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Tijdschrift voor Psychiatrie 50 (2008) 10, 645 - 654

Review article

Schizophrenia and antipsychotics associated with the metabolic syndrome. An overview

A.M.J.W. Scheepers-Hoeks, S.J.W. Wessels-Basten, M.J.W.T. Scherders, B. Bravenboer, A.J.M. Loonen, R.T. Kleppe, R.J.E. Grouls

Cardiovascular morbidity and mortality are higher in patients with schizophrenia than in the general population because the metabolic side-effects of antipsychotics and schizophrenia increase the risk of cardiovascular disease (cvd) and diabetes mellitus type 2 (dm2). The metabolic syndrome is defined in order to discover which patients have a high risk of developing cvd and dm2.
aim To survey the current knowledge about the relationship between schizophrenia and the metabolic syndrome, the influence of the use of antipsychotics on the development of the metabolic syndrome, and the possible differences in the effects that first and second generation antipsychotics have on the syndrome.
method The PubMed and Medscape databases were searched for relevant articles published between 2000 and July 2008.
results Schizophrenia and the use of antipsychotics increase the prevalence of abdominal obesity, dyslipidemia and dm2 (i.e. the metabole syndrome). Second generation antipsychotics tend to cause a marked increase in the prevalence of abdominal obesity and dyslipidemia, whereas first generation antipsychotics hardly have any of these effects. Both first and second generation antipsychotics increase the risk of dm2.
conclusion The metabolic syndrome has a significant effect on the morbidity and mortality of patients with schizophrenia because it increases the risk they will develop cvd and dm2. The risk increases still further if patients are taking antipsychotics. The risk of cvd can be decreased if patients with schizophrenia are screened in time and are monitored regularly.


keywords antipsychotics, cardiovascular risk, diabetes mellitus type 2, metabolic syndrome, schizophrenia