Double-edged sword of antipsychotic therapy: Navigating the intersection of psychiatric recovery, endoplasmic reticulum stress, and cardiovascular survival

doi:10.5498/wjp.v16.i6.118149

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Jun 19, 2026; 16(6): 118149
Published online Jun 19, 2026. doi: 10.5498/wjp.v16.i6.118149

Double-edged sword of antipsychotic therapy: Navigating the intersection of psychiatric recovery, endoplasmic reticulum stress, and cardiovascular survival

Takahiko Nagamine

Takahiko Nagamine, Psychiatric Internal Medicine, Sunlight Brain Research Center, Hofu 7470066, Yamaguchi, Japan

Author contributions: Nagamine T conducted conceptualization, investigation, writing the manuscript.

AI contribution statement: The author denies using AI for proofreading or writing the manuscript. The only tool related to AI that was used was Google's English proofreading service.

Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.

Corresponding author: Takahiko Nagamine, MD, PhD, Professor, Psychiatric Internal Medicine, Sunlight Brain Research Center, 4-13-18 Jiyugaoka, Hofu 7470066, Yamaguchi, Japan. anagamine@yahoo.co.jp

Received: December 25, 2025
Revised: January 28, 2026
Accepted: February 26, 2026
Published online: June 19, 2026
Processing time: 155 Days and 1 Hours

Core Tip

Core Tip: Cardiovascular mortality in schizophrenia is a systemic failure that cannot be solved by psychiatric or medical intervention in isolation. Effective care requires managing the molecular risks of medication alongside the functional necessity of psychiatric stability to enable life-saving lifestyle changes. Clinicians must recognize that antipsychotics like olanzapine pose dual risks: Chronic insulin resistance and acute, ketosis-prone diabetic emergencies.