Managing Common Medical Comorbidities in Schizophrenia
Whether preexisting or exacerbated by antipsychotic medications, medical comorbidities may complicate treatment planning for patients with schizophrenia. In this video taken on-site at the 2025 Psych Congress, Steering Committee Member Amber Hoberg, PMHNP-BC, walks clinicians through her approach to managing some common comorbid conditions that may impact schizophrenia patients. While explaining how to best select a medication in these complex cases, Hoberg underscores how prioritizing psychiatric stability is foundational in setting patients up for success in other areas of their health.
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Read the Transcript
Amber Hoberg, PMHNP-BC: Hi, my name is Amber Hoberg. I'm a Psychiatric Mental Health Nurse Practitioner in San Antonio, Texas. I work for Morningstar Family Medicine in the Baptist Health System.
Psych Congress Network: What are the most common medical comorbidities you see complicating schizophrenia care, and how do you prioritize which conditions to address first in treatment planning?
Hoberg: The common comorbidities I see medically with schizophrenia, because I take care of patients that often are older, though this can even happen when they're younger as well, but I often see diabetes—it tends to be a common complication, our medications that we use, antipsychotic medications can sometimes attribute to this—as well as hypertension. Hyperlipidemia tends to be very common as well. Occasionally I'll get some patients that have some of the metabolic syndromes, like obesity tends to sometimes be one of those major medical factors.
When I'm selecting a treatment for schizophrenia, I take a lot of that into account: What medical conditions do [patients] currently have? I'm going to factor that in when I'm trying to select a medication to help treat them. I want to try to be more metabolically friendly if they're having that cholesterol problem or they're having problems with diabetes or obesity as a factor. I want to try to select a medication that is more friendly when it comes to that side. So it's something I will give them as an option. I always say no medication is perfect. We try really hard to try to mitigate side effects or worsening conditions that they already have, but I try really hard to try to align with picking medications that aren't necessarily going to make these factors worse.
The thing I try to prioritize first, of course, is going to be psychiatric stability, because I know if I can't get them not hearing voices or their depression better controlled or their anxiety better controlled, that's going to keep them from doing the lifestyle factors that I need them to do to try to improve some of these medical concerns. So of course, psychiatric stability is always first and foremost.
Once I obtain that, then the next step is to try to implement lifestyle factors, things to try to help them with obesity or weight gain or trying to drive down their blood pressure, but then also maybe having to work in collaboration with medical to try to address any diabetes needs or any kind of medication needs that are going to be there to try to manage those medical comorbidities.
Thank you so much for joining me today. I'm Amber Hoberg. I hope this was helpful to your clinical practice, and I look forward to doing more of these with you guys.
Amber Hoberg, MSN, APRN, PMHNP-BC, is a Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) with extensive experience spanning various clinical settings and populations. She holds a master’s degree in advanced practice nursing, specializing in Family Psychiatric Mental Health, obtained from the University of Texas Health Science Center at San Antonio in 2010. Currently based in Hillsboro, Oregon, at Visionary Psychiatry, Amber serves as a PMHNP-BC, focusing on nursing home and group home settings. She also practices at Morning Star Family Medicine PLLC in Floresville, Texas, where she practices and manages medication regimens for residents across outpatient, nursing home, and group home settings. At Northeast/Downtown Baptist Hospital in San Antonio, she manages acute psychiatric care in an inpatient setting.
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