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TREATING PSYCHOTROPIC ASSOCIATED WEIGHT GAIN IN INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITY: A RETROSPECTIVE CHART REVIEW STUDY

Nicolette Stogios — Centre for Addiction and Mental Health, University of Toronto

2026 ASCP Annual Meeting

Background

Individuals with intellectual and/or developmental disability (IDD) have higher rates of co-occurring psychiatric disorders and may experience challenges with emotional and behavioural regulation. This often leads to the prescription of antipsychotic medications. These individuals also face an increased risk of metabolic comorbidities, such as type 2 diabetes and cardiovascular disease, which can be further influenced by the metabolic side effects of antipsychotic drugs. Despite the well-established association, there is presently a lack of effective treatment options for antipsychotic-induced metabolic disturbances in people with IDD. This study presents real-world data from a Mental Health and Metabolism Clinic that specializes in providing psychiatrist-led care for metabolic dysfunction in those treated with psychotropic medications.

Methods

We conducted a retrospective chart review of all patients attending the Mental Health and Metabolism Clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada, between 2016 and 2023. This study presents a subgroup analysis of individuals with any form of IDD given the specialized risk in this population. The primary outcome measures were change in weight at 3, 6, 9, and 12 months in the clinic.

Results

The sample consisted of 46 patients who were followed in the clinic for at least 6 months (males: 73.9%, age: 27.2 +/- 1.3 years). The mean baseline body weight of the sample was 109.4 +/- 4.4 kg and BMI 37.1 +/- 1.2 kg/m2. Approximately 46% of the sample had pre-diabetes, 2% had type 2 diabetes, and 35% had metabolic syndrome. All patients except for two were treated in the clinic with a pharmacological intervention such as metformin (N=35), topiramate (N=1), semaglutide (N=2), or a combination of these medications (N=6). Among the 44 patients receiving pharmacological treatment, a significant effect of the clinic (including all medications) was observed on body weight over time (F=3.17, p=0.015), while controlling for age, sex, and baseline weight. The mean change in weight was -1.90 +/- 1.66 (p=0.26), -1.66 +/- 1.65 (p=0.32), -4.06 +/- 1.91 (p=0.035), and 6.85 +/- 2.06 (p=0.001) at 3, 6, 9 and 12 months, respectively.

Discussion

Individuals with IDD are a vulnerable but currently invisible and largely ignored population when it comes to prevention and treatment of psychotropic-induced weight gain. There is presently a lack of evidence to help guide safe and effective treatment of metabolic comorbidities in this population. Accordingly, we present the first naturalistic cohort study to demonstrate the effectiveness of pharmacological interventions in managing weight gain in individuals with IDD. This provides real world evidence of effective treatment strategies for addressing this persistent health challenge and supports the implementation of psychiatristled management of metabolic dysfunction in individuals with IDD.

References

  1. Smith E, Stogios N, Au E, et al. The metabolic adverse effects of antipsychotic use in individuals with intellectual and/or developmental disability: A systematic review and metaanalysis. Acta Psychiatr Scand. 2022 Sep;146(3):201-214.
  2. Stogios N, Hahn MK, Lunsky Y, Desarkar P, Agarwal SM. Addressing Metabolic Comorbidity in Individuals With Intellectual and Developmental Disability on Antipsychotics: A Clinical Case Series. J Clin Psychopharmacol. 2023 Jan-Feb 01;43(1):6063.