Chapter 7. Glucose Metabolism: Effects of Atypical Antipsychotics
  • Chapter 8. Serum Lipids: Effects of Antipsychotics
  • Chapter 9. Metabolic Risk Assessment, Monitoring, and Interventions: Translating What We Have Learned Into Practice
  • Index


    Richard A. Bermudes, M.D.
    Kamran Bordbar, M.D.
    David D'Alessio, M.D.
    Anna Guerdjikova, Ph.D.
    Rakesh Kaneria, M.D.
    Paul E. Keck Jr., M.D.
    Craig R. Keenan, M.D.
    Jakub Z. Konarski, M.Sc.
    Renu Kotwal, M.D.
    Robert M. McCarron, D.O.
    Susan L. McElroy, M.D.
    Roger S. McIntyre, M.D., F.R.C.P.C.
    Jonathan M. Meyer, M.D.
    John W. Newcomer, M.D.
    Joanna K. Soczynska, B.Sc.

About the Authors

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.

Metabolic disturbances represent perhaps the major medical concern impacting patients with psychiatric conditions, yet many psychiatrists are still struggling with how to best manage these common problems. In this excellent text, Drs. Keck, Bermudes, and McElroy have compiled practical, relevant information for managing metabolic abnormalities and the related medical issues in psychiatric patients that practitioners will find timely, useful and important in their day-to-day practice. The editors have gathered an outstanding group of experts to write clear descriptions and recommendations that are easily incorporated into psychiatric care. I recommend this book highly.—Stephen M. Strakowski, M.D., Professor of Psychiatry, Psychology, Neuroscience & Biomedical Engineering; Director, Center for Imaging Research, University of Cincinnati College of Medicine

The final chapter is a superb synthesis of clinical guidelines and can stand alone as the pearl of [Managing Metabolic Abnormalities in the Psychiatrically Ill].—Doody's Book Review Service, 10/1/2009

This book is a long overdue text addressing the complicated relationships between psychiatric and metabolic disorders. Its scope is comprehensive yet succinct. This
multi-authored text was written by leaders on the interface of psychiatric and metabolic disorders along with junior members in the field. This volume offers excellent guidance on assessing, monitoring, and reducing the risks of metabolic abnormalities when prescribing second generation antipsychotic medications that will be invaluable to practicing psychiatrists.—E. Baron Short, MD, Journal of Psychiatric Practice, 10/1/2009

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