Baseline Metabolic Parameters Before Antipsychotic Initiation
Baseline labs anchor every later comparison in treatment.
- ~26: Baseline BMI (typical pre-treatment average)
- ~90 mg/dL: Fasting glucose (normal reference range)
- ~100 mg/dL: LDL cholesterol (baseline lipid panel)
- ~90 cm: Waist circumference (baseline anthropometry)
Why baseline matters
Baseline values distinguish drug effect from prior risk.
Always measure weight, lipids, and glucose before the first dose.
Weight Gain Trajectory Under Antipsychotic Treatment
Weight rises fastest in early months, then plateaus gradually.
- 0–12 wk: Peak gain window (fastest weight accrual)
- >7% gain: Clozapine/olanzapine (common at 1 year)
- <2% gain: Aripiprazole (lower-risk agent)
- H1 / 5-HT2C: Mechanism (appetite receptor blockade)
Drivers of weight gain
Histamine and serotonin receptor blockade increases appetite.
High-risk agents can add 4–10 kg within the first year.
Dyslipidemia Development With Chronic Antipsychotic Exposure
Lipid panels shift toward an atherogenic pattern over months.
- ↑ 20–50%: Triglycerides (with high-risk agents)
- ↓ 5–15%: HDL cholesterol (protective lipid decline)
- ↑ modestly: LDL cholesterol (variable by agent)
- ~3 months: Onset (detectable lipid shift)
Lipid panel changes
Triglycerides rise while HDL falls, raising cardiovascular risk.
Check a fasting lipid panel at baseline and 3 months.
Hyperglycemia and Insulin Resistance During Treatment
Glucose regulation worsens independent of weight gain alone.
- ~2–3×: New-onset diabetes (relative risk increase)
- +5–15 mg/dL: Fasting glucose shift (typical drift over 1 yr)
- annual: HbA1c monitoring (or sooner if high-risk)
- insulin resistance: Mechanism (plus direct beta-cell effect)
Glucose dysregulation
Insulin resistance can develop even before major weight gain.
Some cases progress to diabetic ketoacidosis without warning.
Metabolic Monitoring Protocol for Antipsychotic Therapy
Scheduled screening catches metabolic syndrome before complications.
- wk 4,8,12,q3mo: Weight/BMI checks (ADA/APA consensus schedule)
- baseline, annual: Waist circumference (central adiposity marker)
- baseline, 3mo, annual: Lipid panel (fasting lipids)
- baseline, 3mo, annual: Fasting glucose/HbA1c (glycemic monitoring)
Monitoring schedule
Consensus guidelines set fixed checkpoints across the first year.
Early detection allows switching agents before irreversible harm.