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

This volume addresses an extremely important topic for psychiatrists given that many of the medications available for patients with severe mental illness have considerable risk of inducing or worsening weight gain, dyslipidemias, and diabetes mellitus, all risk factors for cardiovascular disease. Furthermore, it is very timely in light of the recent report from the National Association of State Mental Health Program Directors that patients with severe mental illness die, on average, a startling 25 years earlier than patients without these illnesses, with most of this difference because of medical causes.

The authors, distinguished researchers and experts in their field, divided the book into nine chapters. Chapters 1, 2, and 5 provide an excellent review and update on diabetes, the metabolic syndrome, and cardiovascular disease, respectively. Chapters 3 and 4 review the literature on the overlap of severe mental illness and obesity and diabetes mellitus, respectively. Chapters 6, 7, and 8 focus on the effects of antipsychotic medications on weight gain, glucose metabolism, and serum lipids. Chapter 9, titled "Metabolic Risk Assessment, Monitoring and Interventions: Translating What We Have Learned Into Clinical Practice," then attempts to synthesize this information.

The clear strength of this volume is the very scholarly literature reviews presented on each of the topics. At the end of the chapters I felt that I had a good grasp of the relevant literature. Furthermore, the reviews of obesity, diabetes, and cardiovascular disease are written in a very readable manner.

Where the book falls somewhat short of expectations is in not meeting one of the stated objectives, which is to address "the unmet need of the lack of integration of general medical care with psychiatric care, and the related problems of barriers to collaboration and communication among health care providers." Although the authors acknowledge that there is some disagreement among psychiatrists about whose responsibility it is to monitor the general medical conditions of people with mental illnesses, there is an absence of discussion about what the specific issues are and possible collaborative models. I suspect that this may reflect a gap in the research literature because the style of the book is congruent with a research review of the topic.

Overall, I think this volume is well worth reading. The specific topics are extremely relevant for the practicing psychiatrist. Though 326 pages long, the book is a relatively quick, easy, and painless read. Given the published literature reviewed, it is becoming increasingly clear that what tardive dyskinesia was for the older antipsychotics, metabolic abnormalities are for the atypical antipsychotics. This book not only helps us make sure that we are aware of the issues, but it also provides us with practical aids to monitor for these serious medical conditions.