Managing Metabolic Syndrome in Schizophrenia

Patients with schizophrenia carry a heightened risk for developing metabolic syndrome (MetS). The prevalence of dyslipidemia, hypertension, obesity, and type 2 diabetes is approximately 1.5 to 2 times higher in individuals with schizophrenia and related disorders than in the general population,¹ with estimates of MetS prevalence in adults with schizophrenia ranging between 20–60%.² People with schizophrenia and related disorders have a reduced life expectancy compared to the general population, with a nearly doubled risk of dying from cardiovascular disease.²

Although patients most vulnerable to MetS are those taking second generation antipsychotics (SGAs), several studies have found that even treatment-naive patients are at risk, showing impaired glucose tolerance, increased insulin resistance, and increased visceral fat distribution, compared with normal controls.^3-5 It is possible that diabetes and schizophrenia share familial risk factors or a common genetic disposition.⁶ Additional risk factors include sedentary lifestyle, poor diet, substance use, high rates of smoking,⁷ and longer duration of illness.⁸

These disturbing statistics make it urgent to address MetS in the schizophrenia population. In her recent article “Interventions for the Metabolic Syndrome in Schizophrenia: A Review,”⁶ Papanastasiou summarizes the efficacy of currently available interventions for preventing and treating MetS and reviews consensus guidelines for monitoring patients taking SGAs.

The author reviews 95 original studies of which 42 investigated behavioral and 44 targeted pharmacologic interventions. Nine studies tested the efficacy of combined behavioral and pharmacologic interventions.

Behavioral Interventions

Behavioral interventions reviewed by Papanastasiou included holistic well-being programs, cognitive behavioral therapy (CBT), nutritional education, weight management, and psychoeducation. The author reports that well-being support programs (consisting of holistic approaches or exercises) showed some modest evidence of success in improving general physical health and cardiovascular fitness in people with schizophrenia and related disorders. Caloric restriction, combined with nutritional education and behavioral or motivational strategies, showed effectiveness in tackling weight gain. Most comprehensive weight reduction programs that included an array of components (diet, exercise, and general and lifestyle modification counseling) were helpful in improving weight, reducing smoking, and improving self-esteem.