Long-term health considerations in schizophrenia: Metabolic effects and the role of abdominal adiposity

Patients with schizophrenia have increased rates of morbidity and mortality compared with the general population, primarily due to cardiovascular disease. Thus there is an increasing need for clinicians in the psychiatric field to recognise and address cardiovascular risk factors such as abdominal obesity, dyslipidaemia, high blood pressure and elevated fasting blood glucose levels that contribute to this long-term health burden. The combination of three or more of these risk factors leads to a diagnosis of metabolic syndrome, further predisposing individuals to cardiovascular disease. A cluster of risk factors, such as in the metabolic syndrome, is being increasingly seen in patients with schizophrenia. Abdominal obesity is a key contributor to overall cardiovascular risk and is a particularly important consideration in schizophrenia as some atypical antipsychotics are associated with drug-induced weight gain. Lifestyle factors such as smoking, lack of exercise and poor diet undoubtedly contribute further. Psychiatrists need to be aware of metabolic risk when initiating treatment in patients with schizophrenia and should take steps to identify and monitor patients. A first step is to establish a risk profile for the patient based on medical, lifestyle and genetic factors, and measurement of waist circumference is a good indicator of overall cardiovascular and metabolic risk. Strategies recommended to reduce risk include promoting healthy lifestyle/behavioural habits and close monitoring of weight, glucose, and lipid profiles both before and during treatment. Established risk factors should also be considered when selecting the most appropriate antipsychotic medication for an individual patient, based on differences in the potential effect of individual medications to induce weight gain, risk of diabetes or worsening lipid profile.