What is metabolic syndrome? Metabolic syndrome is a general term for a group of diseases including obesity, insulin resistance, abnormal lipid metabolism, abnormal glucose metabolism and hypertension, in addition to microalbuminuria, hyperuricemia, abnormal blood clotting and fibrinolysis, leptin resistance, fatty liver, etc. The main manifestations are: obesity, insulin resistance/hyperinsulinemia, dyslipidemia, glucose tolerance abnormalities/type 2 diabetes, and hypertension. How is metabolic syndrome diagnosed? The diagnostic criteria for metabolic syndrome vary, but according to the criteria in the 2007 Chinese guidelines for the prevention and treatment of adult dyslipidemia, patients who meet the following 3 criteria can be diagnosed with metabolic syndrome: 1. Abdominal obesity: waist circumference > 90 cm for men and > 85 cm for women 2. TG ≥ 1.7 mmol/L 3. HDL-C < 1.04 mmol/L 4. Blood pressure > 130/85 mmHg 5. Fasting blood glucose ≥ 6.1 mmol/L, 2-hour postprandial blood glucose ≥ 7.8 mmol/L or a history of diabetes. Why are people with schizophrenia more likely to develop metabolic syndrome? There are many reasons why patients with schizophrenia are more likely to develop metabolic syndrome than other people, for example, antipsychotic drugs can cause metabolic disorders by disrupting the control of the hypothalamus and affecting the concentration of various neurotransmitters. . What is the extent to which different antipsychotic drugs affect patients’ metabolism? Second-generation antipsychotics are more likely to cause metabolic syndrome. Among second-generation antipsychotics, clozapine and olanzapine have the highest risk of causing metabolic syndrome in patients, followed by quetiapine, risperidone, and amisulpride, with aripiprazole having a smaller effect and ziprasidone having the least effect. How to prevent metabolic syndrome in patients 1 Assess the risk of metabolic syndrome All patients need to assess the risk of developing metabolic syndrome such as fasting blood glucose, glycosylated hemoglobin, lipid levels, body mass index and any history of metabolic syndrome in the family line before using the drug, and then try to choose a drug that has little effect on the patient’s metabolism after weighing other aspects. 2. Regular monitoring of metabolic indicators including weight, lipids and blood glucose, especially triacylglycerol and HDL-C are the more sensitive indicators of metabolic syndrome, and pay attention to the dynamic changes of the indicators. For children and adolescents, their metabolic indicators need to be closely monitored. Risk factors that predispose pediatric patients to diabetes are: obesity, rapid weight gain, hyperlipidemia, history of coronary artery disease, and olanzapine or clozapine therapy. For patients who exceed 7% of their baseline risk, they should promptly adjust their diet and lifestyle and increase exercise; if they exceed 10%, they need to readjust their medication regimen. Choose the appropriate medication to control the patient’s metabolic problems: for example, metformin and rosiglitazone can submit insulin tolerance, and aripiprazole, metformin and sibutramine can lower lipid levels. How to treat metabolic syndrome in patients? 1.Medication Many studies have shown that metformin can improve the metabolic problems caused by antipsychotic drugs in many ways than other drugs, and some studies have shown that patients can lose 1-4 kg of weight within 3 months after using metformin. in addition, thiazolidinediones and acarbose can also be chosen. 2. Lifestyle interventions are divided into two main areas, one is diet control and the other is strengthening exercise. For the caloric aspect of the diet, 55% of the total daily caloric intake is derived from carbohydrates, more than 15% from protein, less than 30% from fat, and 15 g/kacl of fiber; in addition, patients are advised to have a low salt diet and to consume more potassium-rich foods. In terms of physical activity: aerobic exercise can stabilize glucose levels by enhancing glucose transport in skeletal muscle and reducing insulin resistance; in addition, aerobic exercise can increase HDL-C levels and lower triglycerides. In summary, patients are advised to adhere to half an hour of aerobic exercise daily. If the patient’s metabolic problems cannot be solved by lifestyle adjustments and medication changes, some experts suggest that effective medications are needed to control the patient’s insulin levels and insulin resistance, regardless of the presence of diabetes. 3. Ask for endocrine specialist consultation If the patient has rapid and serious weight gain, dyslipidemia, and abnormal blood sugar, he or she needs to be handled by endocrinology. So, the next time a patient has a significant weight gain, you’ll know exactly what to do, right?