Metabolic syndrome is a complex medical condition that involves multiple related diseases including obesity, elevated blood sugars, high blood pressure (hypertension) and high cholesterol (hyperlipidemia, hypercholesterolemia,hypertriglyceridemia). People with metabolic syndrome are at increased risk for developing many serious medical complications including type 2 diabetes, heart attack (myocardial infarction), stroke (cerebrovascular disease), and if not addressed, even early death. Unfortunately, people living with mental illness are at increased risk for developing metabolic syndrome. Due to the severity of this condition, early detection and intervention are critically important.
People with mental illness are more likely than other individuals to develop this complex medical condition. Scientific research has shown that certain people are at an even greater risk of having metabolic syndrome:
As metabolic syndrome and diabetes are a complex combination of medical illnesses, there are multiple precautions that can be taken to prevent these severe conditions. In general, maintaining a healthy lifestyle is one of the best preventative measures against developing metabolic syndrome. A healthy lifestyle includes the following:
Choosing appropriate medications with one’s physicians can be critical in preventing metabolic syndrome and diabetes. For example, a person with schizophrenia who is gaining a lot of weight with a particular SGA (including olanzapine [Zyprexa], clozapine [Clozaril] and quetiapine [Seroquel]) may be better treated with another similar medication that does not have the same risk of weight gain, metabolic syndrome and diabetes (e.g., certain first generation antipsychotics such as haloperidol [Haldol] or perphenazine [Trilafon]). Given the complexities of these decisions—specifically, weighing the risks of metabolic syndrome against the benefits of continuing a medication that appears to be working well—all medication management issues should be discussed with one’s family, psychiatrist and other treating physicians. Some people who are taking SGAs may also find that medications used in the treatment of diabetes (e.g., metformin) may be helpful in preventing metabolic syndrome. This is a possible treatment option that can be discussed with one’s psychiatrist and other physicians.
Treating metabolic syndrome and diabetes involves many of the same strategies used for preventing these conditions. This includes regular doctor appointments, eating a healthy diet, exercising and avoiding smoking, alcohol and other drugs.In addition to these life-style modifications and regular medical follow up, there are medications that are helpful in treating metabolic syndrome and diabetes. These include medications to treat high blood pressure (antihypertensives), medications to treat high cholesterol (including statins such as simvastatin [Zocor] and atorvastatin [Lipitor]) and medications to treat diabetes (including insulin as well as other medications such as metformin). Most primary care physicians are well trained in diagnosing and managing metabolic syndrome and diabetes. However, some people with severe metabolic syndrome and diabetes may also seek a consultation or referral to an endocrinologist—a doctor who has specialized training in treating these conditions.
It is very troubling to know that many people living with mental illness and metabolic syndrome or diabetes are not getting good preventive medical care. Scientific studies have shown that a significant portion of people with schizophrenia are not even getting the basic screening tests for these conditions to try and prevent them. It is important to facilitate communication between one’s psychiatrists and other doctors. This can help to make sure that everyone receives appropriate medical and psychiatric care to prevent—and if necessary to treat—these serious conditions.
To learn more about becoming your own medical self-advocate by exploring the Medical Self Advocacy section of the NAMI Hearts & Minds website.Additionally, speaking with one’s doctors, local clubhouse, NAMI Chapter or community mental health program may help to find other forms of support. Many communities have walking groups, nutritional and fitness groups or other peer support programs that can be helpful in maintaining a healthy lifestyle. Below are some tools that might be helpful for some people. The use of websites like these should be done with the support and collaboration of one’s doctors:
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., April 2013