Obesity and nutrition: Edited by Caroline M. Apovian and Jeffrey I. MechanickMetabolic syndrome with the atypical antipsychoticsPramyothin, Pornpoja; Khaodhiar, LalitabAuthor Information aBoston Medical Center bBoston University School of Medicine, Center for Nutrition and Weight Management, Boston Medical Center, Boston, Massachusetts, USA Correspondence to Lalita Khaodhiar, MD, Assistant Professor of Medicine, Boston University School of Medicine, Center for Nutrition and Weight Management, Boston Medical Center, 88 East Newton Street Robinson Bldg, Suite 4400, Boston, MA 02118, USA Tel: +1 617 638 8638; fax: +1 617 638 8599; e-mail: Lalita.firstname.lastname@example.org Current Opinion in Endocrinology, Diabetes and Obesity: October 2010 - Volume 17 - Issue 5 - p 460-466 doi: 10.1097/MED.0b013e32833de61c Buy Metrics Abstract Purpose of review Metabolic syndrome and cardiovascular diseases are important causes of morbidity and mortality among patients with severe mental illnesses. Atypical or second-generation antipsychotics (SGAs) are associated with obesity and other components of metabolic syndrome, particularly abnormal glucose and lipid metabolism. This review aims to provide a summary of recent evidence on metabolic risks associated with SGAs, current recommendations for metabolic monitoring, and efficacy of treatment options currently available. Recent findings Studies have identified younger, antipsychotic-naive patients with first-episode psychosis as a population vulnerable to adverse metabolic effects from SGAs. These patients gained more weight and developed evident lipid and glucose abnormalities as soon as 8–12 weeks after treatment initiation. Findings are more striking among children and adolescents. The differential effects of various SGAs are well described, with clozapine and olanzapine associated with the highest metabolic risk. In addition to behavioral therapy, emerging data suggest that pharmacological therapy, most notably metformin, is efficacious in the treatment and possibly prevention of SGA-associated metabolic derangements. Summary More data have become available on the burden from metabolic complications associated with SGAs. New and effective treatment options are required in the near future to improve cardiovascular health in this susceptible population. © 2010 Lippincott Williams & Wilkins, Inc.