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Metabolic disturbance in first-episode schizophrenia

Senior Lecturer in Psychiatry, Royal College of Surgeons in Ireland; Neuroscience Centre, St Vincent’s Hospital, Richmond Road, Fairview, Dublin 3, Ireland.

Correspondence: Tel: +353 1 884 2400; fax: +353 1 884 2450; E-mail: jthakore{at}rcsi.ie

Declaration of interest J.H.T. is supported by a grant from Eli Lilly & Co.

Background Schizophrenia shortens life, e.g. through suicide and obesity-related diseases such as type 2 diabetes mellitus. It is assumed that medications play a major role, but most of the evidence for this comes from studies poorly controlled for variables such as lifestyle and medication status.

Aims To determine whether schizophrenia is associated (independently of medication) with the development of certain metabolic disturbances and whether these might be explained by stress axis dysfunction.

Method Literature review.

Results Most studies did not control for confounding factors such as previous usage of medication, lifestyle, age and ethnicity. A few conducted in drug-naïve patients with first-episode schizophrenia appear to indicate that these patients have higher than expected rates of visceral obesity and impaired fasting glucose concentrations, which may be related to a subtle disturbance of the hypothalamic–pituitary–adrenal axis.

Conclusions Schizophrenia is independently associated with physical illnesses that have a metabolic signature. Therefore, patients need to have a thorough physical assessment at diagnosis and at regular intervals thereafter. Metabolic disturbances have been found in drug-naïve patients with first-episode illness and may be an inherent part of the illness.

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