The burden of antipsychotic treatment for patients with mental health disorders

Introduction

Antipsychotic treatment is documented to be associated with significant metabolic disturbances including weight gain, dyslipidaemia, hyperglycaemia and metabolic syndrome. This metabolic vulnerability is not exclusively attributable to the effects of medication, but is potentiated by the clinical characteristics of the patient — especially negative symptoms: abulia, anergy and social withdrawal that induce a sedentary lifestyle and disorderly eating behavior.

Aim(s)

The study aimed to: assess the prevalence of metabolic disorders in hospitalized patients under antipsychotic treatment; compare the metabolic profile according to the class of antipsychotic administered; identify clinical and demographic factors associated with increased metabolic risk.

Material and Methods

A retrospective study was carried on a cohort of 500 patients hospitalized between January 2023 and December 2025, diagnosed with psychotic disorders (ICD-10: F20–F29). Inclusion criteria specified an age range of 18–65 years who had been on antipsychotic treatment for a minimum of 6 months. Clinical and metabolic data were collected from observation charts: type and duration of treatment, BMI, waist circumference, fasting blood glucose, lipid profile, and blood pressure. Metabolic syndrome was defined according to ATP III criteria. Statistical analysis included Chi-square tests, one-way ANOVA, and multivariate logistic regression, with a significance threshold of p<0.05.

Results

The group included 284 men (56.8%) and 216 women (43.2%). Metabolic syndrome was identified in 37.8% of patients (n=189), and weight gain ≥7% was observed in 52.6%. The incidence of metabolic syndrome was significantly higher in patients with schizophrenia compared to those in their second or third psychotic episode (43.2% vs. 24.7%; p<0.001), suggesting a cumulative risk associated with the course of the disease. Patients with metabolic syndrome had significantly higher scores on the PANSS negative subscale compared to those without (28.4 vs. 22.7; p<0.001), and this association remained as an independent predictor of increased metabolic risk. The analysis revealed a higher prevalence of metabolic syndrome in women than in men (44.9% vs. 32.7%; p=0.01), accompanied by a more severely altered lipid profile. Age over 45 years was associated with significantly increased rates of hyperglycemia (38.6% vs. 21.3%; p<0.001) and hypertension (41.2% vs. 24.8%; p<0.001). Depending on the treatment, olanzapine and clozapine presented the most unfavorable metabolic profile (50.4% and 47.2%), followed by risperidone (33.8%), while aripiprazole and quetiapine were associated with lower rates (17.4% and 22.1%). Dyslipidemia represented the most frequent metabolic component (61.2%), followed by hyperglycemia (29.4%). Multivariate logistic regression identified as independent predictors of metabolic syndrome: duration of treatment over 18 months (OR=2.94; 95% CI 1.87–4.62; p<0.001), female gender (OR=1.71; 95% CI 1.12–2.61; p=0.02) and antipsychotic polytherapy (OR=2.18; 95% CI 1.39–3.42; p<0.001).

Conclusions

Metabolic disorders are a frequent comorbidity with significant prognostic impact in psychiatric patients under antipsychotic treatment. Stratification by disease stage, age, sex, and severity of negative symptoms allows for a finer assessment of individual risk, with direct implications for therapeutic agent selection and monitoring intensity—supporting the transition to metabolically responsive and individualized psychiatry.

References

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