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 Table of Contents    
REVIEW ARTICLE
Year : 2013  |  Volume : 35  |  Issue : 3  |  Page : 227-240  

Metabolic syndrome in schizophrenia


Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication8-Oct-2013

Correspondence Address:
Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7176.119471

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   Abstract 

To review the data with respect to prevalence of metabolic syndrome (MetS) and its correlates in schizophrenia. For this review, electronic search engines PUBMED, Sciencedirect, and Google Scholar were used. Available data suggests that most of the studies have been of cross-sectional design. Prevalence rates of MetS have varied from 11% to 69% in medicated patients, and 4-26% in drug naive patients in cross-sectional evaluations. Longitudinal studies have shown the prevalence rates to range from 0% to 14% at the baseline in drug naive patients, which increase to as high as 52.4% by 3 months of antipsychotic medication treatment. The prevalence rates of MetS in patients with schizophrenia are much higher than that seen in general population or healthy controls. Though there is no causal association with any demographic or clinical variables, the risk increases with increase in age. Among antipsychotics, there seems to be an association between MetS and atypical antipsychotics like clozapine and olanzapine. Therefore, the psychiatrists should be more vigilant regarding the presence of MetS in these high risk groups. Research on biological correlates of MetS in schizophrenia is still in its primitive stage, however, these is some evidence to suggest an association of MetS with adiponectin levels, hematological indices, methylenetetrahydrofolate reductase (MTHFR) and Alpha-1A adrenergic receptor (ADRA1A) gene. These areas hold promise, and targeting these with appropriate interventions may help us to prevent the occurrence of MetS in patients with schizophrenia in future.

Keywords: Cardiovascular risk, metabolic syndrome, schizophrenia


How to cite this article:
Malhotra N, Grover S, Chakrabarti S, Kulhara P. Metabolic syndrome in schizophrenia. Indian J Psychol Med 2013;35:227-40

How to cite this URL:
Malhotra N, Grover S, Chakrabarti S, Kulhara P. Metabolic syndrome in schizophrenia. Indian J Psychol Med [serial online] 2013 [cited 2019 Nov 17];35:227-40. Available from: http://www.ijpm.info/text.asp?2013/35/3/227/119471


   Introduction Top


It is a well-established fact that schizophrenia is associated with increased mortality and shortened life span. [1],[2] Earlier, the increased risk of mortality in schizophrenia was attributed to high incidence of suicide and other natural causes of death. [3] More recently, research has focused on medical co-morbidities in this disabling disorder, and cardiovascular risk factors have emerged as the major cause of mortality in schizophrenia. [1],[2],[4] Hence, identification, prevention, and modification of the cardiovascular risk factors should be one of the important therapeutic objectives in the management of schizophrenia. To help the psychiatrists to focus more on these cardiovascular risks in patients with schizophrenia, the concept of Metabolic Syndrome (MetS) has received a lot of attention in psychiatric literature.

The mechanism underlying increased prevalence of MetS among patients with schizophrenia is not well understood. A number of explanations like lifestyle and dietary habits that facilitate the development of obesity among patients with schizophrenia, direct antipsychotic drug action on lipid and carbohydrate metabolism, [5] the tendency to accumulate intra-abdominal adiposity and fat, [6] certain alterations of the hypothalamic pituitary-adrenal axis (HPA) producing hypercortisolemia, [7] and its genotypic expression in the form of truncal obesity, poor blood glucose control, [8] and possible associated alterations in hippocampal volume [9] have been proposed.

This review aims to update the existing knowledge regarding prevalence of MetS and its correlates in schizophrenia. For this review, search of electronic databases and manual search of relevant publications or cross references were done. The electronic search engines PUBMED, Sciencedirect, and Google Scholar were searched using the key words like schizophrenia, psychosis, metabolic syndrome, metabolic disturbances, glucose metabolism, obesity, dyslipidemia, and antipsychotics in various combinations. The search was limited to articles published in English. Cross-searches of key references (both electronic and hand-search) often yielded other relevant material. If articles published in any other language were found during the searches of cross references, then these were also included. Abstracts of all the relevant articles were initially reviewed by the first and the second author and only those articles reporting research findings were evaluated further.


   Prevalence of Metabolic Syndrome in Schizophrenia Top


Cross-sectional studies

Numerous studies from different countries and ethnic backgrounds have reported the prevalence of MetS in patients with schizophrenia. Though a few researchers have studied the change in prevalence rates over time, largely the estimates have been cross-sectional. Amongst the cross sectional studies, as depicted in [Table 1], [10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59],[60],[61],[62],[63],[64],[65],[66],[67],[68],[69],[70],[71],[72],[73],[74],[75],[76],[77],[78],[79],[80],[81],[82],[83],[84],[85],[86],[87],[88],[89],[90],[91],[92],[93],[94],[95],[96],[97],[98],[99] most studies have evaluated the patients who are already on treatment and only a few have assessed the prevalence of MetS in drug naive population. Most of the studies have used National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATP-III) criteria for estimating the prevalence rates. Some of the studies have used more than one definition for MetS and show comparable figures for the prevalence of MetS with more than one definition. [12],[19],[25],[26],[35],[36],[37],[39],[52],[61],[73],[74],[83],[95] The sample sizes in studies evaluating the patients already on treatment have varied from 20 to 2,270 patients and the prevalence rates of MetS vary widely from 11% to 69% across different studies. The sample size in the drug naive patients has been less than 100 and prevalence has ranged from 4% to 26%. Most of the authors have limited themselves to patients with schizophrenia; however, few have included patients with schizoaffective disorder [20],[21],[42],[44],[59],[63],[72],[83],[88] and schizophreniform psychosis. [69]

Very few studies have employed proper control groups and studies, which have done so, suggest that the prevalence of metabolic syndrome appears to be higher in schizophrenia than in healthy controls [39],[54],[81] and comparable to other disorders such as Bipolar affective disorder (BPAD). [14],[23],[24],[30],[80],[88] Some of the studies have been limited to patients with clozapine and suggest a prevalence of MetS in patients of clozapine to vary from 46% to 62%. [18],[35],[54],[86]
Table 1: Prevalence of MetS in patients with schizophrenia across different cross‑sectional studies

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Longitudinal studies

Assessing MetS over a period of time in the same set of patients can help us in understanding the etiological causes responsible for the same, especially the antipsychotic medications. Keeping this in mind many authors have evaluated the drug naïve patients with schizophrenia at the baseline and have followed up them over varying period of time to see the changes in the prevalence of MetS. As shown in [Table 2], [100],[111],[112],[113],[114],[115],[116],[117],[118] studies involving the drug naïve patients suggest that the prevalence of MetS vary from 0% to 14% at the baseline, which increases to as high as 52.4% by 3 months of antipsychotic medication. [104]
Table 2: Prevalence of MetS in longitudinal studies

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The studies which have taken medicated patients at baseline have followed different study designs. While some have just followed up patients on the same antipsychotics that they have been receiving at baseline, [106],[107],[111],[113] a few have reported the change in prevalence rate after change in antipsychotic. [112],[114],[116],[117] Some of the studies have evaluated the effect of various antipsychotics by randomizing the study sample to different antipsychotic medications. [109],[110],[118] While most of the studies have included adult patients, two studies longitudinally evaluated MetS in pediatric population. [100],[114] Goeb et al., 2010 [100] followed up 26 children and adolescents with early onset schizophrenia on risperidone for a period of 6 months. None of the children had MetS at baseline or end of 6 months. Maayan and Vakhruseva, 2010 [114] followed up eight children on risperidone for a period of 8 weeks. While none of the children had MetS at baseline, one child developed MetS at the end of 8-week-period.


   Predictors of Mets in Schizophrenia Top


Socio-demographic predictors of metabolic syndrome in schizophrenia

Although many attempts have been made to study the sociodemographic predictors of MetS in patients with schizophrenia, none of the sociodemographic variable has emerged as a consistent predictor of MetS. Among the various sociodemographic variables, many studies have shown higher prevalence of MetS in those who are older. [11],[14],[15],[18],[19],[30],[36],[39],[40],[44],[52],[54],[61],[63],[64],[74],[82],[83],[87],[95],[98] Kang et al., 2011 [48] showed that the relationship of older age with MetS was limited only to males. There is no conclusive evidence regarding the relationship of gender with MetS. Some studies have reported that MetS is more common in females, [16],[44],[64],[73],[87],[88],[89] while others have reported no gender differences in the prevalence rates of MetS [10],[15],[18],[31],[41],[54],[82] and only a few studies have reported higher prevalence in males. [96],[111] Occasional studies have reported association of MetS with higher education level, [35],[98] urban background, [38] employed status, [37],[38] and marital status. [11],[37]

Clinical predictors of metabolic syndrome in schizophrenia

While a longer duration of illness has been demonstrated to be associated with higher prevalence of MetS in some of the studies, [10],[19],[36],[39],[50],[87] some studies have shown no association of MetS and duration of illness. [52],[96] Another clinical variable inconclusively associated with MetS is age of onset with Yaziki et al. [95] demonstrating the prevalence to be higher in those with late age at onset of illness, while Kaya et al. [52] refuting such an association. Old age at hospitalization [95] and more number of hospital admissions [11] have also been shown to be associated with MetS. Similarly, smoking has been inconsistently associated with presence of MetS; with some studies reporting higher prevalence of MetS in patients who smoke [30],[87] while others have reported no association between MetS and smoking. [18],[38],[54] Poor lifestyle habits are associated with MetS, [45] but data with regards to the level of exercise in patients with and without MetS in inconclusive. [11],[38]

Psychotropics and metabolic syndrome in schizophrenia

Use of atypical antipsychotics has been cited as one of the reason for increased prevalence of MetS in schizophrenia. Literature suggests that the prevalence of MetS is in the range of 3-26% [98],[104] in drug naïve patients with schizophrenia, while the same reaches up to 69% in medicated patients. [89] Pallava et al. [98] compared the prevalence rates between drug naïve patients and those on treatment and demonstrated that the prevalence was nearly double in those on treatment. Studies that have followed up drug naïve patients after institution of antipsychotics have demonstrated increment of prevalence rate ranging from 7% to 42% over a period ranging from 3 months to 4 years. Though many authors have failed to demonstrate an association of MetS with a specific atypical antipsychotic, [34],[38],[39],[43],[51],[82],[96] or the mean chlorpromazine (CPZ) dose, [50] still there is some evidence to suggest that atypical antipsychotics do differ in their propensity to cause metabolic syndrome. Highest association was seen with clozapine and olanzapine in cross-sectional studies. [10],[75] Longitudinal studies have also demonstrated that the patients on clozapine and olanzapine are more likely to develop metabolic syndrome when compared to other atypical antipsychotics. [101],[109],[111],[118] In a study done by Dehert et al. [101] data from an historic cohort of consecutively admitted first episode patients with schizophrenia treated with typical antipsychotics were compared with an age and sex matched series of consecutive first episode patients treated only with atypical antipsychotics. Rates of MetS were compared at baseline and after 3 years of treatment exposure. At first episode, there was no difference in the prevalence of MetS between the historic and the current cohort. Rates of MetS increased over time in both groups, but patients started on atypical antipsychotics had a three times higher incidence rate of MetS. The difference between the two groups was no longer significant when patients started on clozapine and olanzapine were excluded. Gautam and Meena [109] randomized 120 patients with schizophrenia who were either drug naive or had not received any antipsychotic in the last 6 months into four treatment groups receiving haloperidol, olanzapine, clozapine, and risperidone and followed up the patients for 4 months. None of the patients in the haloperidol group developed MetS, 23.3%, 10%, and 13.3% of the patients developed metabolic syndrome in olanzapine, risperidone, and clozapine group, respectively. In another study [111] 110 patients with schizophrenia on antipsychotics were randomized to three groups receiving clozapine, olanzapine, and haloperidol. This study reported that the incidence of metabolic syndrome over a period of 12 weeks was significantly higher in clozapine as compared to the other two antipsychotics. Meyer et al. [115] estimated the prevalence rates of MetS in patients with schizophrenia included in Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial twice at an interval of 3 months and demonstrated a significant increase in incidence of MetS in olanzapine group when compared to perphenazine, quetiapine or risperidone group. Also, a significant reduction by 8% was observed in ziprasidone group over a period of 3 months. Patel et al. [118] also demonstrated that a higher proportion of patients in olanzapine group developed MetS as compared to quetiapine and perphenazine over a period of 1 year. Nebhinani et al., 2013 [117] estimated the prevalence of MetS in patients with schizophrenia on antipsychotics before and 3 months after switching them to clozapine, and reported the prevalence to increase from 33.3% to 53.3%. Lin et al. [112] followed up patients after switching from an atypical antipsychotic to amisulpride and demonstrated a decrease in prevalence of MetS from 65% to 30% within a year. Meyer and Pandira [116] followed up 71 patients with schizophrenia of schizoaffective disorder for 20 weeks after switching from olanzapine to risperidone and demonstrated that the prevalence rates decreased from 53% to 36%, suggesting a differential effect of antipsychotics on development of MetS.

Though many of the aforementioned studies have demonstrated higher risk of MetS with atypical, however, many authors have also concluded that atypical or typical antipsychotics do not differ in their propensity to cause MetS. [22],[28],[31] Few studies, which have measured the prevalence of MetS in patients receiving clozapine suggest that the presence of MetS is not dependent on dose and duration. [18],[86] While there is some evidence to suggest association of MetS with polypharmacy, [22],[44],[66] a few authors have refuted such association. [32],[51] There is no conclusive evidence regarding the association of duration of antipsychotic use with MetS. Though multiple studies have demonstrated that the duration of treatment does not influence the prevalence, [11],[54],[64] a few have demonstrated a definite relationship of MetS with the duration of treatment. [19],[50],[54]

Biological correlates of metabolic syndrome in schizophrenia

Some researchers have attempted to identify biological markers for MetS in schizophrenia and have shown that low levels of adiponectin, [13],[42],[119] low levels of leptin, [119] lower uric acid, [107] hyperhomocyseniemia, [94] high alanine transferase, [58] high white blood cell count, [120],[121] high monocytes, and high C-reactive protein [121] to be associated with MetS in schizophrenia. Lee et al. [122] studied the association of cardiac autonomic control with MetS and failed to show any positive association.

Some authors have tried to study the genetic basis of high prevalence of MetS in schizophrenia. Methylenetetrahydrofolate reductase (MTHFR) gene has been the most often studied and a few studies have demonstrated that MTHFR 677T allele [30] and MTHFR 677C/T as compared to 677C/C allele [29] is more likely to be associated with MetS. Arg347 allele in Alpha-1A adrenergic receptor (ADRA1A) [123] has been demonstrated to be associated with a high prevalence and alpha-2A adrenergic receptor (ADRA2A) 1291-G allele with lower prevalence of MetS. [124] Similarly COMT158Val allele was shown to be associated with MetS prevalence in one of the studies. [30] Kang et al. [32] studied the relationship of MetS and 5-hydroxytryptamine (serotonin) receptor 2C (HTR2C), but failed to demonstrate any association.


   Impact of Metabolic Syndrome Top


Although studies have evaluated the prevalence of MetS in schizophrenia, there is a serious lack of data about its impact. There is inconclusive evidence that MetS influences the quality of life. [64] Some of the studies have shown that patients of schizophrenia with MetS tend to have higher residual psychopathology scores on Positive and Negative Syndrome Scale (PANSS) and Computer-generated imagery (CGI). [11] Studies have also linked presence of MetS with presence of more anxiety symptoms. [62] Others have not found any association between MetS and symptom severity, depression, and self-rated mental health. [64]

Poor cognitive functioning has been inconsistently associated with MetS. [59],[64] Patients with MetS have also been reported to have significantly lower physical health as assessed by Short Form-12 (SF-12). [64] Padmavati et al., 2010 [97] demonstrated that malnutrition is very common in patients with schizophrenia having MetS.


   Discussion Top


First study measuring the prevalence of MetS in schizophrenia was published in 2004 by Almeras et al. [10] As per this study, the prevalence rate of MetS in schizophrenia varied from 11% to 33% depending on the antipsychotic patients were receiving. Over the years, many studies have accumulated and the estimates have ranged from 15% to 69% in cross-sectional studies in medicated patients. The available research has many shortcomings. Though a few have estimated the prevalence rates in large sample sizes, most of the studies have been on small sample sizes. Secondly, most of the research has been on medicated patients. Thirdly, the research has largely been cross-sectional. There is a large variation in the prevalence rates across various countries. This can partly be explained by the fact that different definitions have been used and different cut-offs for waist circumference have been used in different ethnic populations. Among the various definition, the definition of NCEP ATP-III [125] has been the most commonly used criteria-set for defining MetS and it requires presence of at least three out five criteria (abnormal blood pressure, raised triglycerides, reduced high density lipoprotein, raised fasting blood glucose, and increased waist circumference) for diagnosing MetS. Some authors have used the criteria of International Diabetes Federation (IDF); [126] which are identical to NCEP ATP III, with a fundamental difference of mandatory requirement of fulfilment of abnormal waist circumference criteria along with presence of two other criteria. Other definitions (World Health Organization, European Group for the Study of Insulin Resistance, American Association of Clinical Endocrinology, American Heart Association) [127],[128],[129],[130] of MetS, which have been used differ slightly in cut offs of subcomponents but most of these require the fulfilment of three criteria for the diagnosis of MetS. Recently, in an attempt to harmonize various definitions of MetS a joint interim statement of the IDF has provided a consensus definition, according to which, abdominal obesity is no more a pre-requite criterion and presence of any three of the five risk factors is sufficient for considering MetS. Additionally, in a major change from the NCEP-ATP III criteria, the consensus definitions requires use of population and country-specific cut offs for waist circumference. Moreover, it has been suggested that while defining MetS those with established diabetes mellitus and known cardiovascular disease should be excluded so as to consider MetS as a premorbid condition to predict the development of diabetes mellitus and cardiovascular disease in future as once diabetes develops MetS is invariably present. [131]


   What can be concluded from the data? Top


Review of the available data suggests that MetS is fairly prevalent in patients with schizophrenia. The prevalence rate is similar to other severe mental illness like BPAD and other psychotic conditions and is much higher than that seen in general population or healthy controls. [39],[54],[81] Though there is no causal association with any demographic or clinical variables, the risk appears to be higher in older people. [11],[14],[15],[18],[19],[30],[36],[39],[40],[44],[52],[54],[61],[63],[64],[74],[82],[83],[87],[95],[98] and in those with long duration of illness. [11],[19],[36],[39],[50],[87] Effect of psychotropics on prevalence of MetS is inconclusive but there is some evidence to suggest higher association with atypical antipsychotics like clozapine and olanzapine. [101],[109],[111],[118] Therefore, the psychiatrists should be more vigilant regarding the presence of MetS in these high risk groups. Research on biological correlates of MetS in schizophrenia is still in its primitive stage; however, data on adiponectin levels, hematological indices appear to be promising. There is some evidence base to suggest association of MetS with MTHFR and ADRA1A gene; however it is still in its juvenile phase. These areas hold promise, and targeting these with appropriate interventions may help us to prevent the occurrence of MetS in patients with schizophrenia in future.


   Limitations and Future Direction Top


The major limitations of many of the studies reviewed here are small sample size and cross-sectional study design. Even many of the longitudinal studies have included only medicated patients, hence not providing the prevalence rates in patients who have never been exposed to antipsychotics. Data with regards to the role of different antipsychotics are also scarce. In addition, very few studies have tried to study the association of MetS with demographic and clinical variables and there is hardly any data on the impact MetS has on patients with schizophrenia. Future studies should focus more on prevalence of MetS in drug naive patients and follow-up these patients longitudinally to understand the factors which contribute to development of MetS. In addition, large randomized controlled trials are warranted to compare the potential of different antipsychotics to cause MetS. The risk factors for development of metabolic abnormalities as well as their pathophysiology in schizophrenia also need further research. Also, we need to focus on the impact MetS has on course and outcome of schizophrenia. In addition, the impact of MetS on quality of life, and psychological functioning of the patients with schizophrenia also warrants further research.


   Alternatives to Metabolic Syndrome in Understanding the Cardiovascular Mortality Top


It has been established that when present, MetS is highly predictive of cardiovascular disease. Cardiovascular risk has also been estimated in schizophrenia using Systematic Coronary Risk Evaluation (SCORE) function [132] for cardiovascular mortality risk (CVM) (including coronary death, sudden death, stroke, aortic aneurism, and heart failure) and the Framingham function [133] to estimate the overall risk of any fatal or non-fatal coronary heart disease (CHD) (including, in addition to the fatal CHD events mentioned above, any type of angina, myocardial infarction, other type of coronary ischemia, congestive heart failure, intermittent claudication, or peripheral arterial ischemia) within 10 years. Both functions are mathematical probability models obtained using multivariate analysis techniques from follow-up studies of individuals in the general population, in which the incidence of a fatal or non-fatal CHD event is related to the individual risk factors of each subject. In the SCORE function, the CVM risk is calculated from the values for age, sex, total cholesterol, High-density lipoprotein (HDL) cholesterol, systolic blood pressure (SBP), and smoking status. The Framingham function calculates the risk from the same values as the SCORE function, but with the addition of diabetes. Some of the risk factors which estimate the cardiovascular risk as per SCORE and Framingham function are similar to those constituting MetS. Arango et al. [11] compared the CHD 10-year risk in patients of schizophrenia with and without MetS using both SCORE and Framingham function. Higher percentage (6.6%) of patients with MetS as against 2.8% without MetS showed high/very-high CVM risk (SCORE ≥ 3%), and 44.2% with MetS as against 12.9% without MetS showed high/very-high CV event risk (Framingham ≥ 10). Similarly, Correll et al. [134] reported the 10 year cardiovascular risk as per Framingham function to be significantly higher in patients with MetS. Bobes et al. [15] estimated mean overall 10-year cardiovascular risk in patients with schizophrenia which was 0.9 (SCORE) and 7.2 (Framingham). Eight percent and 22.1% of patients showed a high/very high risk according to SCORE and Framingham function, which is higher than in general population. Similarly Cohn et al. [21] reported Framingham 10-year risk of myocardial infarction to be greater in the patients with schizophrenia as compared to general population. Correl et al. [23] reported Framingham 10-year risk of cardiovascular events in schizophrenia to be similar to BPAD. However, there is a need to study this area further to understand the best predictors of cardiovascular mortality in patients with schizophrenia.


   Do we need to monitor the schizophrenia for metabolic syndrome? Top


MetS is one of the primary reasons for increased mortality in patients with schizophrenia. This very fact merits routine screening of these patients for the prevalence of MetS. It is important to identify the high risk patients and educate them regarding the preventive measures. Attempts should be made to change unhealthy lifestyle like inactivity; overeating, smoking, and use of appropriate psycho-educational programs in this regard need to be developed. Although, the data with respect to association of MetS and psychotropics in schizophrenia remain inconclusive, nonetheless, a cautious approach in prescribing psychotropics is advisable. Studies in schizophrenia patients do suggest that atypical like clozapine and olanzapine pose a higher risk of metabolic abnormalities hence, due consideration should be given to their potential to cause metabolic disturbances while prescribing an agent, and whenever used, the prescription should be revised frequently to maintain a balance between appropriate control of symptoms and minimal metabolic abnormalities.

 
   References Top

1.Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: Is the differential mortality gap worsening over time? Arch Gen Psychiatry 2007;64:1123-31.  Back to cited text no. 1
[PUBMED]    
2.Capasso RM, Lineberry TW, Bostwick JM, Decker PA, St Sauver J. Mortality in schizophrenia and schizoaffective disorder: An Olmsted County, Minnesota cohort: 1950-2005. Schizophr Res 2008;98:287-94.  Back to cited text no. 2
[PUBMED]    
3.Brown S. Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 1997;171:502-8.  Back to cited text no. 3
[PUBMED]    
4.Laursen TM. Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophr Res 2011;131:101-4.  Back to cited text no. 4
[PUBMED]    
5.Basu R, Brar JS, Chengappa KN, John V, Parepally H, Gershon S, et al. The prevalence of the metabolic syndrome in patients with schizoaffective disorder--bipolar subtype. Bipolar Disord 2004;6:314-8.  Back to cited text no. 5
[PUBMED]    
6.Thakore JH, Mann JN, Vlahos I, Martin A, Reznek R. Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia. Int J Obes Relat Metab Disord 2002;26:137-41.  Back to cited text no. 6
[PUBMED]    
7.Kaneda Y, Fujii A, Ohmori T. The hypothalamic-pituitary- adrenal axis in chronic schizophrenic patients long-term treated with neuroleptics. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:935-8.  Back to cited text no. 7
[PUBMED]    
8.Rosmond R. The glucocorticoid receptor gene and its association to metabolic syndrome. Obes Res 2002;10:1078-86.  Back to cited text no. 8
[PUBMED]    
9.Starkman MN, Giordani B, Gebarski SS, Berent S, Schork MA, Schteingart DE. Decrease in cortisol reverses human hippocampal atrophy following treatment of Cushing's disease. Biol Psychiatry 1999;46:1595-602.  Back to cited text no. 9
[PUBMED]    
10.Alméras N, Després JP, Villeneuve J, Demers MF, Roy MA, Cadrin C, et al. Development of an atherogenic metabolic risk profile associated with the use of atypical antipsychotics. J Clin Psychiatry 2004;65:557-64.  Back to cited text no. 10
    
11.Arango C, Bobes J, Aranda P, Carmena R, Garcia-Garcia M, Rejas J. CLAMORS Study Collaborative Group. A comparison of schizophrenia outpatients treated with antipsychotics with and without metabolic syndrome: Findings from the CLAMORS study. Schizophr Res 2008;104:1-12.  Back to cited text no. 11
    
12.Azanza JR, Bernardo M, Rojo L, Rejas-Gutiérrez J, Mesa F. Prevalence of metabolic syndrome in Spanish patients with schizophrenia and overweight. Eur Psychiatry 2009;24:S1163.  Back to cited text no. 12
    
13.Bai YM, Lin CC, Chen JY, Chen TT, Su TP, Chou P. Association of weight gain and metabolic syndrome in patients taking clozapine: An 8-year cohort study. J Clin Psychiatry 2011;72:751-6.  Back to cited text no. 13
[PUBMED]    
14.Baptista T, Serrano A, Uzcátegui E, ElFakih Y, Rangel N, Carrizo E, et al. The metabolic syndrome and its constituting variables in atypical antipsychotic-treated subjects: Comparison with other drug treatments, drug-free psychiatric patients, first-degree relatives and the general population in Venezuela. Schizophr Res 2011;126:93-102.  Back to cited text no. 14
    
15.Bobes J, Arango C, Aranda P, Carmena R, Garcia-Garcia M, Rejas J. CLAMORS Study Collaborative Group. Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: Results of the CLAMORS Study. Schizophr Res 2007;90:162-73.  Back to cited text no. 15
    
16.Boke O, Aker S, Sarisoy G, Saricicek EB, Sahin AR. Prevalence of metabolic syndrome among inpatients with schizophrenia. Int J Psychiatry Med 2008;38:103-12.  Back to cited text no. 16
[PUBMED]    
17.Bernardo M, Cañas F, Banegas JR, Casademont J, Riesgo Y, Varela C. RICAVA Study Group. Prevalence and awareness of cardiovascular risk factors in patients with schizophrenia: A cross-sectional study in a low cardiovascular disease risk geographical area. Eur Psychiatry 2009;24:431-41.  Back to cited text no. 17
    
18.Brunero S, Lamont S, Fairbrother G. Prevalence and predictors of metabolic syndrome among patients attending an outpatient clozapine clinic in Australia. Arch Psychiatr Nurs 2009;23:261-8.  Back to cited text no. 18
[PUBMED]    
19.Cerit C, Özten E, Yildiz M. The prevalence of metabolic syndrome and related factors in patients with schizophrenia. Turk Psikiyatri Derg 2008;19:124-32.  Back to cited text no. 19
    
20.Cerit C, Vural M, Bos Gelmez SÜ, Ozten E, Aker AT, Yýldýz M. Metabolic syndrome with different antipsychotics: A multicentre cross-sectional study. Psychopharmacol Bull 2010;43:22-36.  Back to cited text no. 20
    
21.Cohn T, Prud'homme D, Streiner D, Kameh H, Remington G. Characterizing coronary heart disease risk in chronic schizophrenia: High prevalence of the metabolic syndrome. Can J Psychiatry 2004;49:753-60.  Back to cited text no. 21
[PUBMED]    
22.Correll CU, Frederickson AM, Kane JM, Manu P. Does antipsychotic polypharmacy increase the risk for metabolic syndrome? Schizophr Res 2007;89:91-100.  Back to cited text no. 22
[PUBMED]    
23.Correll CU, Frederickson AM, Kane JM, Manu P. Equally increased risk for metabolic syndrome in patients with bipolar disorder and schizophrenia treated with second-generation antipsychotics. Bipolar Disord 2008;10:788-97.  Back to cited text no. 23
[PUBMED]    
24.Correll CU, Druss BG, Lombardo I, O'Gorman C, Harnett JP, Sanders KN, et al. Findings of a U.S. national cardiometabolic screening program among 10,084 psychiatric outpatients. Psychiatr Serv 2010;61:892-8.  Back to cited text no. 24
    
25.De Hert M, van Winkel R, Van Eyck D, Hanssens L, Wampers M, Scheen A, et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res 2006;83:87-93.  Back to cited text no. 25
    
26.De Hert M, van Winkel R, Van Eyck D, Hanssens L, Wampers M, Scheen A, et al. Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: A cross-sectional study. Clin Pract Epidemiol Ment Health 2006;27:2-14.  Back to cited text no. 26
    
27.De Hert M, Hanssens L, Wampers M. Prevalence and incidence rates of metabolic abnormalities and diabetes in a prospective study of patients treated with second-generation antipsychotics. Schizophr Bull 2007;33:560.  Back to cited text no. 27
    
28.De Hert M, Mauri M, Shaw K, Wetterling T, Doble A, Giudicelli A, et al. The METEOR study of diabetes and other metabolic disorders in patients with schizophrenia treated with antipsychotic drugs. I. Methodology. Int J Methods Psychiatr Res 2010;19:195-210.  Back to cited text no. 28
    
29.Ellingrod VL, Miller DD, Taylor SF, Moline J, Holman T, Kerr J. Metabolic syndrome and insulin resistance in schizophrenia patients receiving antipsychotics genotyped for the methylenetetrahydrofolate reductase (MTH-FR) 677C/T and 1298A/C variants. Schizophr Res 2008;98:47-54.  Back to cited text no. 29
[PUBMED]    
30.Ellingrod VL, Taylor SF, Dalack G, Grove TB, Bly MJ, Brook RD, et al. Risk factors associated with metabolic syndrome in bipolar and schizophrenia subjects treated with antipsychotics: The role of folate pharmacogenetics. J Clin Psychopharmacol 2012;32:261-5.  Back to cited text no. 30
[PUBMED]    
31.Fan X, Liu EY, Freudenreich O, Park JH, Liu D, Wang J, et al. Higher white blood cell counts are associated with an increased risk for metabolic syndrome and more severe psychopathology in non-diabetic patients with schizophrenia. Schizophr Res 2010;118:211-7.  Back to cited text no. 31
[PUBMED]    
32.Falissard B, Mauri M, Shaw K, Wetterling T, Doble A, Giudicelli A, et al. The METEOR study: Frequency of metabolic disorders in patients with schizophrenia. Focus on first and second generation and level of risk of antipsychotic drugs. Int Clin Psychopharmacol 2011;26:291-302.  Back to cited text no. 32
[PUBMED]    
33.Ferreira L, Belo A, Abreu-Lima C. RICAVA study group. A case-control study of cardiovascular risk factors and cardiovascular risk among patients with schizophrenia in a country in the low cardiovascular risk region of Europe. Rev Port Cardiol 2010;29:1481-93.  Back to cited text no. 33
    
34.Gordon PC, Xavier JC, Louzã MR. Weight gain, metabolic disturbances, and physical health care in a Brazilian sample of outpatients with schizophrenia. Neuropsychiatr Dis Treat 2013;9:133-8.  Back to cited text no. 34
    
35.Grover S, Nebhinani N, Chakrabarti S, Avasthi A, Kulhara P. Metabolic syndrome among patients receiving clozapine: A preliminary estimate. Indian J Pharmacol 2011;43:591-5.  Back to cited text no. 35
[PUBMED]  Medknow Journal  
36.Grover S, Aggarwal M, Dutt A, Chakrabarti S, Avasthi A, Kulhara P, et al. Prevalence of metabolic syndrome in patients with schizophrenia in India. Psychiatry Res 2012;200:1035-7.  Back to cited text no. 36
[PUBMED]    
37.Grover S, Nebhinani N, Chakrabarti S, Avasthi A, Kulhara P, Basu D, et al. Comparative study of prevalence of metabolic syndrome in bipolar disorder and schizophrenia from North India. Nord J Psychiatry 2013.  Back to cited text no. 37
    
38.Gulzar M, Rafiq A, OCuill M. Prevalence of metabolic syndrome in elderly schizophrenic patients in Ireland. Eur Arch Psychiatry Clin Neurosci 2009;259 Suppl 1:S85.  Back to cited text no. 38
    
39.Güveli H, Cem IM, Yener F, Karamustafalioðlu N, Ipekçioðlu D, Abanoz Z. The frequency of metabolic syndrome in schizophrenia patients using antipsychotic medication and related factors. Yeni Symp 2011;49:67-76.  Back to cited text no. 39
    
40.Hatata H, El-Gohary G, Abd-Elsalam M, Elokda E. Risk Factors of Metabolic Syndrome among egyptian patients with schizophrenia. Curr Psychiatry 2009;16:85-95.  Back to cited text no. 40
    
41.Hagg S, Lindblom Y, Mjorndal T, Adolfsson R. High prevalence of the metabolic syndrome among a Swedish cohort of patients with schizophrenia. Int Clin Psychopharmacol 2006;21:93-8.  Back to cited text no. 41
    
42.Hanssens L, van Winkel R, Wampers M, Van Eyck D, Scheen A, Reginster JY, et al. A cross-sectional evaluation of adiponectin plasma levels in patients with schizophrenia and schizoaffective disorder. Schizophr Res 2008;106:308-14.  Back to cited text no. 42
[PUBMED]    
43.Heiskanen T, Niskanen L, Lyytikäinen R, Saarinen PI, Hintikka J. Metabolic syndrome in patients with schizophrenia. J Clin Psychiatry 2003;64:575-9.  Back to cited text no. 43
    
44.Huang MC, Lu ML, Tsai CJ, Chen PY, Chiu CC, Jian DL, et al. Prevalence of metabolic syndrome among patients with schizophrenia or schizoaffective disorder in Taiwan. Acta Psychiatr Scand 2009;120:274-80.  Back to cited text no. 44
[PUBMED]    
45.James BO, Lawani AA, Okolo M, Morakinyo O. Prevalence of the metabolic syndrome among schizophrenia patients on antipsychotics in Nigeria. Schizophr Res 2010;117:2-3.  Back to cited text no. 45
    
46.Kagal UA, Torgal SS, Patil NM, Malleshappa A. Prevalence of the metabolic syndrome in schizophrenic patients receiving second-generation antipsychotic agents--a cross-sectional study. J Pharm Pract 2012;25:368-73.  Back to cited text no. 46
[PUBMED]    
47.Kang SH, Kim KH, Kang GY, Lee KH, Kim KK, Soh M, et al. Cross-sectional prevalence of metabolic syndrome in Korean population with schizophrenia. Schizophr Res 2011;128:179-81.  Back to cited text no. 47
[PUBMED]    
48.Kang SH, Lee JI, Chang AK, Joo YH, Kim CY, Kim SY. Genetic polymorphisms in the HTR2C and peroxisome proliferator-activated receptors are not associated with metabolic syndrome in patients with schizophrenia taking clozapine. Psychiatry Investig 2011;8:262-8.  Back to cited text no. 48
[PUBMED]    
49.Kato MM, Currier MB, Gomez CM, Hall L, Gonzalez-Blanco M. Prevalence of metabolic syndrome in Hispanic and non-Hispanic patients with schizophrenia. Prim Care Companion J Clin Psychiatry 2004;6:74-7.  Back to cited text no. 49
[PUBMED]    
50.Kim CH, Nam YY, Ahn CW. Clinical correlates of metabolic syndrome in patients with chronic schizophrenia. Schiophr Res 2008;102:242-3.  Back to cited text no. 50
    
51.Krane-Gartiser K, Breum L, Glümrr C, Linneberg A, Madsen M, Køster A, et al. Prevalence of the metabolic syndrome in Danish psychiatric outpatients treated with antipsychotics. Nord J Psychiatry 2011;65:345-52.  Back to cited text no. 51
    
52.Kaya MC, Virit O, Altindag A, Selek S, Bülbül F, Bulut M, et al. Prevalence of metabolic syndrome, characteristics of metabolic syndrome and relationship with the antipsychotics used in schizophrenia. Nöropsikiyatri Arºivi 2009;46:13.  Back to cited text no. 52
    
53.Kurt E, Altinbas K, Alatas G, Ozver I. Metabolic syndrome prevalence among schizophrenic patients treated in chronic inpatient clinics. Türkiye'de Psikiyatri 2007;9:141-5.  Back to cited text no. 53
    
54.Lamberti JS, Olson D, Crilly JF, Olivares T, Williams GC, Tu X, et al. Prevalence of the metabolic syndrome among patients receiving clozapine. Am J Psychiatry 2006;7:1273-6.  Back to cited text no. 54
    
55.Larsen JT, Fagerquist M, Holdrup M, Christensen B, Sigalin C, Nilsson PM. Metabolic syndrome and psychiatrists' choice of follow-up interventions in patients treated with atypical antipsychotics in Denmark and Sweden. Nord J Psychiatry 2011;65:40-6.  Back to cited text no. 55
    
56.Lee NY, Kim SH, Jung DC, Kim EY, Yu HY, Sung KH, et al. The prevalence of metabolic syndrome in Korean patients with schizophrenia receiving a monotherapy with aripiprazole, olanzapine or risperidone. Prog Neuropsychopharmacol Biol Psychiatry 2011;35:1273-8.  Back to cited text no. 56
    
57.Lee J, Nurjono M, Wong A, Salim A. Prevalence of metabolic syndrome among patients with schizophrenia in Singapore. Ann Acad Med Singapore 2012;41:457-62.  Back to cited text no. 57
    
58.Lee NY, Roh MS, Kim SH, Jung DC, Yu HY, Sung KH, et al. The prevalence of metabolic syndrome and its association with alanine aminotransferase in clozapine-treated Korean patients with schizophrenia. Int Clin Psychopharmacol 2013;28:71-9.  Back to cited text no. 58
    
59.Lindenmayer JP, Khan A, Kaushik S, Thanju A, Praveen R, Hoffman L, et al. Relationship between metabolic syndrome and cognition in patients with schizophrenia. Schizophr Res 2012;142:171-6.  Back to cited text no. 59
    
60.Lin CC, Yu SC, Wu BJ, Chang DJ. Measurement of waist circumference at different sites affects the detection of abdominal obesity and metabolic syndrome among psychiatric patients. Psychiatry Res 2012;197:322-6.  Back to cited text no. 60
    
61.McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res 2005;80:19-32.  Back to cited text no. 61
    
62.Maslov B, Marcinko D, Milicevic R, Babiæ D, Dordeviæ V, Jakovljeviæ M. Metabolic syndrome, anxiety, depression and suicidal tendencies in post-traumatic stress disorder and schizophrenic patients. Coll Antropol 2009;33:7-10.  Back to cited text no. 62
    
63.Medeiros-Ferreira L, Obiols JE, Navarro-Pastor JB, Zúñiga-Lagares A. Metabolic syndrome and health-related quality of life in patients with schizophrenia. Actas Esp Psiquiatr 2013;41:17-26.  Back to cited text no. 63
    
64.Meyer JM, Nasrallah HA, McEvoy JP, Goff DC, Davis SM, Chakos M, et al. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial: Clinical comparison of subgroups with and without the metabolic syndrome. Schizophr Res 2005;80:9-18.  Back to cited text no. 64
    
65.Meyer J, Loh C, Leckband SG, Boyd JA, Wirshing WC, Pierre JM, et al. Prevalence of the metabolic syndrome in veterans with schizophrenia. J Psychiatr Pract 2006;12:5-10.  Back to cited text no. 65
    
66.Misawa F, Shimizu K, Fujii Y, Miyata R, Koshiishi F, Kobayashi M, et al. Is antipsychotic polypharmacy associated with metabolic syndrome even after adjustment for lifestyle effects?: A cross-sectional study. BMC Psychiatry 2011;11:118.  Back to cited text no. 66
    
67.Nurjono M, Lee J. Predictive utility of blood pressure, waist circumference and body mass index for metabolic syndrome in patients with schizophrenia in Singapore. Early Interv Psychiatry 2013;7:205-9.  Back to cited text no. 67
    
68.Oyekcin DG. The frequency of metabolic syndrome in patients with schizophrenia and schizoaffective disorder. Anatolian J Psychiatry 2009;10:26-33.  Back to cited text no. 68
    
69.Phutane VH, Tek C, Chwastiak L, Ratliff JC, Ozyuksel B, Woods SW, et al. Cardiovascular risk in a first-episode psychosis sample: A 'critical period' for prevention? Schizophr Res 2011;127:257-61.  Back to cited text no. 69
    
70.Rahman AH, Asmara HS, Baharudin A, Sidi H. Metabolic syndrome in psychiatric patients with primary psychotic and mood disorders. Asean J Psychiatry 2009;10:1-8.  Back to cited text no. 70
    
71.Rejas J, Bobes J, Arango C, Aranda P, Carmena R, Garcia-Garcia M. Concordance of standard and modified NCEP ATP III criteria for identification of metabolic syndrome in outpatients with schizophrenia treated with antipsychotics: A corollary from the CLAMORS study. Schizophr Res 2008;99:23-8.  Back to cited text no. 71
    
72.Rivas-Vazquez RA, Bello I, Sarria M, Fernandez ND, Rey GJ. Prevalence of metabolic syndrome in a predominantly cuban, psychiatrically ill, and homeless population. Prim Care Companion CNS Disord 2011;13.  Back to cited text no. 72
    
73.Rezaei O, Khodaie-Ardakani MR, Mandegar MH, Dogmehchi E, Goodarzynejad H. Prevalence of metabolic syndrome among an Iranian cohort of inpatients with schizophrenia. Int J Psychiatry Med 2009;39:451-62.  Back to cited text no. 73
    
74.Roshdy R. Prevalence of metabolic syndrome in patients with schizophrenia. Middle East Curr Psychiatry 2011;18:109-17  Back to cited text no. 74
    
75.Said MA, Sulaiman AH, Habil MH, Das S, Bakar AK, Yusoff RM, et al. Metabolic syndrome and cardiovascular risk among patients with schizophrenia receiving antipsychotics in Malaysia. Singapore Med J 2012;53:801-7.  Back to cited text no. 75
    
76.Saari KM, Lindeman SM, Viilo KM, Isohanni MK, Jarvelin MR, Lauren LH, et al. A 4-fold risk of metabolic syndrome in patients with schizophrenia: The northern Finland 1966 birth cohort study. J Clin Psychiatry 2005;66:559-63.  Back to cited text no. 76
    
77.Schorr SG, Lucas M, Slooff CJ, Bruggeman R, Taxis K. The prevalence of metabolic syndrome in schizophrenic patients in the Netherlands. Schizophr Res 2008;102 (Suppl 2):241.  Back to cited text no. 77
    
78.Schorr SG, Slooff CJ, Bruggeman R, Taxis K. The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year. J Psychiatr Res 2009;43:1106-11.  Back to cited text no. 78
    
79.Srisurapanont M, Likhitsathian S, Boonyanaruthee V, Charnsilp C, Jarusuraisin N. Metabolic syndrome in Thai schizophrenic patients: A naturalistic one year follow-up study. BMC Psychiatry 2007;23:7-14.  Back to cited text no. 79
    
80.Sicras A, Rejas J, Navarro R, Serrat J, Blanca M. Metabolic syndrome in bipolar disorder: A cross-sectional assessment of a Health Management Organization database. Bipolar Disord 2008;10:607-16.  Back to cited text no. 80
    
81.Subashini R, Deepa M, Padmavati R, Thara R, Mohan V. Prevalence of diabetes, obesity, and metabolic syndrome in subjects with and without schizophrenia (CURES-104). J Postgrad Med 2011;57:272-7.  Back to cited text no. 81
[PUBMED]  Medknow Journal  
82.Straker D, Correll CU, Kramer-Ginsberg E, Abdulhamid N, Koshy F, Rubens E, et al. Cost-effective screening for the metabolic syndrome in patients treated with second generation antipsychotic medications. Am J Psychiatry 2005;162:1217-21.  Back to cited text no. 82
    
83.Sugawara N, Yasui-Furukori N, Sato Y, Umeda T, Kishida I, Yamashita H, et al. Prevalence of metabolic syndrome among patients with schizophrenia in Japan. Schizophr Res 2010;123:244-50.  Back to cited text no. 83
    
84.Sugawara N, Yasui-Furukori N, Sato Y, Kishida I, Yamashita H, Saito M, et al. Comparison of prevalence of metabolic syndrome in hospital and community-based Japanese patients with schizophrenia. Ann Gen Psychiatry 2011;10:21.  Back to cited text no. 84
    
85.Suvisaari JM, Saarni SI, Perala J, Suvisaari JV, Harkanen T, Lonnqvist J, et al. Metabolic syndrome among persons with schizophrenia and other psychotic disorders in a general population survey. J Clin Psychiatry 2007;68:1045-55.  Back to cited text no. 85
    
86.Steylen PM, van der Heijden FF, Verhoeven W, Kok JD, van Soest M, Tuinier S. Metabolic syndrome during clozapine treatment. PW Wetenschappelijk Platform 2009;3:96-100.  Back to cited text no. 86
    
87.Sweileh WM, Zyoud SH, Dalal SA, Ibwini S, Sawalha AF, Ali I. Prevalence of metabolic syndrome among patients with schizophrenia in Palestine. BMC Psychiatry 2012;12:235.  Back to cited text no. 87
    
88.Teixeira PJ, Rocha FL. The prevalence of metabolic syndrome among psychiatric inpatients in Brazil. Rev Bras Psiquiatr 2007;29:330-6.  Back to cited text no. 88
    
89.Tirupati S, Chua LE. Obesity and metabolic syndrome in a psychiatric rehabilitation service. Aust N Z J Psychiatry 2007;41:606-10.  Back to cited text no. 89
    
90.Van Der Heijden F, Steylen P, Kok H, Slaar A, Verhoeven W. Low rates of treatment of cardiovascular risk factors in patients treated with antipsychotics. Eur Psychiatry 201;26.  Back to cited text no. 90
    
91.van Winkel R, Rutten BP, Peerbooms O, Peuskens J, van Os J, De Hert M. MTHFR and risk of metabolic syndrome in patients with schizophrenia. Schizophr Res 2010; 121:193-8.  Back to cited text no. 91
    
92.van Winkel R, van Os J, Celic I, Van Eyck D, Wampers M, Scheen A, et al. Psychiatric diagnosis as an independent risk factor for metabolic disturbances: Results from a comprehensive, naturalistic screening program. J Clin Psychiatry 2008;69:1319-27.  Back to cited text no. 92
    
93.Vancampfort D, Sweers K, Probst M, Maurissen K, Knapen J, Minguet P, et al. Association of the metabolic syndrome with physical activity performance in patients with schizophrenia. Diabetes Metab 2011;37:318-23.  Back to cited text no. 93
    
94.Vuksan-Cusa B, Sagud M, Jakovljeviæ M. C-reactive protein and metabolic syndrome in patients with bipolar disorder compared to patients with schizophrenia. Psychiatr Danub 2010;22:275-7.  Back to cited text no. 94
    
95.Yazici MK, Anil Yaðcioðlu AE, Ertuðrul A, Eni N, Karahan S, Karaaðaoðlu E, et al. The prevalence and clinical correlates of metabolic syndrome in patients with schizophrenia: Findings from a cohort in Turkey. Eur Arch Psychiatry Clin Neurosci 2011;261:69-78.  Back to cited text no. 95
    
96.Yoon BH, Bae A, Bahk WM. Prevalence and characteristics of metabolic syndrome in schizophrenic inpatients. Schizophr Res 2008;102:244.  Back to cited text no. 96
    
97.Padmawati R, McCreadle RG, Tirupati S. Low prevalence of obesity and metabolic syndrome in never treated chronic schizophrenia. Schizophr Res 2010;121:199-202.  Back to cited text no. 97
    
98.Pallava A, Chadda RK, Sood M, Lakshmy R. Metabolic syndrome in schizophrenia: A comparative study of antipsychotic-free/naïve and antipsychotic-treated patients from India. Nord J Psychiatry 2012;66:215-21.  Back to cited text no. 98
    
99.Grover S, Nebhinani N, Chakrabarti S, Parakh P, Ghormode D. Metabolic syndrome in antipsychotic naïve patients diagnosed with schizophrenia. Early Interv Psychiatry 2012;6:326-31.  Back to cited text no. 99
    
100.Goeb JL, Marco S, Duhamel A, Kechid G, Bordet R, Thomas P, et al. Metabolic side effects of risperidone in early onset schizophrenia. Encephale 2010;36:242-52.  Back to cited text no. 100
    
101.De Hert M, Schreurs V, Sweers K, Van Eyck D, Hanssens L, Sinko S, et al. Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: A retrospective chart review. Schizophr Res 2008;101:295-303.  Back to cited text no. 101
    
102.Medved V, Kuzman MR, Jovanovic N, Grubisin J, Kuzman T. Metabolic syndrome in female patients with schizophrenia treated with second generation antipsychotics: A 3-month follow-up. J Psychopharmacol 2009;23:915-22.  Back to cited text no. 102
    
103.Saddichha S, Ameen S, Akhtar S. Incidence of new onset metabolic syndrome with atypical antipsychotics in first episode schizophrenia: A six-week prospective study in Indian female patients. Schizophr Res 2007;95:247.  Back to cited text no. 103
    
104.Sahoo S, Ameen S, Akhtar S. Metabolic syndrome in drug-naïve first episode psychosis treated with atypical antipsychotics. Aust N Z J Psychiatry 2007;41:629.  Back to cited text no. 104
    
105.Saddichha S, Manjunatha N, Ameen S, Akhtar S. Metabolic syndrome in first episode schizophrenia-a randomized double-blind controlled, short-term prospective study. Schizophr Res 2008;101:266-72.  Back to cited text no. 105
    
106.Attux C, Quintana MI, Chaves AC. Weight gain, dyslipidemia and altered parameters for metabolic syndrome on first episode psychotic metabolic syndrome on first episode psychotic patients after six-month follow-up. Rev Bras Psiquiat 2007;29:346-9.  Back to cited text no. 106
    
107.Chiu CC, Chen CH, Chen BY, Yu SH, Lu ML. The time-dependent change of insulin secretion in schizophrenic patients treated with olanzapine. Prog Neuropsychopharmacol Biol Psychiatry 2010;34:866-70.  Back to cited text no. 107
    
108.Fleischhacker WW, Siu CO, Bodén R, Pappadopulos E, Karayal ON, Kahn RS. The EUFEST study group. Metabolic risk factors in first-episode schizophrenia: Baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial. Int J Neuropsychopharmacol 2013;16:987-95.  Back to cited text no. 108
    
109.Gautam S, Meena PS. Drug-emergent metabolic syndrome in patients with schizophrenia receiving atypical (second-generation) antipsychotics. Indian J Psychiatry 2011;53:128-33.  Back to cited text no. 109
[PUBMED]  Medknow Journal  
110.Krakowski M, Czobor P, Citrome L. Weight gain, metabolic parameters, and the impact of race in aggressive inpatients randomized to double-blind clozapine, olanzapine or haloperidol. Schizophr Res 2009;110:95-102.  Back to cited text no. 110
    
111.Kraemer S, Minarzyk A, Forst T, Kopf D, Hundemer HP. Prevalence of metabolic syndrome in patients with schizophrenia, and metabolic changes after 3 months of treatment with antipsychotics--results from a german observational study. BMC Psychiatry 2011;11:173.  Back to cited text no. 111
    
112.Lin CC, Bai YM, Wang YC, Chen TT, Lai IC, Chen JY, et al. Improved body weight and metabolic outcomes in overweight or obese psychiatric patients switched to amisulpride from other atypical antipsychotics. J Clin Psychopharmacol 2009;29:529-36.  Back to cited text no. 112
    
113.Malhotra N, Kulhara P, Chakrabarti S, Grover S. A prospective, longitudinal study of metabolic syndrome in patients with bipolar disorder and schizophrenia. J Affect Disord 2013.  Back to cited text no. 113
    
114.Maayan LA, Vakhrusheva J. Risperidone associated weight, leptin, and anthropometric changes in children and adolescents with psychotic disorders in early treatment. Hum Psychopharmacol 2010;25:133-8.  Back to cited text no. 114
    
115.Meyer JM, Davis VG, Goff DC, McEvoy JP, Nasrallah HA, Davis SM, et al. Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: Prospective data from phase 1. Schizophr Res 2008;101:273-86.  Back to cited text no. 115
    
116.Meyer JM, Pandina G, Bossie CA, Turkoz I, Greenspan A. Effects of switching from olanzapine to risperidone on the prevalence of the metabolic syndrome in overweight or obese patients with schizophrenia or schizoaffective disorder: Analysis of a multicenter, rater-blinded, open-label study. Clin Ther 2005;27:1930-41.  Back to cited text no. 116
    
117.Nebhinani N, Grover S, Chakrabarti S, Kate N, Avasthi A. A longitudinal study of change in prevalence of metabolic syndrome and metabolic disturbances 3 months after Clozapine therapy. Journal of Mental Health and Human Behavior 2013;18:9-17.  Back to cited text no. 117
    
118.Patel JK, Buckley PF, Woolson S, Hamer RM, McEvoy JP, Perkins DO, et al. CAFE Investigators. Metabolic profiles of second-generation antipsychotics in early psychosis: Findings from the café study. Schizophr Res 2009;111:9-16.  Back to cited text no. 118
    
119.Beumer W, Drexhage RC, De Wit H, Versnel MA, Drexhage HA, Cohen D. Increased level of serum cytokines, chemokines and adipokines in patients with schizophrenia is associated with disease and metabolic syndrome. Psychoneuroendocrinology 2012;37:1901-11.  Back to cited text no. 119
    
120.Na KS, Kim WH, Jung HY, Ryu SG, Min KJ, Park KC, et al. Relationship between inflammation and metabolic syndrome following treatment with paliperidone for schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2012;39:295-300.  Back to cited text no. 120
    
121.Miller BJ, Mellor A, Buckley P. Total and differential white blood cell counts, high-sensitivity C-reactive protein, and the metabolic syndrome in non-affective psychoses. Brain Behav Immun 2012.  Back to cited text no. 121
    
122.Lee K, Park J, Choi J, Park CG. Heart rate variability and metabolic syndrome in hospitalized patients with schizophrenia. J Korean Acad Nurs 2011;41:788-94.  Back to cited text no. 122
    
123.Cheng C, Chiu HJ, Loh el-W, Chan CH, Hwu TM, Liu YR, et al. Association of the ADRA1A gene and the severity of metabolic abnormalities in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2012;36:205-10.  Back to cited text no. 123
    
124.Risselada AJ, Vehof J, Bruggeman R, Wilffert B, Cohen D, Al Hadithy AF, et al. Association between the 1291-C/G polymorphism in the adrenergic α-2a receptor and the metabolic syndrome. J Clin Psychopharmacol 2010;30:667-71.  Back to cited text no. 124
    
125.Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.  Back to cited text no. 125
    
126.Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new worldwide definition. A consensus statement from the International Diabetes Federation. Diabet Med 2006;23:469-80.  Back to cited text no. 126
    
127.World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation. Geneva: World Health Organisation; 1999.  Back to cited text no. 127
    
128.Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999;16:442-3.  Back to cited text no. 128
    
129.American College of Endocrinology Task Force on the insulin resistance syndrome. Endocr Pract 2003;9:236-52.  Back to cited text no. 129
    
130.Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute scientific statement: Executive Summary. Crit Pathw Cardiol 2005;4:198-203.  Back to cited text no. 130
    
131.Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. International Diabetes Federation Task Force on Epidemiology and Prevention, Hational Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity. Harmonizing the Metabolic Syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute; American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. Circulation 2009;120:1640-5.  Back to cited text no. 131
    
132.Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: The SCORE project. Eur Heart J 2003;24:987-1003.  Back to cited text no. 132
    
133.Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837-47.  Back to cited text no. 133
    
134.Correll CU, Frederickson AM, Kane JM, Manu P. Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. J Clin Psychiatry 2006;67:575-83.  Back to cited text no. 134
    



 
 
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  [Table 1], [Table 2]


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