National Institute of Mental Health and Neuro Sciences (NIMHANS) Metabolic Clinic in Psychiatry has now concrete evidence on the relationship between metabolic abnormalities and psychiatric disorders. In this regard, a team of medical experts is now working to formulate guidelines to choose the right interventions in dealing with anti psychotic drug side-effects which are increasingly affecting patients.

The metabolic abnormalities resulting out of anti psychotic drugs consumption include obesity, insulin resistance, high levels of lipid and prolactin elevation. These conditions have been observed in patients who are treated with drugs like olanzapine, clozapine, risperidone and other antipsychotics/psychotropics.

Anti psychotic drugs prescribed to treat chronic cases are showing side- effects in patients. At least 30 percent of 100 patients have proven side effects. Therefore, the focus of the year-old dedicated Metabolic Clinic in Psychiatry is to systematically assess and formulate specific interventions to treat the side effects, Dr G Venkatasubramanian assistant professor of psychiatry, consultant, The Metabolic Clinic in Psychiatry and Schizophrenia Clinic, National Institute of Mental Health & Neurosciences, told Pharmabiz.

"We have initiated the metabolic clinic in psychiatry to cater the clinical needs of the patient in this special area. Moreover, this is one-of-the-first initiatives in contemporary international psychiatry," he added.

In fact, the Metabolic Clinic has made a good beginning in identifying a strategy to avoid side effects as well as put together specific treatments to reverse these side effects. The panel of experts manning the clinic recommend prescribing 'metformin' which is a common first line oral anti- diabetic drug to control sugar levels in particularly over weight and obese patients to tackle obesity factor in psychiatric cases.

In some cases, the medical experts have also addressed the life style interventions by recommending diets and exercises to bring condition under control.

So long psychiatrists only offered the consultancy which included diagnosis and treatment without specific attention. Now the treatment approach is more comprehensive in terms of assessing the side-effects besides sensitizing the importance of adaptive life style in addition to special psychopharmacological treatments.

About 125 patients have been assessed at the Metabolic clinic in Psychiatry at NIMHANS over the past one year. Each patient assessment takes over an hour and half which indicates the depth of study to treat side-effects of anti psychotic drugs. This clinic which operates every Wednesday has anywhere between five-10 patients.

Going forward, the Metabolic Clinic in Psychiatry is now looking formulating specific guidelines in choosing interventions. Attempts are ongoing in formulating specific guidelines to facilitate choosing psycho-pharmacological as well as life style related interventions. It will also take information from the ongoing schizophrenia imaging genomics research project funded by department of Biotechnology under the Innovative Young Biotechnologist Award scheme. "This will allow us to provide a plan of action from an Indian stand point after which we proceed to gather consensus from an international panel of experts", said Dr Venkatasubramanian.

The clinic has also been conducting a series of lectures with interactive sessions focused on special training of doctors towards assessment and formulation of guidelines to handle metabolic disorders in psychoses. There is a need to comprehend the biological link between the metabolic disorders and schizophrenia and formulate 'holistic interventions'. This is where NIMHANS which has a 'multi-modal intervention' platform with psychiatrics, psychologists and social workers who also look at integrating yoga and Ayurveda to tackle the biological as well as psychosocial aspects of schizophrenia, Dr Venkatasubramanian added.