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Choosing Psychiatric Medications for Patients with Severe Obesity and Pharmacological Treatments for Severe Obesity in Patients with Psychiatric Disorders: A Case Study

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Psychiatric Care in Severe Obesity

Abstract

Patients with psychiatric disorders are at a high risk of gaining weight and developing metabolic illnesses. Metabolic comorbidities not only add to the risk for cardiovascular disease, but they also associate with greater mental disorder severity. Although lifestyle and genetic factors play an important role, undoubtedly, one of the major drivers for weight gain in patients with psychiatric conditions is their pharmacologic treatment. Therefore, the risk of metabolic illness has become one of the major determinants of treatment choice and psychiatrists are advised to consider these concerns when considering pharmacologic therapy for their patients. Herein, we evaluate a range of possible psychiatric medications and discuss the specific risks and benefits of each medication with particular consideration given to the risk of causing metabolic illnesses in general, and weight gain/obesity in particular. Specifically a range of anticonvulsants (valproate, carbamazepine), lithium and antipsychotics (olanzapine, clozapine, risperidone, quetiapine, ziprasidone, asenapine, lurasidone and aripiprazole) will be discussed. Furthermore, we aim to describe the most promising anti-obesity agents (orlistat, lorcaserin, combined treatment of phentermine and topiramate, combined treatment of bupropion and naltrexone as well as liraglutide) and their application in mental health settings.

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Authors and Affiliations

  1. Department of Psychiatry, Department of Molecular Medicine and Development, University of Siena School of Medicine, Viale Bracci, 1, Via XXIV Maggio, 23, Tuscany, Siena, 53100, Italy

    Giovanni Amodeo M.D.

  2. Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, Canada, M5T 2S8

    Mehala Subramaniapillai H.B.Sc., M.Sc., Rodrigo B. Mansur M.D. & Roger S. McIntyre M.D., F.R.C.P.C.

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  1. Giovanni Amodeo M.D.
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  2. Mehala Subramaniapillai H.B.Sc., M.Sc.
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  3. Rodrigo B. Mansur M.D.
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  4. Roger S. McIntyre M.D., F.R.C.P.C.
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Correspondence to Mehala Subramaniapillai H.B.Sc., M.Sc. .

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Editors and Affiliations

  1. Toronto Western Hospital Bariatric Surgery Program, Centre for Mental Health, University Health Network, Toronto, Ontario, Canada

    Sanjeev Sockalingam

  2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Raed Hawa

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Amodeo, G., Subramaniapillai, M., Mansur, R.B., McIntyre, R.S. (2017). Choosing Psychiatric Medications for Patients with Severe Obesity and Pharmacological Treatments for Severe Obesity in Patients with Psychiatric Disorders: A Case Study. In: Sockalingam, S., Hawa, R. (eds) Psychiatric Care in Severe Obesity. Springer, Cham. https://doi.org/10.1007/978-3-319-42536-8_22

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  • DOI: https://doi.org/10.1007/978-3-319-42536-8_22

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