Revista de Psicologia e Psicoterapia
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Metabolic Challenges in Schizophrenia

Mubeen Khan and Udaya M Kabadi

Schizophrenia is a psychiatric disorder requiring constant vigilance and lifelong intervention with psycho therapeutic counseling and administration of Antipsychotic drugs. Metabolic aberrations are documented to occur more frequently in subjects with Schizophrenia (SCH) prior to treatment and the prevalence of these metabolic alterations is significantly raised following administration of Antipsychotic drugs especially the newer ones. Adiposity in SCH prior to drug therapy is significantly increased in comparison to age matched healthy subjects (N) as documented by several indices. Body Mass Index, kg/m2 (26.7 for SCH vs. 22.8 for N, p<0.003); Waist/Hip Ratio (0.99 for SCH vs. 0.86 for N, p<0.005); Total Body Fat, mm2 (34681 in SCH vs. 27692 in N, p<0.01) and Intraabdominal fat, mm2 (13232 in SCH vs. 3880 in N, p<0.005). Squealed of obesity involve almost every organ and system in the body and contribute to increase both morbidity and mortality in SCH. Thus, the prevalence of other disorders constituting metabolic syndrome e.g. Hypertension, Pre Diabetes or Type 2 Diabetes and Dyslipidemia rise markedly and presence of these disorders more than double the relative risks of mortality in SCH in comparison to general population. The mortality risk is likely to be increased further with recent documentation of rising prevalence of cancer amongst subjects with obesity and diabetes. In several subjects with SCH, the initial manifestation of Diabetes is Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar State resulting in hospitalization with obtundation and coma. Moreover, the severity of these metabolic changes is more pronounced at diagnosis in subjects with SCH as compared to non SCH subjects due to lack of recognition of symptoms and/or neglect on part of the subjects with SCH, leading to a far greater mortality. Moreover, increased frequency of smoking in subjects with SCH induces even greater risks of morbidity and mortality via rise in infectious and respiratory disorders. Finally, some of the newer antipsychotic drugs especially Olanzapine and Quetiapine are well documented to cause a rise in prevalence of all disorders constituting Metabolic Syndrome. Therefore, we concur with the recommendations for management of subjects with Schizophrenia formulated by the consensus development conference conducted by several organizations They include Metabolic risk considerations prior to and at initiation of atypical antipsychotics: 1) Patient, family, and caregiver education, 2) Baseline screening, 3) Regular frequent monitoring at 3-6 months’ interval and 4) Referral to specialized services, when appropriate