The metabolic syndrome and schizophrenia.
OBJECTIVE
To summarize the accumulated data on metabolic syndrome prevalence in patients with schizophrenia, examine evidence for a biological contribution of the mental illness to metabolic risk and review novel options available for management of prediabetic states.


METHODS
A Medline search using metabolic syndrome, insulin resistance and insulin sensitivity cross-referenced with schizophrenia was performed on articles published between 1990 and May 2008.


RESULTS
Recent evidence indicates that schizophrenia increases predisposition towards metabolic dysfunction independent of environmental exposure. Both fasting and non-fasting triglycerides have emerged as important indicators of cardiometabolic risk, while metformin, thiazolidinediones and GLP-1 modulators may prove promising tools for managing insulin resistance.


CONCLUSIONS
Because of lifestyle, disease and medication effects, schizophrenia patients have significant risk for cardiometabolic disease. Routine monitoring, preferential use of metabolically neutral antipsychotics and lifestyle education are critical to minimizing risk, with a possible role for antidiabetic medications for management of insulin resistant states that do not respond to other treatment strategies.
Meyer
J M
JM
Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA. jmmeyer@ucsd.edu
Stahl
S M
SM
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003927:Diet, Diabetic; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D008019:Life Style; D008403:Mass Screening; D024821:Metabolic Syndrome / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D011236:Prediabetic State / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology
D014150:Antipsychotic Agents; D007004:Hypoglycemic Agents