Improving the physical health of overweight/obese people suffering from severe mental disorders: What is the role of antipsychotic drugs and of lifestyle psychosocial interventions?

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People with severe mental disorders experience premature mortality compared with the general population. Several factors contribute to the mortality gap, including the adoption of unhealthy lifestyle behaviours, poor screening for physical illnesses, difficulties in accessing healthcare facilities, specific clinical features of mental disorders and some pharmacological treatment such as antipsychotic medications with serious metabolic side effects. In the present study, carried out in the framework of the LIFESTYLE trial, a funded nationwide multicentric study, we aimed to assess the impact of different antipsychotics in mediating the effectiveness of psychosocial intervention on healthy lifestyle behaviours. The antipsychotics have been grouped in metabolically more problematic (MMP) vs. metabolically less problematic (MLP). The final sample consists of 401 participants with a mean age of 45.6 ± 11.8 years, mainly female (57.1%), suffering from bipolar disorder (43.4%), schizophrenia spectrum disorders (29.7%) and depressive disorders (26.9%). 36.2% of patients (N = 145) received MMP antipsychotics, 32.2% were treated with MLP antipsychotics and 31.6% did not take any antipsychotic medication, but were treated with antidepressants, mood stabilizers and/or benzodiazepines. At 6-month follow-up, patients receiving the experimental lifestyle intervention and treated with MLP medication reported a significant reduction in BMI ( p < .05). Our findings clearly indicate that a multilevel, personalized and individualized therapeutic approach for the treatment of patients with severe mental disorders is needed, with the involvement of different physicians and health providers for an appropriate long-term management of patients with severe mental disorders. • People with severe mental disorders experience premature mortality, due to many physical comorbidities and adoption of unhealthy lifestyle. • Some pharmacological treatment such as antipsychotic medications can have serious metabolic side effects. • Antipsychotic medications can be grouped in metabolically more problematic (MMP) vs. metabolically less problematic (MLP). • Patients receiving the experimental lifestyle intervention and treated with MLP medication reported a significant reduction in BMI (p<0.05). • A multilevel and personalized approach for people with severe mental disorders is needed, selecting less metabolically problematic drugs

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