Bring Immunopsychiatry Into Clinical Practice
The ImmunoPsychiatric Care Institute helps psychiatric and behavioral health professionals recognize when immune, inflammatory, autonomic, and other medical factors may be contributing to a patient's psychiatric presentation—and provides practical tools for addressing these complex cases within clinical practice.
Through professional education, clinical mentorship, and the Immunopsychiatric Care (IPC) Framework, IPCI translates emerging research into practical assessment strategies, clinical reasoning, treatment considerations, and collaborative-care approaches that providers can integrate into their own work.
Clinicians can also refer appropriate patients to IPCI for focused immunopsychiatric evaluation and short-term stabilization. Our goal is not to take over your patient's long-term psychiatric care. When IPCI accepts a patient for direct treatment, we collaborate with the existing treatment team, address the specialty concerns, develop recommendations for ongoing management, and transition the patient back to their established provider.
Your patient remains your patient. Our role is to help you see the bigger clinical picture—and give you the tools to manage it.
Myth 1: "Assessing for medical conditions isn't part of the psychiatric role."
Fact: Professional consensus explicitly places physical-health assessment inside routine psychiatric practice. Sowers, Arbuckle, and Shoyinka, writing in Community Mental Health Journal (2016), state that all psychiatrists should monitor the physical aspects of their patients' health concurrently with behavioral treatment — including a review of systems, medication side-effect assessment, vital signs, BMI and waist circumference, and periodic labs (lipids, fasting glucose, thyroid, liver, and renal function). Ward and Druss, in JAMA Psychiatry (2019), frame screening for medical comorbidity and metabolic abnormalities as a core responsibility of mental-health professionals caring for the whole patient. The "medical clearance" meta-analysis by Srivastava and Nair (Psychiatric Services, 2022) found that a careful history and physical exam — the highest-yield medical screening steps at roughly 15.6% and 14.9% — perform comparably whether the examiner is a psychiatrist or a non-psychiatrist, directly rebutting the idea that medical assessment belongs to someone else.
Myth 2: "We only order labs to diagnose or rule out psychiatric conditions."
Fact. A large share of the labs we order exist to establish medication safety — organ function before and during treatment — not to make a psychiatric diagnosis. The CANMAT/ISBD 2018 bipolar guidelines specify a baseline panel before pharmacotherapy that includes CBC, electrolytes and calcium, liver enzymes, serum creatinine and eGFR, fasting glucose and lipids, and TSH. Park and Zarate, in the New England Journal of Medicine (2019), describe baseline screening in any patient presenting with depressive symptoms — CBC, basic metabolic studies, thyroid function, and B12/folate, with liver function, RPR, HIV, and toxicology as clinically indicated — precisely to catch reversible medical contributors such as hypothyroidism, B12 deficiency, or infection. These labs are medical assessment by any definition.
Myth 3: "Metabolic monitoring on antipsychotics is primary care's job, not ours."
Fact. The responsibility sits with the prescriber, and the guidelines say so explicitly. The 2004 ADA/APA/AACE/NAASO consensus — the foundational metabolic monitoring schedule — was directed at clinicians prescribing atypical antipsychotics and asked them to build metabolic and weight monitoring into routine psychiatric practice. The Canadian guideline of Pringsheim and colleagues (2017) names "prescribers" as responsible for scheduled monitoring of BMI, waist circumference, blood pressure, glucose, lipids, prolactin, and ECG. De Hert and Detraux, in JAMA Psychiatry (2018), recommend that the specialist mental-health team assume lead responsibility for metabolic monitoring for at least the first 12 months or until stabilization, before any handoff to primary care. The 2025 ESC clinical consensus statement goes further, noting that because people with serious mental illness use general health services so little, mental-health professionals may need to take the lead on screening, diagnosis, and treatment of cardiovascular risk factors.
Myth 4: "If I'm not going to manage the diabetes, I don't need to look for it."
Fact. Detection and management are different obligations, and only the second is optional for us. The FDA label for olanzapine states that patients starting the drug should undergo fasting blood glucose testing at baseline and periodically during treatment, and be monitored for worsening glucose control — an instruction to the prescriber, not to a hypothetical future PCP. Olanzapine and clozapine carry the highest risk of treatment-emergent hyperglycemia, new-onset diabetes, and even ketoacidosis among the second-generation agents (Fathallah et al., Drug Safety, 2015). Consider the schizophrenia patient who tolerates nothing but olanzapine and develops type 2 diabetes on it: we may not be the one adjusting the antidiabetic regimen, but we are absolutely expected to catch the rising glucose, name it, and coordinate care. Failing to look is not "staying in our lane" — it is missing a complication of our own prescription.
Myth 5: "Lithium is a psych med, so the only monitoring that matters is the lithium level."
Fact. Lithium obligates the prescriber to run endocrine and renal surveillance, not just drug levels. The FDA lithium label requires evaluation of renal function, electrolytes, and thyroid function before initiation. The ISBD consensus and CANMAT guidelines add serum calcium and TSH to the baseline battery, and specify ongoing renal function, thyroid, and calcium monitoring at roughly 6-month to annual intervals during maintenance. Lithium raises the risk of hypothyroidism roughly six-fold and is associated with hyperparathyroidism and chronic kidney disease over time. Monitoring the thyroid and kidneys of a lithium patient is thyroid and renal medicine — performed by the psychiatric prescriber because the psychiatric prescriber started the drug.
Myth 6: "We manage fine without all this monitoring."
Fact. We largely do not — and patients pay for it. The systematic review and meta-analysis by Mitchell and colleagues (Psychological Medicine, 2012; 48 studies, >290,000 patients) found baseline screening exceeded 50% only for blood pressure and triglycerides; fasting glucose was checked in about 44% and HbA1c in under 25%. More than half of patients on second-generation antipsychotics receive no metabolic monitoring at all. This gap is not benign: people with serious mental illness die 10–20 years early, predominantly from preventable cardiovascular and metabolic disease (Ward & Druss, JAMA Psychiatry, 2019). Under-monitoring is a measurable contributor to that mortality gap, not a defensible norm.
Medical assessment is not an encroachment on psychiatric practice — it is a defined, guideline-mandated, FDA-labeled component of it. We order and interpret metabolic panels, thyroid studies, renal function, hepatic function, and neutrophil counts as a routine condition of safe prescribing. That is medical assessment, and it is unambiguously ours. The immunopsychiatric extension of this — actively looking for medical drivers and medical consequences of a patient's presentation before committing them to a purely psychiatric pathway — is the same principle applied with intention. We are not asking anyone to manage every medical condition we detect. We are insisting, correctly, that detecting them is our job.
Scope of Practice
Myth vs Fact
A recurring objection lands on the immunopsychiatric provider's desk: "Assessing for medical problems isn't in the psychiatric scope of practice." It is worth settling this directly, because the objection is not just wrong as a matter of opinion — it is contradicted by the FDA drug labels we prescribe under, by every major bipolar and schizophrenia monitoring guideline, and by the basic structure of how we already practice.
Here is the cleanest way to see it: we draw baseline metabolic panels, thyroid studies, renal function, and neutrophil counts on our patients routinely. We do not order those labs to diagnose a mental illness — there is no blood test for schizophrenia. We order them to assess organ function before and during pharmacotherapy, and to detect emergent medical disease our drugs cause. That is, by definition, medical assessment. A discipline that mandates a comprehensive metabolic panel before starting an antipsychotic cannot coherently claim that medical assessment is outside its scope. The monitoring is the assessment.
The distinction that resolves most of the pushback is detection versus management. We may not be the clinician who titrates the metformin for the type 2 diabetes a patient developed on olanzapine. But we are unambiguously the clinician expected to find that diabetes, name it, and route it for treatment. Detecting a medical consequence of our own prescribing — and screening for medical drivers of psychiatric presentations — is not stepping outside our lane. It is the center of it.
Professional Resources
Explore our downloadable resources designed for mental health providers using the IPCI framework. Enhance your support for patients in the Rest and Reset Program with our comprehensive tools.
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Clinical Protocol
