Study Objective. To assess the usefulness of a metabolic risk screening program, including point‐of‐care glucose testing, to quantify baseline metabolic risk in outpatients receiving antipsychotics. Design. Retrospective, cross‐sectional, cohort study. Setting. University‐affiliated department of psychiatry clinic. Patients. A total of 92 adult outpatients (49 women, 43 men; mean ± SD age 38.96 ± 12 yrs) who were receiving antipsychotics and had undergone screening for metabolic syndrome at the clinic during 2004–2007. Measurements and Main Results. Patient data were recorded on a metabolic screening checklist by a pharmacist or nurse. The checklist captured demographics, vital signs (height, weight, body mass index [BMI], blood pressure, waist and hip circumference, point‐of‐care random glucose level), personal and family knowledge of current illnesses (diabetes mellitus, hypertension, hyperlipidemia), modifiable risk factors (smoking, alcohol, level of activity), current drug therapy, and recommendations to the psychiatrist. The patient population who underwent screening included 49 African‐Americans (53%), 21 Caucasians (23%), 16 Hispanics (17%), and 6 Asians (7%). Diagnoses were documented for 88 patients: schizophrenia or schizoaffective disorder in 53 patients (60%), and bipolar disorder and major depressive disorder was equally divided in the remaining 35 patients (40%). Of 89 patients (three patients had missing data on waist circumference), 63 (71%) met criteria for level 1 metabolic risk (abdominal obesity); of these 63 patients, 38 (60%) met criteria for level 2 risk (abdominal obesity plus hypertension). Patients with a random glucose level greater than 140 mg/dl had a higher likelihood for being at level 2 risk than level 1 risk (χ2=5.99, df=1, p=0.014). Women had a significantly higher likelihood for level 1 metabolic risk compared with men (χ2=5.99, df=1, p=0.019). African‐Americans had a significantly higher likelihood of level 1 risk (p=0.026) and BMI greater than 30 kg/m2 (p=0.003) compared with Caucasians. Patients with a BMI greater than 30 kg/m2 had a significantly higher likelihood of diabetes (p=0.006), hypertension (p=0.03), and hyperlipidemia (p=0.05). Overall, 5 (5%) of the 92 patients met criteria for prediabetes risk. Conclusion. Point‐of‐care metabolic risk screening, done with a systematic interprofessional team approach, can provide clinicians with a practical method for identifying metabolic risk in patients prescribed antipsychotics.

ClinicalTrials.gov identifier: NCT02029989.

Monitoring for metabolic sequelae of antipsychotic medications is inconsistent in clinical settings. In this study, frequency of such monitoring in 40 individuals experiencing a first episode of psychosis was analyzed according to the setting in which they received treatment (i.e., inpatient unit, outpatient clinic, or metabolic screening clinic). The traditional outpatient clinic was the least likely of the three settings to monitor blood glucose, blood pressure, weight, and waist circumference. In any setting, blood lipids were measured in only 2 of the 40 patients. Reasons for these findings and recommendations for reducing barriers to screening are presented.

Abstract Pharmacogenomic (PGx) testing aided by therapeutic drug monitoring (TDM) has the potential to improve medication-related outcomes in some individuals prescribed psychiatric medications. Many commonly prescribed psychiatric medications are metabolized through polymorphic drug metabolizing enzymes such as cytochrome p450 (CYP) 2D6 (CYP2D6) and CYP2C19. Through PGx testing, clinicians can make biologically informed choices when selecting a new medication, and TDM may help inform dose adjustments or assess exposures to current treatments. Herein, we describe 2 complex case reports of individuals with multiple psychiatric diagnoses and extensive histories of medication failures who underwent PGx testing in addition to TDM as part of a pharmacist-led comprehensive medication therapy management evaluation in a community mental health clinic setting.

Acetazolamide (AZD), a sulfa-like moiety, is a potent, nonspecific inhibitor of carbonic anhydrase (CA) enzymes and has been demonstrated to decrease lipogenesis in adipose cells in in vitro cell culture studies. In contrast, topiramate (a sulfamate moiety) appears to inhibit specific (CA) enzymes II and V. Four placebo-controlled trials with topiramate have demonstrated positive results in weight loss. There is only anecdotal evidence that AZD may cause weight loss. The following case is of a 49-year-old African-American woman with a long history of schizoaffective disorder, hypertension, diabetes type II, stress incontinence, and obesity (body mass index, 45.5 kg/m2). Previous trials of topiramate demonstrated temporary but significant weight loss before AZD use. A 4 week washout period occurred before starting AZD, 250 mg twice daily. Significant weight loss of 11.5 lbs was seen over 4 weeks. During washout periods of either topiramate or AZD, her total mean weight was approximately 2 to 7 lbs higher than when she was treated with AZD. Although tolerance and side effects may limit the use of AZD as a safe and effective strategy for medication-related weight gain, the pharmacology may provide research insights into the causes and treatments of obesity.