Article Type: Original Articles
The Effect of Positive Lifestyle on Reversal of Metabolic Syndrome in Patients with Schizophrenia Followed-up for Two Years
Zeynep Baran Tatar
Objective: The risk of metabolic impairment is higher in patients with schizophrenia due to long disease period, increasing age, unhealthy lifestyle, antipsychotic medication use, and genetic factors. Among these risk factors, unhealthy lifestyle and antipsychotic medication use are factors that can be changed by external interventions. Main objectives of our study were to retrospectively analyse the parameters of metabolic syndrome (MetS) in patients with schizophrenia whose metabolic parameters have been monitored for at least 2 years and whose medications and clinical conditions were stable, to detect new cases of MetS and cases with reversal of MetS, and to examine the factors that predict the incidence and reversal of MetS.

Methods: The sample group of the study comprised patients who were followed and monitored at the Psychotic Disorders Outpatient Clinic of Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery as outpatients between January 1st, 2014 and January 1st, 2017 and were admitted with schizophrenia diagnosis in accordance with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). We present a retrospective analysis of longitudinal data addressing socio-demographic characteristics, metabolic parameters, positive lifestyle features in these patients. MetS was defined by the criteria defined by ATP-III A. The Positive and Negative Syndrome Scale, Schedule for Assessment of Insight, Clinical Global Impression Severity of Illness were also administered retrospectively. The interviews of the patients conducted in 2014 were regarded as the “first evaluation” and their interviews conducted 2 years after the first evaluation were regarded as the “final evaluation.”

Results: Three hundred and fifty patients had a mean age of 42.6 were included in the study. The rate of MetS was 20% in the first evaluation and 25.4% in the final evaluation. Increase in the prevalence of MetS between the first and final evaluation was not significant. Two-year incidence were found as 13% with a rate of 30% for reversal of MetS. The logistic regression analysis revealed that the increase in age and less positive lifestyle had a significant predictive effect in incident cases and the only significant variable that predicted the reversal was the positive lifestyle.

Conclusions: In conclusion, the present study is important in terms of showing the variability of metabolic parameters of the patients with schizophrenia. Thus, the outcomes of interventions can be better understood by detecting new cases of MetS along with reversed cases. Finally, our study is important in terms of showing that positive lifestyle characteristics contribute to the reversal of MetS.


1.Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective analysis of the insülin resistance syndrome (syndrome X). Diabetes 1992;41(6):715-722.

2.De Hert M, Schreurs V, Vancampfort D, VAN Winkel R. Metabolic syndrome in people with schizophrenia: a review. World Psychiatry 2009;8(1):15–22.

3.De Hert MA, van Winkel R, Van Eyck D, Hanssens L, Wampers M, Scheen A, et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizoph Res 2006;83(1):87-93.

4. Meyer JM, Davis VG, Goff DC, McEvoy JP, Nasrallah HA, Davis SM, et al. Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: prospective data from phase 1. Schizoph Res 2008;101(1-3):273–286.

5.Strassnig M, Brar JS, Ganguli R. Nutritional assessment of patients with schizophrenia: a preliminary study. Schizophr Bull 2003;29(2):393-397.

6.Vancampfort D1, Knapen J, Probst M, van Winkel R, Deckx S, Maurissen K, Peuskens J, De Hert M. Considering a frame of reference for physical activity research related to the cardiometabolic risk profile in schizophrenia. Psychiatry Res 2010;177(3):271-279.

7.Yoca G, Yazici K, Yagcioglu E, Eni N, Karahan SR, Turkoglu I, Akal Yildiz E. Schizophrenia and Metabolic Syndrome: a follow-up study. Poster session presented at: 5th Biennial Schizophrenia International Research Society Conference; Florence: Italy, 2016, p.2-6.

8.Vancampfort D, Probst M, Scheewe T, De Herdt A, Sweers K, Knapen J, et al. Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with schizophrenia. Psychiatry Res 2013;207(1-2):25-32.

9.Eskelinen S, Sailas E, Joutsenniemi K, Holi M, Suvisaari J. Clozapine use and sedentary lifestyle as determinants of metabolic syndrome in outpatients with schizophrenia. Nord J Psychiatry 2015;69(5):339-345.

10.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, text rev. Washington, DC: Author; 2000.

11.Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.

12.Kostakoglu AE, Batur S, Tiryaki A. Pozitif ve Negatif Sendrom Ölçeğinin (PANSS) Türkçe Uyarlamasının Geçerlik ve Güvenilirliği [Validity and Reliability of Turkish Adaptation of Positive and Negative Syndrome Scale (PANSS)]. Türk Psikoloji Dergisi 1999;14:23-32. [Turkish]

13.David AS. Insight and psychosis. Br J Psychiatry 1990;156:798-808.

Key words: Follow-up, lifestyle, metabolic syndrome, schizophrenia
Psychiatry and Behavioral Sciences 2019;9(3):85-93
Online ISSN: 2636-834X
Creative Commons License This work is licensed under a Creative Commons Attribution 3.0 Unported License