Managing Metabolic Syndrome in Schizophrenia

Pharmacologic Interventions

Maayan performed a literature review of pharmacologic interventions designed to attenuate antipsychotic-related weight gain to rank interventions in order of efficacy in reducing weight (from the most efficacious to the least).9 Numerous pharmacologic interventions showed promise in improving risk factors for MetS. These included metformin, d-fenfluramine, sibutramine, topiramate, reboxetine, amantadine, nizatidine, orlistat, metformin plus sibutramine, famotidine, dextroamphetamine sulfate, fluoxetine, and rosiglitazone.9 The author adds that atomoxetine, chlorphenetermine, phenmetrazine, and phenylpropanolamine were not effective in reducing antipsychotic-induced weight gain. Findings from nizatidine and fluvoxamine studies were contradictory.

Studies of Combined Behavioral and Pharmacologic Interventions

Several studies attempted to test the efficacy of combining behavioral and pharmacologic interventions. The author noted that combination of NR and/or bupropion and behavioral techniques (group therapy, motivational enhancement, positive reinforcement, CBT, and anxiety reduction) helped maintain abstinence from smoking. Metformin and lifestyle intervention was found more effective than either intervention alone in addressing weight loss.

Monitoring Patients for MetS

The author points to the paramount importance of using a “rigorous monitoring plan” for early detection of incipient MetS. Several sets of consensus guidelines lay out monitoring protocols, which include an array of components (depending on the particular guideline): personal and family history; baseline electrocardiogram (ECG), obtaining urea, electrolytes, prolactin levels, and complete blood count at baseline and at specified intervals thereafter; and measurement of weight and waist circumference, fasting plasma glucose, fasting plasma lipids, and blood pressure both at baseline and at specific intervals thereafter.10-13


The author concluded that, although findings were inconsistent, almost all behavioral interventions appeared to have some benefit for patients, either toward improving physical health, lifestyle habits (ie, smoking, exercise, and diet), or health perception and views. Pharmacologic interventions antipsychotic-induced weight gain were supported by “more robust studies.” But better outcomes were achieved through combining pharmacologic and nonpharmacologic interventions than using either alone.

The author noted that guideline implementation is still sorely lacking among clinicians, and emphasized the critical importance of “monitoring, monitoring, monitoring.” Monitoring regimens can vary, depending on the particular guideline the clinician is using and the needs of the individual patient.