Extensive, selective literature review of 2500 articles from the last years (up to December 2007) predominantly from Medline and Cochrane, using as search terms "antipsychotic or schizophrenia or individual drug names (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone)" and the terms "BMI, weight gain, metabolic syndrome, diabetes, lipid(s), cholesterol, triglycerides" was conducted. Regardless of the advantages ascribed to atypical antipsychotics and the special effectiveness of clozapine in patients resistant to therapy and at risk for suicide, the probability of weight gain is considerably increased for some of these substances. Patients with schizophrenia have a considerably reduced life expectancy associated with an increased prevalence of cardiovascular risk factors. There is a lack of practical guidelines integrated into clinical psychiatric care for the management of cardiovascular risk factors. The monitoring of patients treated with atypics, which has been recommended in the APA/ADA Consensus Paper in light of these facts, is insufficiently established in clinical practice. A regular monitoring can convey self control and motivation to the patient. In the case of corresponding risk constellations further decisions regarding indication and therapy have to be considered. Especially patients with a high cardiovascular risk profile are highly recommended to participate in a weight-management program for prevention purposes. Such a special program should include elements of dietetic treatment and behaviour and exercise therapy. First controlled studies suggest an effective prevention of weight gain and metabolic changes when applying such a structured program. The practice oriented step by step concept presented here is meant to provide points of reference for the implementation of required medical and psychoeducative measures facilitating the management of weight and further cardiovascular risk factors in the context of psychiatric care in patients with schizophrenia.

Background/Aims:The metabolic syndrome is associated with an increased cardiovascular comorbidity and mortality. Many epidemiological studies prove an increased prevalence of the metabolic syndrome among psychiatric patients compared to the general population.Methods:In this on-going naturalistic observational study carried out in an inpatient treatment setting we as yet surveyed the parameters of the metabolic syndrome in 188 psychiatric patients at admission and at discharge. According to the NCEP definition at least three of the five following criteria have to be fulfilled for diagnosing the metabolic syndrome: visceral adipositas (waist circumference: male > 102 cm; female > 88 cm), diabetes mellitus (fasting glucose > 110 mg/dl), arterial hypertonia (≥130 mmHg systol., ≥ 85 mmHg diastol.), elevated triglycerides (≥ 150 mg/dl), reduced HDL cholesterol (male< 40 mg/dl; female< 50 mg/dl).Results:At discharge we found significantly more patients with visceral adipositas (p=0.0001) and elevated triglycerides (p=0.014) compared to the time of admission. A significantly higher percentage of female in comparison to male patients were diagnosed a metabolic syndrome. Higher age was associated with a higher prevalence of the metabolic syndrome (p=0.001, N=186).Conclusions:Our results demonstrate a deterioration of parameters of the metabolic syndrome in the course of an inpatient treatment. As visceral adipositas constitutes an essential risk factor for metabolic and cardiovascular diseases, an uncomplicated and easily manageable measurement of visceral body fat percentage would be desirable. In a pilot study we are evaluating the informative value of visceral body fat percentage as measured by a body composition analyzer.