Metabolic risk reduction in patients with schizophrenia treated with antipsychotics: recommendations of the Polish Psychiatric Association
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Instytut Psychiatrii i Neurologii w Warszawie, III Klinika Psychiatryczna
Uniwersytet Jagielloński Collegium Medicum, Katedra Psychiatrii, Klinika Psychiatrii Dorosłych
Instytut Psychiatrii i Neurologii w Warszawie, Klinika Psychiatrii Sądowej
Warszawski Uniwersytet Medyczny, I Katedra i Klinika Kardiologii
Warszawski Uniwersytet Medyczny, III Klinika Chorób Wewnętrznych i Kardiologii
Pomorski Uniwersytet Medyczny w Szczecinie, Katedra i Klinika Psychiatrii
Warszawski Uniwersytet Medyczny, Wydział Nauk o Zdrowiu, Klinika Psychiatryczna
Warszawski Uniwersytet Medyczny, Katedra i Klinika Psychiatryczna
Adam Wichniak   

III Klinika Psychiatryczna, Instytut Psychiatrii i Neurologii w Warszawie
Submission date: 2019-09-29
Final revision date: 2019-10-15
Acceptance date: 2019-10-19
Online publication date: 2019-12-31
Publication date: 2019-12-31
Psychiatr Pol 2019;53(6):1191–1218
Patients with schizophrenia are susceptible to physical illnesses, which reduces their life expectancy by an average of 20 years compared with the general population. The most common physical illnesses amongst patients with schizophrenia are metabolic disorders and cardiovascular diseases. The aim of this paper is to present recommendations on metabolic risk reduction in patients with schizophrenia treated with antipsychotics, accepted as a position statement of the Polish Psychiatric Association for use in the management of persons suffering from schizophrenia in Poland. A routine assessment of metabolic risk is recommended for the early detection of metabolic disorders and to monitor the safety of the antipsychotic treatment. It includes: medical history, physical examination, laboratory tests. Each patient should undergo this assessment before the initiation of treatment, after 6 and 12 weeks of treatment, and at least once a year thereafter. In men and women suffering from schizophrenia who are over the age of 40 and 50 years, respectively, a cardiovascular risk assessment using the SCORE charts is also recommended. (1) Antipsychotics with a low potential to cause metabolic disorders should be preferred and administered at the appropriate dose in order to reduce metabolic risk. (2) If other agents found to cause metabolic disorders are used, the treatment should be modified by augmentation or by switching to another antipsychotic with a lower potential to cause metabolic disorders. (3) Consultation by an internal medicine specialist and medical treatment should be recommended. (4) Patients should be assisted in developing healthy eating habits, encouraged to pursue regular physical activity and (5) to quit smoking, drinking alcohol and using psychoactive substances