Targeting metabolic abnormalities in mental health prevention strategies

People with severe mental disorders (SMI) have a shorter life expectancy of 10–20 years than the general population, mainly due to physical comorbidities, predominantly cardiovascular disease (CVD) and type 2 diabetes (T2D). Patient lifestyle-related risk factors (e.g., smoking, alcohol abuse, lack of physical activity, sedentary lifestyle, unhealthy diet) as well as the use of antipsychotics and antidepressants are likely to be involved. Furthermore, recent evidence shows that cardio-metabolic alterations are present at the beginning of psychosis and major depressive disorder, are probably related to the disease, and worsen with drugs, especially if taken for a long time. Therefore, it is of paramount importance to develop and implement strategies that can prevent and address the problem of physical comorbidity in mental disorders, and it is also essential to raise awareness among health professionals about these insidious and life-threatening conditions. The interventions that can be implemented are both pharmacological and non-pharmacological and can be applied to prevent the development of cardio-metabolic diseases or to reduce their effects in those who have already manifested alterations. The most effective interventions will be presented in the chapter. Despite the evidence that various interventions (e.g., improving physical activity) work and different editorials have required action, “lifestyle interventions” are still limited in routine clinical care.