Approach to managing increased risk for cardiovascular disease in patients with severe mental illness

* Assess patient's ability/willingness to follow through on referral to primary care or medical specialist. If patient's health care is limited to mental health setting, psychiatrist should consider treating cardiovascular risk factors with primary care or specialist consultation.

¶ Olanzapine, quetiapine, and risperidone have a higher risk of causing weight gain and dyslipidemia; aripiprazole and ziprasidone have a lower risk.

Δ For patients with the willingness and capability to participate, a lifestyle intervention is generally recommended first, with medication to follow if the intervention is not effective. Data on antipsychotic-induced weight gain, however, support an earlier introduction of medication treatment.