Metabolic syndrome screening is important for all patients with psychiatric disorders, not just those on antipsychotics. Careful communication of metabolic risk is needed to avoid unintended consequences, such as medication nonadherence. In the second episode of “Psychopharm Today,” host Jessica Gannon, MD, and guests Benjamin I. Perry, PhD; Nicolette Stogios, PhD; and Katharine Liang, MD, PhD, discuss metabolic syndrome in psychiatry. The discussion is based on a recent panel at the 2026 ASCP annual meeting about a transdiagnostic approach to metabolic health and mental illness. The conversation covers the gap between screening for metabolic risk and actually providing interventions. Certain patient populations, such as those with posttraumatic stress disorder or intellectual disabilities, have unique metabolic risks and may require tailored interventions and guidelines. Biological pathways (eg, noradrenergic activation in trauma-exposed patients) may contribute to metabolic disturbances independent of medication effects. “There may be a noradrenergic pathway that is independent of medications, specifically independent of antipsychotics, that may be driving metabolic disturbances. I think it goes beyond the risk factors of what medications patients are on. We must look at the pathophysiological pathways that are disturbed in patients with mental health disorders,” said Liang. Stogios discussed the neglected research on cardiometabolic risk in individuals with intellectual disabilities. There is a high prevalence of overweight and obesity in this patient population, which increases their metabolic risk. Unfortunately, there is a lack of population-specific guidelines for managing metabolic risk in individuals with intellectual disabilities, despite high prevalence. Stogios stressed the importance of tailoring interventions specifically for this population due to their unique vulnerabilities. Perry higlighted the PsyMetRiC tool, which is a new, clinically available risk calculator for predicting metabolic risk in young people with psychosis. PsyMetRiC is currently approved in Great Britain and has shown an ability to predict metabolic risks over time. There is a need, mentioned Perry, to conduct further studies that explore the utility of PsyMetRiC in other patient groups, including young people with mood disorders and intellectual disabilities. However, there is concern with PsyMetRiC regarding the potential harm of discussing metabolic risks with vulnerable patients. “We have to give patients an informed choice with medication, and I think if we understand that there are metabolic risks associated with antipsychotics, we do need to be open and honest about that. The timing for those conversations, I think, is very important,” said Perry. Both pharmacological (eg, metformin) and nonpharmacological interventions are important, but a balanced, individualized approach is needed. Psychiatric comorbidities (eg, depression, PTSD) can worsen metabolic outcomes, and vice versa, highlighting the need for holistic care. “There is evidence that suggests that worsening depression can feed back into worsening insulin resistance, and vice versa. Same with PTSD symptoms. That is something that is underappreciated: just the expression of mental health symptoms may be impacting metabolic outcomes,” said Liang.
