Effectiveness of a Psychiatrist-Led Clinic for Metabolic Health in Severe Mental Illness: A Retrospective Chart Review Study.

BACKGROUND: Psychotropic medications are associated with serious metabolic adverse effects, which contribute to an increased risk of cardiometabolic comorbidities in patients with severe mental illness (SMI). Several intervention strategies are available to mitigate these metabolic adverse effects; however, data on their utility in real-world settings are limited. The aim of this study was to evaluate the impact of a psychiatrist-led, integrated model of care that combines nonpharmacological and pharmacological interventions to manage metabolic dysfunction in individuals with SMI. METHODS: This is a retrospective chart review of all patients attending the Mental Health and Metabolism Clinic at the Centre for Addiction and Mental Health (CAMH) between 2016 and 2023. The primary outcome measure was the percentage of patients in the clinic that lost ≥ 5% of their baseline weight over a 12-month study period. Secondary outcomes included the percentage of patients that lost ≥ 5% of their baseline weight with each individual metabolic intervention. RESULTS: Among 378 patients, 132/378 (37.5%) patients lost ≥ 5% of their baseline body weight during the 12-month study period. In terms of individual intervention strategies, 29/83 (34.9%) lost ≥ 5% of their baseline body weight with nonpharmacological interventions alone, 79/214 (36.9%) with add-on metformin, 6/13 (46.2%) with add-on topiramate, and 7/11 (77.8%) with add-on semaglutide. Across all interventions, a significant effect of the clinic on body weight over time was observed (F = 7.72; p < 0.001), with a mean change of -1.24 ± 1.45 kg from baseline at 12 months across all interventions. The presumptive number needed to treat was three for nonpharmacological interventions, metformin, and topiramate, and two for semaglutide. CONCLUSIONS: This large naturalistic retrospective cohort study suggests that psychiatrist-led care for metabolic dysfunction in mental illness is effective in reducing psychotropic-induced weight gain. This approach may streamline the implementation of monitoring strategies and interventions in a systematic manner.