Interventions for the metabolic syndrome in schizophrenia: a review

Abstract

Abstract:The metabolic syndrome (MetS) is an increasingly prevalent condition in people with schizophrenia. It remains highly prevalent in the general population in developed countries, but recently health promotion campaigns and greater awareness of the high associated mortality rates have resulted in improvements in the rates of cardiovascular risk factors. This is not the case for people with schizophrenia who continue to have more than twice the rates of MetS and significantly higher mortality rates than the general population. Various behavioural and pharmacological interventions have been used to improve conditions that are linked to MetS, mainly smoking and obesity. This review aims to provide an update of the latest knowledge about the behavioural, pharmacological and other interventions that might help to combat this life-threatening problem in people with schizophrenia.

Etiopathogenesis of metabolic syndrome in schizophrenia – recent findings

“…Nadalje, studije koje su istražile učinak antipsihotičnih lijekova na pojedinačne komponente metaboličkog sindroma ukazuju da je terapija antipsihoticima povezana s čak 6 -55 %-tnom prevalencijom prekomjerne tjelesne mase i pretilosti, 2 -28 %-tnom prevalencijom dijabetesa tipa 2, prevalencijom dislipidemije od 15 -53 % te hipertenzije od 16 -49 % 33 . Uočeno je da politerapija antipsihotičnim lijekovima i, kao što je već spomenuto, upotreba atipič-nih antipsihotika (antipsihotičnih lijekova druge generacije) posebice pridonose razvoju metaboličkih abnormalnosti 6,34 . Atipični antipsihotici, za razliku od tipičnih antipsihotičnih lijekova, posjeduju veći afinitet za serotoninske 5-HT2 receptore, negoli dopaminske D2 receptore, brže disociraju s dopaminskih D2 receptora, a mnogi od njih su se pokazali i potentnim blokatorima histaminskih H1 receptora te receptora drugih neurotransmiterskih sustava.…”

“…U odnosu na tipične antipsihotike, pripisuje im se značajno manje ekstrapiramidnih nuspojava, manji učinak na poviše-nje koncentracije prolaktina, kao i superiorniji učinak u terapiji, posebice kod negativnih i kognitivnih simptoma 35,36 . Ipak, istraživanja ukazuju na gotovo trostruko veću učestalost metaboličkog sindroma u pacijenata koji su uzimali atipične antipsihotike u usporedbi sa skupinom oboljelih čija je terapija uključivala isključivo tipične antipsihotične lijekove (28 % vs. 10 %) 29,34 . Nadalje, čini se da klozapin i olanzapin najviše od svih antipsihotičnih lijekova pridonose riziku za nastanak meta-S. Nadalin, M. Gudeljević, J. Severec et al: Etiopatogeneza metaboličkog sindroma u shizofreniji -najnovije spoznaje medicina fluminensis 2017, Vol.…”

An Intervention with Physical Activity and Lifestyle Counseling Improves Health-Related Quality of Life and Shows Small Improvements in Metabolic Risks in Persons with Psychosis

“…Study design, content of interventions, and measured outcomes vary greatly (Pearsall et al, 2014, Bonfioli et al, 2012. Likewise, they have included participants with different psychiatric diagnoses, for instance, persons with psychosis (Bonfioli et al, 2012), schizophrenia (Papanastasiou, 2012), mental Illness (Happell et al, 2012), or serious mental illness (Lowe and Lubos, 2008), which may hamper the possibility to compare results between studies (Fernández-San-Martín et al, 2014). Lowe and Lubos (2008) have called for more research with standardized outcome measures to determine and compare the effectiveness of educational and exercise intervention, with usual treatment.…”

“…Previous studies (Pearsall et al, 2014, Bonfioli et al, 2012, Happell et al, 2012, Papanastasiou, 2012, Lowe and Lubos, 2008 have demonstrated a great variety of lifestyle interventions for persons with psychosis. In the absence of convincing research findings, there is no consensus or "golden standard" of lifestyle interventions.…”

Exploring the Economic Implications of a Group-Based Lifestyle Intervention for Middle-Aged Adults with Chronic Schizophrenia and Co-Morbid Type 2 Diabetes

“…Recent systematic reviews suggest positive impacts on weight loss, BMI, glucose tolerance etc. [7,8].…”