Over the past decades the prevalence of metabolic syndrome (MS) among adolescents has increased significantly. Psychiatric disorders and treatment with psychopharmacological drugs are among the risk factors for the development of MS. The risks of drug-induced metabolic disturbances in adolescents are higher than in adults. Conversely, potential reversibility of MS at its initial stages emphasizes the importance of early detection and treatment. The aim of this narrative review is to summarize the available data on the diagnostics, prevention and treatment of MS in adolescents with mental disorders. Medline and RSCI electronic databases were searched to identify relevant sources of information. Synthesis of information based on 157 publications demonstrates the lack of universally accepted criteria for the diagnosis of MS in adolescents and the limited data on effective preventive or therapeutic interventions. In this review the diagnostics of the components of MS and associated disturbances in adolescents are overviewed, pharmacological and nonpharmacological approaches to MS prophylaxis and treatment are discussed. The results of the reviewed studies reveal a number of factors contributing to the development and progression of MS (both unmodifiable and modifiable): genetic, systemic immune-inflammatory, environmental, pharmacological. Further exploration of these factors in adolescents with mental disorders, as well as the development of preventive and therapeutic strategies based on these factors, are important directions for future research.