Atypical Antipsychotic Drugs, Schizophrenia, and Metabolic Syndrome in Non-Euro-American Societies

Objective: There has been an increase in the European and North American schizophrenia literature discussing the high prevalence of metabolic syndrome induced by atypical antipsychotic agents. The aim of this article was to review available data on metabolic syndrome induced by atypical antipsychotic agents in patients with schizophrenia or schizoaffective disorders selected from societies different from European and North American ones (termed non-Euro-American societies [NEAS]). Methods: A review of the literature published via MedLine between 1975 and July 2011 was consulted. Terms used for the search were "glucose intolerance, metabolic syndrome, insulin resistance, weight gain, dyslipidemia" in association with "atypical antipsychotic drugs, second generation antipsychotics, risperidone, olanzapine, aripiprazole, ziprasidone, quetiapine, clozapine, zotepine, perospirone, paliperidone, iloperidone, asenapine, amisulpride, lurasidone." Results: Prospective studies selecting patients from NEAS show that olanzapine poses the highest metabolic syndrome incidence. Clozapine poses the highest prevalence of this syndrome. In NEAS, the prevalence of this syndrome ranges from 14.7% to 69.3%. The incidence could be considered as 20% (according to the International Diabetes Federation criteria) after 1 year of treatment with an atypical antipsychotic drug. Female sex, older age, and high body mass index seem to be the most frequent risk factor mentioned. A possible stratification of the risk of metabolic syndrome in patients with schizophrenia receiving atypical antipsychotic drugs is as follows: Minimal-risk societies are constituted by societies living in Eastern Asian countries, whereas intermediate-risk societies are constituted by societies living in Western Asia and South America, and high-risk societies are societies living in Australia. Conclusion: The metabolic syndrome development profile in patients with schizophrenia receiving atypical antipsychotic drugs in NEAS seems to be comparable to that in European and North American societies, especially when, among NEAS, high-risk societies are concerned. Comparative controlled studies are needed for a better comprehension of this adverse drug effect between both types of societies.