Monitoring and metabolic risks with second generation antipsychotics

As the armamentarium of antipsychotic medications continues to grow, so does data supporting expansion of their use for conditions beyond schizophrenia. For this reason, providers other than psychiatrists may see increasing numbers of patients on these medications and need to have an understanding of how to manage such patients. It is, therefore, important to take a moment to remind ourselves that while efficacious, these medications do not come without risk. The potential for extrapyramidal symptoms causes concern with first generation antipsychotics and has played a role in the shift toward increased use of second generation antipsychotics (SGAs), such as olanzapine, quetiapine, risperidone, ziprasidone, or paliperidone. This is due to the fact that SGAs are less likely to cause such movement disorders. The switch comes with a tradeoff, however. SGAs have been shown to increase patients' risk of developing metabolic syndrome