Managing Weight Gain in Patients With Schizophrenia

In this installment of "Your Questions Answered," Christoph Correll, MD, and Sanjai Rao, MD, respond to questions asked by attendees of a Psych Congress 2020 session they presented on managing weight gain and metabolic disruptions in patients with schizophrenia.

Dr. Correll is Professor of Psychiatry and Molecular Medicine, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York. Dr. Rao is Associate Clinical Professor of Psychiatry and Associate Residency Training Director, University of California, San Diego and VA San Diego Healthcare System.

Q: In patients on long-acting injectables (LAIs), what do you suggest besides the addition of metformin to help with weight, when lifestyle changes are a challenge? What else could I do to help control the metabolic effects?

Dr. Correll: In case that metformin is ineffective or the patient does not tolerate it, adjunctive topiramate can be tried. Alternatively, a switch to a lower cardiometabolic risk antipsychotic can be tried.

Q: Have there been any findings regarding weight change in patients switching from olanzapine to ALKS 3831?

Dr. Correll: The 2 available studies that can inform this question suggest that there will be no weight loss when switching from olanzapine to olanzapine/samidorphan (ALKS 3831), but that the weight gain will plateau.

Q: How does lumateperone differ from other weight neutral antipsychotics such as cariprazine or lurasidone?

Dr. Correll: There are no direct comparisons between lumateperone and cariprazine or lurasidone, which will be important to perform. However, the available placebo-controlled studies and those that included risperidone as another active arm suggest that lumateperone will be at least as cardiometabolically safe as cariprazine and lurasidone.

Q: Can you recommend any particular educational materials about schizophrenia that are helpful to patients?

Dr. Rao: A good place for patients to start looking for information on schizophrenia (or any other mental illness) is the National Alliance on Mental Illness (NAMI) website. They have descriptions of each of the illnesses in easy to understand language, including information on diagnosis, treatment, and support. Here is the link to the explanation on schizophrenia: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia.

In this occasional feature, members of the Psych Congress Steering Committee and faculty answer questions asked by attendees at the Psych Congress family of meetings.