Metabolic syndrome in patients with schizophrenia: Underlying mechanisms and therapeutic approaches (Review)

Abstract

Schizophrenia (SCZ) represents a considerable health concern, not only due to its impact on cognitive and psychiatric domains, but also because of its association with metabolic abnormalities. Individuals with SCZ face an increased risk of developing metabolic syndrome (MS), which contributes to the increased cardiovascular burden and reduced life expectancy observed in this population. Metabolic alterations are associated with both the SCZ condition itself and extrinsic factors, particularly the use of antipsychotic medications. Additionally, the link between SCZ and MS seems to be guided by distinct genetic parameters. The present narrative review summarizes the relationship between SCZ and MS and emphasizes the various therapeutic approaches for managing its components in patients with these conditions. Recommended therapeutic approaches include lifestyle modifications as the primary strategy, with a focus on behavioral lifestyle programs, addressing dietary patterns and physical activity. Pharmacological interventions include administering common antidiabetic medications and the selection of less metabolically harmful antipsychotics. Alternative interventions with limited clinical application are also discussed. Ultimately, a personalized therapeutic approach encompassing both the psychological and metabolic aspects is essential for the effective management of MS in patients with SCZ.

Keywords: antidiabetic medications; antipsychotics; diabetes; dyslipidemia; glucagon‑like peptide‑1 receptor agonists; hypertension; insulin resistance; lifestyle; mental illness; metabolic syndrome; metformin; obesity; schizophrenia; sodium‑glucose transport protein 2 inhibitors.

Figure 1.

A summary of the underlying mechanisms linking schizophrenia and metabolic syndrome.

Figure 2.

A summary of the main therapeutic interventions for MS in patients with schizophrenia and MS. MS, metabolic syndrome; GLP-1RAs, glucagon-like peptide-1 receptor agonists; SGLT2i, sodium-glucose transport protein 2 inhibitor; TZDs, thiazolidinediones; APA, antipsychotic agents.