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1. Introduction
Schizophrenia is a major mental disorder that alters the patient’s perception, thought, affect, and behavior. According to the World Health Organization (WHO), it is one of the major mental illnesses that leads to the global burden of disease [1], as the 14th most moderate and severe disability and 6th in the list for the most causes of years lost due to disability (YLD) [1]. There is research reporting that patients with schizophrenia have a shorter life expectancy, as much as 6-7 years shorter [2]. Allebeck et al. [3] examined the overall mortality among the cohort and found that after excluding for suicide, the mortality rate is twice as high as the general population among patients with schizophrenia. Hennekens CH et al. [4] reported that schizophrenia patients have 20% less life expectancy, mainly due to coronary heart disease (CHD) [5], which is strongly related to metabolic syndrome. Patients with schizophrenia were also reported to have a 2-3-fold increased risk of dying from cardiovascular events [6]. From a review by Marc De Hert, patients with schizophrenia have a 2-3 times higher rate of developing metabolic syndrome, while from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, approximately 30% of schizophrenia have metabolic syndrome [7].
Metabolic syndrome consists of obesity, elevated blood pressure (i.e., hypertension (HPT)), impaired insulin sensitivity, and dyslipidemia. The International Diabetic Federation consensus report (2006) estimates as high as 20%-25% of the world’s adult population has metabolic syndrome and patients with schizophrenia are at even higher risk to develop such a syndrome. While diet intake and less active physical activity are to blame, treatment, especially atypical antipsychotics, also contributes to the syndrome. In particular, medications such as olanzapine is known to promote insulin resistance and weight gain. Over the past 20 years, there have been more concerns about metabolic syndrome because of the risk of developing Type 2 Diabetes Mellitus (DM) and coronary heart disease [8,9,10], which are major causes of morbidity and mortality. First episode patients may develop metabolic problems after initiation of antipsychotics, especially the atypical ones, but since they are drug naïve, not much is yet known about the reasons why they develop metabolic conditions. One should, however, suspect similar profiles as chronic patients, making them equally susceptible.
Schizophrenia...