British Association for Psychopharmacology (BAP) guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

In patients with schizophrenia who experience weight gain while taking an antipsychotic agent, there are a number of strategies that can be employed, which are supported by the recent BAP guidelines [Cooper et al. 2016]:

• Start initial therapy with an antipsychotic with a lower risk of associated weight gain (e.g. aripiprazole, ziprasidone, lurasidone, amisulpride)

• In cases where patients have gained weight on an antipsychotic agent, consider switching to a lower risk antipsychotic, as outlined above

• Consider adjunctive treatment with metformin or aripiprazole (if treated with olanzapine or clozapine) to address weight gain

• Ensure that lifestyle changes are implemented, including a healthy diet and exercise.