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Vol. 27, Art. 40 (pp. 968-1002)    |    2026       

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A comparative study of the adverse metabolic consequences of course-based use of antipsychotics in patients with schizophrenia

Bogdashov D.S.1, Kim A.E.2, Shustov T.B.³, Masalova O.O.2, Basharin V.A.2, Ganapolsky V.P.2,4

¹ ‒ Yaroslav the Wise Novgorod State University (Veliky Novgorod, Russia)
² — S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation (Saint Petersburg, Russia)
³ — S.N. Golikov Research and Clinical Center of Toxicology of the Federal Medical Biological Agency of Russia (Saint Petersburg, Russia)
⁴ — I.I. Mechnikov North Western State Medical University of the Ministry of Health of the Russian Federation (Saint Petersburg, Russia)

Brief summary

According to WHO data, approximately 23 million people worldwide suffer from schizophrenia. In the Russian Federation, the number of newly identified cases of mental and behavioural disorders in 2023 amounted to 5 765 811 individuals nationwide. The growing trend in the number of patients with schizophrenia, coupled with the fact that antipsychotic medications are often required for virtually a lifetime, significantly increases the importance of minimizing the development of adverse metabolic consequences associated with their use ‒ including iatrogenic metabolic syndrome, hyperlipidaemia, obesity, and exacerbation of chronic inflammatory processes. Purpose. To optimize individual regimens for the use of antipsychotics in the treatment of schizophrenia in a specialized psychiatric inpatient setting. Methods. The study was conducted as a retrospective, controlled, longitudinal clinical study. It involved an analysis of the medical records of 393 patients diagnosed with schizophrenia who received inpatient treatment at the NKSZP Psychiatric Hospital between 2022 and 2025. The following parameters were analysed: cholesterol, LDL, HDL, body weight and body mass index, glucose, ALT, AST, bilirubin, C reactive protein, ESR, haemoglobin, and the number of erythrocytes in peripheral blood. Data on the antipsychotics used, their daily doses, and duration of use were recorded simultaneously. The control group consisted of 67 patients with psychotic disorders who did not receive antipsychotics. The significance of the controlled factors (type of drug, dose, duration of use) for the baseline metabolic parameters in blood plasma was assessed using one way analysis of variance. Results. Variability in changes in patients’ metabolic blood parameters was found to depend not only on the type of antipsychotic but also on its dose and duration of course based use. If patients have pre existing abnormalities in metabolic parameters, long term course based administration will require dynamic laboratory monitoring of lipid and carbohydrate metabolism, liver function, and the oxygen transport function of blood. Haloperidol, risperidone, quetiapine, and clozapine generally demonstrate a more favourable metabolic profile, including with moderately long term use (up to 5 years). Long term use of zuclopenthixol (more than 2 years) may be limited by the adverse metabolic consequences of its use. Conclusion. The study demonstrates the fundamental possibility of reducing the risks of developing iatrogenic metabolic syndrome in patients with schizophrenia by optimizing the choice of antipsychotic, its dose, and duration of use, based on the assessment of their metabolic parameters at the time of hospitalization.


Key words

antipsychotics; systemic inflammatory responses; hepatic cytolytic syndrome; factorial analysis of variance; schizophrenia; iatrogenic metabolic syndrome

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