Metabolic abnormalities associated with second generation antipsychotics: fact or fiction? Development of guidelines for screening and monitoring

Epidemiological studies have demonstrated a relevant increased risk of diabetes in schizophrenic patients who are treated with many atypical antipsychotics, irrespective of concomitant weight gain. Numerous case reports and some large retrospective cohort studies have documented an increased risk of diabetes with some second-generation antipsychotics (SGAs), leading different authors to identify patients on SGA as another high-risk group for diabetes in their review articles. An American consensus conference dealing with this problem has proposed much awaited guidelines for the monitoring of patients on SGA and recommended acquiring additional data, especially from large-scale prospective studies. A more recent Belgian consensus on the screening and management of antipsychotic-related metabolic disturbances has proposed a more stringent approach. Here, we will cover the current diagnosis of metabolic problems, and provide a review of psychotic-related metabolic problems (diabetes, lipid abnormalities and the metabolic syndrome), as well as guidelines for the screening and management of metabolic abnormalities in people treated with antipsychotic medication.