Schizophrenia with metabolic syndrome has received a great deal of attention in the last decade or so. The increased incidence of schizophrenia with metabolic syndrome is now thought to be related to a variety of factors, including the disease itself, adverse effects of antipsychotic medications, and poor lifestyle. These problems not only seriously affect patients’ compliance with antipsychotic treatment, but also increase the prevalence of somatic diseases and morbidity and mortality. The current approach to the management of metabolic syndrome in patients with schizophrenia includes the following: I. Assessment of metabolic syndrome The American Diabetes Association and the American Psychiatric Association recommend the assessment of personal risk factors and family history prior to and during treatment with 2nd generation antipsychotics, including cardiovascular disease risk factors (obesity, diabetes, hypertension), height and body mass, the waist circumference, blood pressure, fasting glucose, and fasting lipid levels. Patients who develop diabetes and hypertension after taking antipsychotics should receive specialty care. The choice of antipsychotics and medication change treatment should be based on an analysis of the benefits and harms of the medication and the patient’s informed consent. It is generally believed that the order of the effects of antipsychotics on body mass and other indicators when drug doses are comparable is: clozapine > olanzapine > quetiapine > risperidone > chlorpromazine > fenadine > sulpiride > aripiprazole > ziprasidone. In case of severe metabolic syndrome or an increase in body mass > 4 kg, a timely change of medication should be considered. III. Symptomatic treatment Many drugs have been studied to reduce the metabolic syndrome caused by antipsychotics, specifically: 1. Antiplatelet therapy: low-dose aspirin may result in a reduced risk of vascular events in patients with combined diabetes. 2, anti-ischemic drugs: studies have shown that diabetic patients treated with beta-blockers can reduce cardiovascular mortality by 42%. 3.Lowering blood pressure: angiotensin-converting enzyme inhibitor drugs can reduce the incidence of cardiovascular events in patients with diabetes and prevent and improve the complications of diabetes. 4, lipid-lowering drugs: statins mainly reduce LDL cholesterol, which can significantly reduce the incidence of coronary heart disease in diabetic and non-diabetic patients, and beta drugs mainly reduce the incidence of hyperlipidemia and increase HDL cholesterol. 5, insulin sensitizers: can improve insulin resistance, lower blood sugar and reduce plasma free fatty acids. Studies have shown that metformin may have better application prospects. 6, fluoxetine (fluoxetine): is a 5-hydroxytryptamine reuptake inhibitor, the study showed that the most significant reduction in patient body mass at a dose of 60 mg. 7, amantadine (amantadine): the use of amantadine has been reported to reduce the body mass of patients. 8, nizatidine (nizatidine) and cimetidine (cimetidine): some studies have confirmed that H2 receptor blockers may be effective for body mass control. 9, orlistat (orlistat) and sibutramine (sibutramine): is a highly specific pancreatic lipase inhibitor, approved by the U.S. Food and Drug Administration for weight loss. 10, topiramate (topiramate): is a 2nd generation anti-epileptic drugs, can inhibit gastrointestinal motility, causing nausea and anorexia to reduce body mass. None of the currently available research evidence is sufficient to support the above treatments in routine clinical application. 1-4 of them are mainly for patients with cardiovascular risk and 5-10 are mainly for the treatment of increased body mass in patients with schizophrenia. A meta-analysis showed that sibutramine, metformin, and topiramate may have better outcomes, while orlistat and amantadine were less efficacious. Metformin is the only allopathic drug that has been evaluated in our population. When applying these drugs clinically, the adverse effects of the drugs should be closely observed and discontinued immediately in case of serious adverse effects; drug interactions should also be observed when the drugs are combined. Lifestyle modification Many clinical guidelines point out that it is not enough to treat dyslipidemia in patients with schizophrenia through medication alone, but that fundamental improvement of lifestyle and early prevention are the core measures. Despite cognitive deficits in patients with schizophrenia, education can be effective in improving their compliance with interventions. These include psychoeducation, dietary therapy, physical exercise, and enhanced self-management of patients with chronic illnesses to reduce tobacco and alcohol dependence.