The metabolic syndrome and schizophrenia: A comorbidity or an association?

Individuals with schizophrenia have 2-3 times higher rates of mortality than the general population. Causes of excessive mortality are increased suicide rates and mortality of natural causes such as cardiovascular events.[1] During the last two decades, there has been an increase in the schizophrenia literature discussing the high prevalence of type II diabetes mellitus and pre‑diabetic states such as the metabolic syndrome with a consistent pattern of increased metabolic syndrome prevalence in patients suffering from chronic schizophrenia.­[2] Patients suffering from schizophrenia seem to be more prone to have an abdominal obesity, an excess of circulating cortisol as a consequence of their central obesity, and an increased risk of developing insulin resistance. In addition, their reaction to continuous stress hyper‑activates their hypothalamo‑pituitary‑adrenal axis. Moreover, some genetic features might be commonly shared by both schizophrenia and metabolic syndrome. Nevertheless, the lifestyle of patients with schizophrenia is accompanied with risk factors that may increase the risk of development of a metabolic syndrome or aggravate its evolution. Those lifestyle components are excessive sedentarism, excessive smoking, low socio‑economic status, low adherence to medical care, etc