Study data published in The Journal of Clinical Psychiatry indicate that metabolic syndrome (MetS) is strongly predictive of relapse in patients with schizophrenia independent of medication adherence.

Participants were members of the existing FondaMental Academic Centers of Expertise for Schizophrenia (FACE-SZ). The FACE-SZ cohort included clinically stable outpatients with schizophrenia or schizoaffective disorder (n=185) from whom detailed clinical information was collected each year. Investigators abstracted data on various psychiatric measures over 1 year of follow-up, including positive and negative symptoms, depression levels, the presence of mania, and psychotropic treatment. MetS was diagnosed in patients per biologic measures of waist circumference, triglycerides and fasting glucose levels, and cholesterol. Patients had to report at least 1 acute psychotic episode in the past year for a diagnosis of psychotic relapse.

The mean age (SD) of study participants was 32.4 (9.7), and 145 (78.4%) were men. A total of 68 patients (36.8%) experienced at least 1 relapse during the 1 year of follow-up. Individuals who had MetS at baseline were 3 times as likely as patients without MetS to later experience relapse (adjusted odds ratio [aOR], 3.0; 95% CI, 1.1-8.4). Higher depressive, positive, and total scores on the Positive and Negative Symptoms Scale score were also predictive of relapse, although only total score remained significant in the adjusted model (aOR, 1.0; 95% CI, 1.0-1.1). Worse depression at baseline was also associated with relapse, although only in the unadjusted model (OR, 1.1; 95% CI, 1.04-1.2). Individuals with lower medication adherence were more likely to experience relapse, although this confounder did not account for the significant correlation between MetS and risk for relapse.

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Recognizing risk factors for relapse is crucial to providing timely intervention. These data support the monitoring of MetS in patients with schizophrenia, although future research is necessary to determine whether reducing MetS could be protective against relapse.

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Godin O, Leboyer M, Schürhoff F, et al. Metabolic syndrome and illness severity predict relapse at 1-year follow-up in schizophrenia: the FACE-SZ cohort. J Clin Psychiatry. 2018;79(6):17m12007.