Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Oct 19, 2021; 11(10): 696-710
Published online Oct 19, 2021. doi: 10.5498/wjp.v11.i10.696
Metabolic disturbances associated with antipsychotic drug treatment in patients with schizophrenia: State-of-the-art and future perspectives
Shen-Chieh Chang, Kah Kheng Goh, Mong-Liang Lu
Shen-Chieh Chang, Kah Kheng Goh, Mong-Liang Lu, Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
Kah Kheng Goh, Mong-Liang Lu, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
Author contributions: Chang SC and Goh KK contributed equally to this work; Chang SC, Goh KK, and Lu ML performed the literature search and reviewed the selected manuscripts; Chang SC wrote the first draft; Goh KK and Lu ML contributed to the final version of the manuscript; All authors have read and approve the final manuscript.
Supported by the Higher Education Sprout Project of the Ministry of Education, No. DP2-109-21121-01-N-07-04; and the Ministry of Science and Technology, No. MOST109-2314-B-038-083.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mong-Liang Lu, MD, MS, Professor, Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, No. 111 Section 3, Hsin-Long Rd, Taipei 116, Taiwan.
Received: January 30, 2021
Peer-review started: January 30, 2021
First decision: March 8, 2021
Revised: March 16, 2021
Accepted: August 31, 2021
Article in press: August 31, 2021
Published online: October 19, 2021

Metabolic disturbances and obesity are major cardiovascular risk factors in patients with schizophrenia, resulting in a higher mortality rate and shorter life expectancy compared with those in the general population. Although schizophrenia and metabolic disturbances may share certain genetic or pathobiological risks, antipsychotics, particularly those of second generation, may further increase the risk of weight gain and metabolic disturbances in patients with schizophrenia. This review included articles on weight gain and metabolic disturbances related to antipsychotics and their mechanisms, monitoring guidelines, and interventions. Nearly all antipsychotics are associated with weight gain, but the degree of the weight gain varies considerably. Although certain neurotransmitter receptor-binding affinities and hormones are correlated with weight gain and specific metabolic abnormalities, the precise mechanisms underlying antipsychotic-induced weight gain and metabolic disturbances remain unclear. Emerging evidence indicates the role of genetic polymorphisms associated with antipsychotic-induced weight gain and antipsychotic-induced metabolic disturbances. Although many guidelines for screening and monitoring antipsychotic-induced metabolic disturbances have been developed, they are not routinely implemented in clinical care. Numerous studies have also investigated strategies for managing antipsychotic-induced metabolic disturbances. Thus, patients and their caregivers must be educated and motivated to pursue a healthier life through smoking cessation and dietary and physical activity programs. If lifestyle intervention fails, switching to another antipsychotic drug with a lower metabolic risk or adding adjunctive medication to mitigate weight gain should be considered. Antipsychotic medications are essential for schizophrenia treatment, hence clinicians should monitor and manage the resulting weight gain and metabolic disturbances.

Keywords: Antipsychotics, Metabolic disturbances, Weight gain, Schizophrenia, Monitor, Intervention

Core Tip: Metabolic disturbances associated with antipsychotic drug treatment are prevalent in patients with schizophrenia. We herein discuss the epidemiology, the underlying mechanisms, monitoring, and intervention strategies of antipsychotics related metabolic disturbances.