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Review
. 2018 Sep 3;18(1):275.
doi: 10.1186/s12888-018-1848-y.

Antipsychotic polypharmacy and metabolic syndrome in schizophrenia: a review of systematic reviews

Sharea Ijaz  1   2 , Blanca Bolea  3 , Simon Davies  3 , Jelena Savović  4   5 , Alison Richards  4   5 , Sarah Sullivan  4 , Paul Moran  4
Affiliations
Review

Antipsychotic polypharmacy and metabolic syndrome in schizophrenia: a review of systematic reviews

Sharea Ijaz et al. BMC Psychiatry. .

Abstract

Background: There is conflicting evidence on the association between antipsychotic polypharmacy and metabolic syndrome in schizophrenia. We conducted a review of published systematic reviews to evaluate evidence on the association between metabolic syndrome (diabetes, hypertension, and hyperlipidaemia) and exposure to antipsychotic polypharmacy in schizophrenia.

Methods: We searched five electronic databases, complemented by reference screening, to find systematic reviews that investigated the association of antipsychotic polypharmacy in schizophrenia with hypertension, diabetes, or hyperlipidaemia. Selection of reviews, data extraction and review quality were conducted independently by two people and disagreements resolved by discussion. Results were synthesised narratively.

Results: We included 12 systematic reviews, which reported heterogeneous results, mostly with narrative syntheses and without pooled data. The evidence was rated as low quality. There was some indication of a possible protective effect of drug combinations including aripiprazole for diabetes and hyperlipidaemias, compared to other combinations and/or monotherapy. Only one review reported the association between APP and hypertension. The most frequently reported combinations of medication included clozapine, possibly representing a sample of patients with treatment resistant illness. No included review reported results separately by setting (primary or secondary care).

Conclusions: Further robust studies are needed to elucidate the possible protective effect of aripiprazole. Long-term prospective studies are required for accurate appraisal of diabetes risk, hypertension and hyperlipidaemia in patients exposed to antipsychotic polypharmacy.

Keywords: Antipsychotics; Diabetes mellitus; Metabolic syndrome; Schizophrenia.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

BB has received speaker fees on one occasion (8 years ago) from Janssen Pharmaceuticals. Authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
PRISMA flow chart of review selection process
See this image and copyright information in PMC

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