精神分裂症患者长期稳定抗精神病药单药与多药治疗的代谢综合征：一项真实世界比较研究

ORIGINAL RESEARCH article

Front. Psychiatry

Sec. Schizophrenia

• TC Saglik Bakanligi Erenkoy Ruh ve Sinir Hastaliklari Egitim ve Arastirma Hastanesi, Istanbul, Türkiye

Abstract

Background: Metabolic syndrome is a major contributor to premature cardiovascular morbidity and mortality among people with schizophrenia. Antipsychotic polypharmacy is common, but its independent metabolic burden remains uncertain. Objective: To compare metabolic syndrome in patients receiving stable long-term antipsychotic monotherapy or polypharmacy and to examine high metabolic-risk exposure, chlorpromazine-equivalent dose, and long-acting injectable (LAI) use. Methods: This retrospective study included 370 adults with schizophrenia spectrum disorders receiving an unchanged antipsychotic regimen for at least five years at a community mental health center. Patients received monotherapy (n=144) or polypharmacy (n=226). Metabolic syndrome was defined using International Diabetes Federation criteria. Antipsychotic dose was standardized to chlorpromazine equivalents, and multivariable logistic regression was used. Results: Metabolic syndrome was present in 143 patients (38.6%) and was numerically more frequent with polypharmacy than monotherapy (41.2% vs. 34.7%, p=0.216). LAI use (67.3% vs. 37.5%, p<0.001) and median chlorpromazine-equivalent dose (1010.0 vs. 454.5 mg/day, p<0.001) were higher with polypharmacy. However, neither LAI use (adjusted OR=1.220, 95% CI 0.767-1.941, p=0.401) nor chlorpromazine-equivalent dose per 100 mg/day (adjusted OR=1.003, 95% CI 0.954-1.055, p=0.899) was independently associated with metabolic syndrome. Current smoking remained associated with metabolic syndrome (adjusted OR=1.996, 95% CI 1.251-3.185, p=0.004). Conclusions: In this selected cohort with stable long-term treatment, polypharmacy was associated with greater dose and LAI exposure, but independent associations of treatment modality, current dose, LAI use, or olanzapine/clozapine exposure with metabolic syndrome were not detected. Comprehensive cardiometabolic monitoring and smoking cessation remain priorities.

Keywords

Antipsychotic polypharmacy, Cardiometabolic risk, Clozapine, metabolic syndrome, olanzapine, Real-world study, Schizophrenia, Smoking

Received

14 June 2026

Accepted

24 September 2026

Copyright

© 2026 Usta and Keleş. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence:

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