Metabolic disturbances associated with antipsychotic drug treatment in patients with schizophrenia: State-of-the-art and future perspectives

Table 1 Diagnostic criteria for metabolic syndrome

Organization, Year	WHO, 1988	NCEP/ATP III, 2001	Modified NCEP/ATP III for Asians, 2004	IDF, 2006
Criteria	Glucose intolerance, IGT, diabetes mellitus, or insulin resistance together with two or more of the following:	Three or more of thefollowing:	Three or more of thefollowing:	Central obesity as defined by ethnicity/race, specific WC, but can be assumed if BMI > 30 kg/m2 and with two or more of the following:
	BP: ≥ 140/90 mmHg	FPG: ≥ 110 mg/dL1 or on treatment for DM	FPG: ≥ 110 mg/dL1 or on treatment for DM	FPG: ≥ 100 mg/dL or on treatment for DM
	Abdominal obesity: WHR > 0.9 and > 0.85 for men and women, respectively, and/orBMI: > 30 kg/m2	BP: ≥ 130/85 mmHg	BP: ≥ 130/85 mmHg	BP: ≥ 130/85 mmHg or on treatment
	Triglycerides: ≥ 150 mg/dL or onTreatment	Triglycerides: ≥ 150 mg/dL or on treatment	Triglycerides: ≥ 150 mg/dL or on treatment	Triglycerides: ≥ 150 mg/dL or on treatment
	HDL-C: < 35 mg/dL for men and < 39 mg/dL for women	HDL-C: < 40 mg/dL for men and < 50 mg/dL for women	HDL-C: < 40 mg/dL for men and < 50 mg/dL for women	HDL-C: < 40 mg/dL for men and < 50 mg/dL for women or on treatment
	Urine albumin excretion rate: ≥ 2 0 μg/min or urine albumin to creatinine ratio: ≥3 0 mg/g	WC: ≥ 102 cm for men and ≥ 88 cm for women	WC: ≥ 90 cm for men and ≥ 80 cm for women

¹FPG ≥ 100 mg/dL modified in 2004 according to the International Diabetes Federation definition of impaired fasting glucose. The 2001 definition of National Cholesterol Education Program Adult Treatment Panel III identified fasting plasma glucose ≥ 110 mg/dL as elevated. BMI: Body mass index; FPG: Fasting plasma glucose; IFG: Impaired fasting glucose; IGT: Impaired glucose tolerance; IR: Insulin resistance; IDF: International Diabetes Federation, NCEP/ATP III: National Cholesterol Education Program Adult Treatment Panel III; WC: Waist circumference; WHR: Waist-to-hip ratio; WHO: World Health Organization.

Table 2 Metabolic monitoring guidelines as proposed by various organizations

	US consensus[32]	BAP guidelines[86]
Weight	At 4 wk, 8 wk, and 12 wk after initiating or changing SGA therapy, then quarterly	BMI weekly for the first 4–6 wk, then every 2–4 wk for up to 12 wk. At a minimum, once every 4 wk for the first 12 wk, then at 6 mo and at least annually
Blood glucose	Assessed fasting plasma glucose at 3 mo, then annually	Assessed fasting or random plasma glucose in the initial weeks and glycated hemoglobin at 12 wk, 6 mo, and then annually
Lipid profile	At 3 mo, then repeated at 5-yr intervals if normal	At 12 wk, 6 mo, and then annually. The total cholesterol/high-density lipoprotein cholesterol ratio should be required.
Blood pressure	At 3 mo, then annually	At 12 wk, 6 mo, and then annually

US consensus: Consensus proposed by American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, and North American Association for the Study of Obesity[32]; BAP guidelines: Guidelines proposed by the British Association for Psychopharmacology[86]; SGA: Second-generation antipsychotics; BMI: Body mass index.