Metabolic syndrome and antipsychotic polypharmacy

Abstract

Patients with schizophrenia are more likely than the general population to have metabolic syndrome and to live around 15 fewer years largely because of cardiovascular death. Recent studies have suggested that antipsychotic polypharmacy may be associated with metabolic disturbance including metabolic syndrome and the mortality related to it. Although antipsychotic polypharmacy is not recommended and there is limited evidence of its benefits, it is nevertheless becoming common in the treatment of schizophrenia. If it is indeed associated with a greater risk of metabolic syndrome, then more widespread use is a serious concern. In this chapter, we review the effects of antipsychotic polypharmacy on mortality, metabolic disturbance, and metabolic syndrome. The results of earlier studies indicate that antipsychotic polypharmacy might increase the risk of some metabolic disturbances and related mortality but not the risk of metabolic syndrome. The effects of antipsychotic polypharmacy on metabolic disturbance and metabolic syndrome may be unchanged in patients with schizophrenia even after changing unhealthy lifestyles. Further studies are still needed to clarify the association between antipsychotic polypharmacy and metabolic disturbance or metabolic syndrome. At present, in cases when antipsychotic polypharmacy is deemed necessary, it is recommended that testing for metabolic parameters should be undertaken more often in patients receiving polypharmacy than in those receiving monotherapy and stricter lifestyle interventions are needed.