Metformin treatment of antipsychotic-induced metabolic adverse effects in forensic psychiatric patients

Forensic psychiatric patients suffer from psychiatric comorbidities of psychotic-, substance use- and personality disorders, and somatic disorders, such as obesity, metabolic syndrome, diabetes and cardiovascular diseases, ultimately reducing their life span. A particular problem is an antipsychotic-induced body overweight and metabolic syndrome.

A lack of diagnostics and treatments of somatic conditions within forensic mental health services negatively affects forensic psychiatric rehabilitation and the patient´s quality of life.Recent research suggests that metformin treatment reduces over­weight and metabolic syndrome in psychiatric patients.

The current project aims to improve forensic psychiatric patients´ metabolic health through metformin treatment. We will plan a randomised, double-blind, multicenter trial comparing metformin to placebo, and perform a pilot study.

Metformin dose will be 1000 mg daily, the dose will be in­creas­ed to 2000 mg after two weeks if tolerated, and treatment will continue for 12 months.

The primary out­come is the difference in body weight change between the groups, and secondary outcome vari­ables include blood pressure, fasting plasma glucose, blood lipid status, cognitive function, and physical performance.This study would be the first pharmacological randomised controlled trial in Swedish forensic psychiatry and be a step toward evidence-based practice.