Background: Schizophrenia, a serious psychiatric disorder, is among the top 10 global causes of disability and affects nearly 1% of the world population. Antipsychotics constitute the best treatment for patients with schizophrenia, however, this treatment class carries a high risk of metabolic syndrome, including lipids abnormalities. Indeed, the risk of metabolic syndrome would be increased in the population with schizophrenia compared to the general population.
Objectives: To summarize the prevalence, the mechanisms, and the potential treatments of antipsychotic-induced metabolic syndrome.
Methods: This is a narrative review of the literature. We searched the electronic database Medline, accessed through PubMed, using terms referring to 1) antipsychotics and schizophrenia, and 2) metabolic syndrome (including its features like dyslipidemia, weight gain, WC, diabetes/glucose dysregulation). Reference lists of eligible papers were searched manually to find eligible studies which were not previously found during the database search. Abstracts were screened and selected if they met the following inclusion criteria: 1) targeting adults (older than 18 years old) with schizophrenia and using an antipsychotics treatment; 2) addressing the metabolic syndrome or at least one of its features; 3) study type: reviews, 4) study published in the last 10 years and 5) written in English language. investigated the prevalence and treatments of metabolic syndrome in the adult population using antipsychotics.
Results: The prevalence of metabolic syndrome in patients treated with antipsychotics ranges from 37% to 63%. Antipsychotic iatrogenic effects include weight gain/increased waist circumference, dyslipidemia, insulin resistance/type 2 diabetes, and hypertension. Clozapine and olanzapine are reported to precipitate the onset of metabolic syndrome features. In patients with metabolic syndrome, an antipsychotic with less metabolic side effects such as lurasidone, lumateperone, ziprasidone, and aripiprazole should be prioritized. Unlike medications, aerobic exercise and dietetic counseling were found to be efficient as the non-pharmacologic treatment of antipsychotic-induced metabolic syndrome. Few pharmacological treatments were proven effective against weight gain in this patient population.
Conclusions: The risk of metabolic syndrome induced by antipsychotics should be early recognized and closely monitored. Primary and secondary prevention of metabolic syndrome or onset of its feature might help reduce the risk of death for patients using antipsychotics
.jpg "Pelumi Samuel Akinola, RN (he/him/his) photo")
