Skip to content
naulon
Get started

No retraction, correction or concern found when last checked on Oct 18, 2026.

Increased Mortality in Schizophrenia Due to Cardiovascular Disease – A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

Petter Andreas Ringen, John A. Engh, Astrid B. Birkenaes and 2 more

Frontiers in Psychiatry · 2014 · Review

doi:10.3389/fpsyt.2014.00137

Abstract

BACKGROUND: Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed. METHODS: Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors' experience from clinical work and research in the field. RESULTS: In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. DISCUSSION: The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

Full text

From PubMed Central, U.S. National Library of Medicine, as current on Oct 18, 2026. Paragraph numbers are ours, so an answer can point at one.

Introduction

Schizophrenia is a major public health concern, causing extensive suffering and a large need for costly treatment and care. Schizophrenia is among the top 10 causes of disability adjusted life years (DALYs) worldwide. The standardized mortality rate (SMR) calculated by dividing the observed mortality of a cohort by the expected mortality of an age- and gender-matched cohort of the general population is considerably elevated in schizophrenia. Today, the largest single cause of death in schizophrenia is cardiovascular disease (CVD), similar to the general population. The aim of this paper is to review clinical and epidemiological evidence for increased CVD mortality in schizophrenia, possible causes and mechanisms, available treatments and preventions, and focus the discussion on development and implementation of effective interventions to increase life expectancy in schizophrenia.

Methods

We conducted a non-systematic review. We used PubMed search terms including “schizophrenia” and “mortality” or “CVD,” “somatic health,” “screening and interventions,” and included publications selected based on knowledge generated from our research in this field as well as clinical experience from working with people with schizophrenia.

General Mortality in Schizophrenia

Meta-analyses have reported a 2.5- to 3-fold increase in mortality ratios in schizophrenia, in both inpatient and outpatient settings. In a recent survey from Australia including 7000 individuals with psychosis, all deaths in an observation period was registered and SMR was calculated to be as high as 5.5 (65 deaths), with even higher rates for young adults (SMR 15; 8–15 deaths). These mortality ratios are alarming and higher than reported in other similar studies. Possibly, this discrepancy may reflect real variations in SMR in different sub-populations within psychosis spectrum disorders.

Life expectancy for people with schizophrenia is estimated to be about 15–20 years shorter than for the general population. A particular cause for concern is that the mortality gap between the general population and schizophrenia seems to have increased during the last decades. Death from unnatural causes appears to be 10–20 times higher in schizophrenia than in the general population. Suicide and accidents accounted for about 40% of the extra deaths, while 60% were from natural causes.

Increased mortality from natural causes is not a recent phenomenon; two large Scandinavian studies from the first part of the twentieth century found significantly increased SMRs of 2.1 and 4.0. The main causes of death were tuberculosis and pneumonia. The high mortality was ascribed to the general disease prevalence and lack of antibiotics but also to the overcrowding, malnutrition, and poor hygiene of large psychiatric institutions.

Cardiovascular Disease-Related Deaths in Schizophrenia

Several cohort studies addressing the CVD-related mortality have been conducted during the last decade. A large retrospective study from the UK including 46,000 people with a severe mental disorder (schizophrenia-spectrum and -bipolar disorder), and 300,000 controls found the hazard ratios for CVD mortality to be threefold for the age group 18–49 years and twofold for the age group 50–75 years. A retrospective register study from Stockholm county in Sweden including 7800 persons with schizophrenia found CVD to be the main cause of death with a SMR of 2.3 and 2.1 for males and females, respectively. A more recent prospective national register study from Sweden involving 8300 persons with schizophrenia found hazard ratios for CVD mortality to be 3.3 (12 years reduced life expectancy) for women and 2.2 (15 years reduced life expectancy) for men. Another recent prospective study from Sweden, Finland, and Denmark using registers found similar SMRs (range 1.6–2.5) for CVD-related deaths in all the three countries, and life expectancies were 15–20 years shorter than in the general population. The increased rates of CVD-related deaths have been confirmed also in autopsy studies.

Metabolic syndrome and obesity

The metabolic syndrome (MetS) is best seen as a physiological change with a clustering of interrelated metabolic risk factors for developing type-2 diabetes and CVD, as well as a variety of other disorders. The main risk factors are abdominal obesity, elevated blood pressure, dyslipidemia, and insulin resistance, but lately other mechanisms such as endothelial dysfunction, inflammatory activity, and stress are also recognized as important components.

Over the last 10 years, schizophrenia has consistently been shown to be associated with a raised prevalence of the MetS. McEvoy and colleagues reported on baseline findings from 686 persons with chronic schizophrenia in the CATIE Study, where the prevalence of MetS was over 35% in males and over 50% in females. Saari and colleagues found that people with schizophrenia from the Northern Finland 1966 Birth Cohort Study had a fourfold risk of the MetS and that the risk was particularly increased in young individuals. A recent meta-analysis by Mitchell and colleagues investigated the prevalence of specific CVD-risk factors in a schizophrenia population who was either unmedicated (n = 1325), in first episode (n = 2548), or in the chronic phase (n = 24892) to a healthy population. They found that about 25% of the unmedicated and first-episode groups were either overweight, had elevated blood pressure, or dyslipidemia. This prevalence rate is lower compared to the chronic group, but higher compared to an age-matched healthy population. However, the same study reported that the prevalence of type-2 diabetes and hyperglycemia was the same in young people with schizophrenia and their healthy peers.Taken together, these and other results may suggest that the increased prevalence of type-2 diabetes in schizophrenia is related to treatment with second-generation antipsychotics (AP). However, others have shown that first-episode, drug-naive patients with schizophrenia have impaired fasting glucose tolerance, more insulin resistance, and higher levels of plasma glucose compared to healthy controls.

High CVD morbidity is also found in patients with mental disorders other than schizophrenia. In a sample of middle-aged and older patients with psychotic symptoms, the risk for CVD was increased by 60–70% in patients with mood disorder or post-traumatic stress disorder (PTSD) relative to the Framingham 10-year risk of CVD. In a Finnish study, the prevalence of MetS in depressed patients was 36%. CVD-risk in a sample of people with major depressive disorder or bipolar disorder increased with 50% from pre-treatment to 2-year follow-up.

Obesity, part of the MetS, is more prevalent among people with schizophrenia than in the general population. Important causes for obesity include excessive levels of food intake, physical inactivity, as well as genetic disposition and an imbalanced interplay between hormones (insulin, leptin, and adiponectin) and several inflammatory markers (including interleukins, the tumor necrosis factor family, and C-reactive protein).

In this review, the different components of the MetS and obesity are further discussed in the specific chapters.

Tobacco smoking and substance use

Smoking has well-known detrimental effects on CVD-risk profile and mortality. Tobacco smoking is about three times more prevalent in people with schizophrenia than in the general population, and the amount of smoking is also higher among smokers. While tobacco smoking has seen a downturn in the general population, smoking rates do not seem to decline in people with schizophrenia. In a recent Finnish survey of psychotic disorder, smoking at baseline, along with diabetes, was found to be the most important predictor of 8-year mortality. Tobacco-related conditions comprised approximately 53% of total deaths in people with schizophrenia in a recent large cohort study.

Prevalence of substance abuse is also high in schizophrenia, and this is problematic as substance use in itself is associated with lower psychosocial functioning, higher risk of exacerbations, or relapses and may also have direct adverse somatic effects. Recently, mortality from natural causes was found to be especially high in patients with comorbid substance use disorders. However, cannabis use was in one study reported to be associated with decreased mortality in psychotic disorder, which was tentatively associated with anti-inflammatory effects of the endocannabinoid system. The most commonly used illicit substance in schizophrenia is cannabis, followed by amphetamines and cocaine, although availability and preferences vary across nations and regions.

The increased substance use and smoking in schizophrenia may partly be explained by altered reward-seeking behavior and deficits in the representation of value of stimuli. This is in line with the Reward Deficiency Syndrome model proposed for substance abuse, which seems to be associated with the pathophysiology of schizophrenia and the biological pathways implicated in nicotine dependence and smoking cessation. This model also suggests treatment strategies, which may also have implications for interventions targeting other CVD-risk factors.

Physical inactivity and poor diet

Schizophrenia is associated with sedentary behavior. The engagement in recommended weekly physical activity was estimated to 26% in people with schizophrenia, which was lower than in the general population (34%). Other studies applying different assessment tools have also shown that people with schizophrenia are less active and exercise less. Low levels of physical activity and lack of physical fitness reduce life expectancy and increase risk for MetS and CVD in the general population as well as in schizophrenia. Negative symptoms typical for schizophrenia include lack of initiative and withdrawal from activities, often leading to a physically less active life. Passivity and inadequate motivation might also hinder the pursuit of a healthy diet. Furthermore, the lack of self-insight in one’s own illness might complicate the possibilities for health promoting activities in schizophrenia. During hospital admissions, patients have more symptoms and lower levels of functioning. Activities are often restricted and admissions of longer duration may have considerable impact on activity levels. The nature of an inpatient psychiatric setting has been considered “obesogenic”.

Diets rich in calories, fat, and carbohydrates are an important cause for MetS and increased CVD-risk. A balanced diet may have potential to reduce the risk for adverse medical conditions. Unhealthy diets are prevalent in people with schizophrenia. Loss of interest in personal hygiene and physical maintenance are also possible reasons. Alterations in the reward system may also contribute to the unhealthy eating patterns. There are indications that dietary habits of the mother may affect taste preferences in the offspring, and this might add to other factors contributing to unhealthy eating patterns in families.

Poor personal economy is prevalent in schizophrenia, and high levels of unemployment is an important reason. Negative symptoms and cognitive deficits are the main reasons for work disability. Poverty affects the possibilities to engage in a healthy lifestyle, as access to healthy foods and training facilities is expensive.

Antipsychotic medication

With the introduction of chlorpromazine in 1952, the treatment of schizophrenia was revolutionized, and nowadays medication with AP drugs is considered a central element in the treatment of psychotic disorders. However, until second-generation antipsychotics (SGAs) became available in the 1990s, improvement of psychosis often came at the cost of extrapyramidal symptoms and tardive dyskinesia, sometimes causing more subjective suffering to patients than the disorder itself, and making adherence to treatment a great challenge. At the turn of the last century, metabolic disturbances associated with SGA became a major concern in the treatment of severe mental disorders. Several meta-analyses have shown APs to have different liabilities of causing weight gain and other metabolic side effects. On a group level, clozapine and olanzapine are considered to be the most obesogenic, closely followed by quetiapine, with risperidone, sertindole, and typical APs in an intermediate position, while aripiprazole, amisulpride, and ziprasidone seem to carry the lowest risk.

However, most trials have studied previously treated patients with prolonged illness, often receiving co-medication with drugs with their own obesogenic properties. There are few prospective, long-term studies on the effects of different APs on previously drug-naïve patients on strict monotherapy. Several treatment studies have shown results diverging from the apparently clear-cut panorama of metabolic side effects mentioned above. Interestingly, weight gain on olanzapine appeared more rapidly while after 12 months it was the same as haloperidol and risperidone. Furthermore, sensitivity to side effects differs with age, gender, and ethnicity, as well as individual factors that are not well understood. In addition, several lines of evidence suggest that SGAs may have exacerbated existing somatic health issues in schizophrenia. Metabolic disturbances, such as diabetes and slow blood sugar uptake, had already been observed and described in the “the mentally insane” of the pre-AP era. Likewise, the first report on AP-induced obesity, shortly after chlorpromazine had been introduced, states that “increase in weight, often considerable, has (previously) been reported with such diverse treatments as insulin shock, cardiazol, and electric convulsive therapy.”

Antipsychotics constitute a heterogeneous group of drugs that may influence appetite control, body composition, and metabolic regulation through several pathways, a variety of underlying mechanisms of action have been proposed. As APs have complex pharmacological actions and interact with most biogenic amine receptors in the brain, a large number of candidate receptors have been targeted. Kroeze et al. showed that the most robust predictor of a drug’s propensity to induce weight gain was its affinity for the H1-histamine receptor (H1R). Through this mechanism, clozapine and olanzapine have been shown to cause hyperphagia and weight gain in rats by selective stimulation of the intra-neuronal enzyme adenosine monophosphate (AMP)-activated protein kinase (AMPK) in the hypothalamus, thereby blocking the action of the anorexigenic hormone leptin. In accordance with this, findings from one naturalistic study suggest that females with inherent high levels of leptin and high insulin sensitivity might be protected against the obesogenic properties of olanzapine. In addition, weight gain and hyperglycemia might be related to SGA effects on inflammatory pathways. On the other hand, dyslipidemia has been shown to be significantly associated with olanzapine treatment independently of body mass. There are also indications of a direct lipogenic effect of olanzapine caused by increased expression of lipid biosynthesis genes.

Despite the obvious risks due to metabolic side effects, AP use has not been consistently shown to increase CVD morbidity or mortality in schizophrenia. Osborn and colleagues concluded that the excess death rates found among mentally ill people could not be explained neither by smoking, social deprivation, nor by the use of AP medication alone, although patients on APs seemed to be at even greater risk than those without. In a recent meta-analysis of drug trials with placebo controls, AP use was not found to be related to increased mortality in schizophrenia, although the higher general mortality in this patient group was replicated. Furthermore, two large Finnish registry studies demonstrated reduced mortality from all causes in people with schizophrenia on long-term treatment with APs. Better somatic care in patients receiving AP medication could be part of the explanation, however, debate continues on the interpretation of these findings and the role of APs in the all-over schizophrenia mortality. In addition, sudden cardiac death in schizophrenia has in several studies been associated with the use of APs, most probably related to arrhythmias. Not every study confirms this picture; Manu and co-workers found that unexpected deaths in people with schizophrenia most likely was due to coronary events and found no hypermortality related to higher levels of AP-treatment.

Shared pathophysiological mechanisms in schizophrenia and CVD

Several lines of evidence indicate shared underlying pathobiology between schizophrenia and CVD, beyond the effects accounted for by lifestyle and AP medication.

First, this relationship might be due to common genetic factors that contribute to both comorbid medical conditions and mortality in schizophrenia. In particular, there seems to be overlapping genes associated with both increased CVD-risk factors and schizophrenia. This might explain recent findings that first-episode psychosis patients not treated with AP medication are more likely to have obesity, insulin-resistance, dyslipidemia, and hypertension compared with age-matched healthy controls, and the pre-AP era findings mentioned above (see Antipsychotic Medication). Recent molecular studies have indicated that there are abnormalities in the glucose metabolism and insulin signaling pathways in subgroups of unmedicated people with schizophrenia indicating a shared genetic vulnerability between type-2 diabetes and schizophrenia in some cases. Second, many neurotransmitters (dopamine, serotonin, and histamine) implicated in schizophrenia also have peripheral effects on pancreatic β-cells and adipocytes, which regulates blood glucose levels, obesity, and lipid levels. Third, pathways involving the hypothalamic–pituitary–adrenal axis (HPA) might be involved. First-episode psychosis patients have increased cortisol levels possibly due to environmental stress and these alterations in the HPA-axis might account for some of the increased CVD mortality. Finally, recent studies have implicated the immune system in severe mental disorders such as schizophrenia, as well as in CVD, and it is possible that the increased CVD-risk associated with schizophrenia is related to inflammatory mechanisms.

Help seeking and access to somatic health services

Patients with severe mental disorders report greater difficulty and more barriers in accessing primary health care. These patient groups also receive poorer quality of somatic health care services from hospitals. Thus, there is an increased risk for serious conditions to be undiagnosed or inadequately treated. People with schizophrenia seem to receive less somatic health care also compared to people with other mental disorders. In schizophrenia, it is shown that treatment and prevention for CVD is suboptimal, and this seems to affect mortality. This is supported by an increased mortality due to other somatic conditions besides CVD.

In the literature, there are a number of reports of people with schizophrenia who appear to experience little pain despite suffering from painful acute medical conditions, such as myocardial infarction or perforated bowel. A meta-analysis of 12 studies on pain perception in schizophrenia indicated reduced pain sensitivity. The hypoalgesia was also found in drug-free patients, consistent with clinical observations of reduced sensitivity to pain in schizophrenia reported before the introduction of APs. Pain insensitivity is also found in the healthy relatives of patients with schizophrenia, suggesting a genetic component. There is a concern that lack of physical pain sensitivity may result in potentially serious medical conditions passing undiagnosed in schizophrenia. There is some evidence that the insula, a cortical structure with extensive connections to different parts of the cortex and the limbic system, is affected in schizophrenia. The insula is important in establishing awareness of the body’s internal state (interoception) and plays a major role in the processes of pain sensitivity. Apart from patient-related barriers, inadequately organized somatic care in the mental health services and an existing culture with little focus on somatic health issues in psychiatric or mental health clinics may be an important part of the explanation.

Smoking cessation

Reducing smoking-related mortality will require the delivery of effective anti-smoking strategies. Smoking cessation may have considerable impact on CVD death risk, while just a reduction in smoking does not seem to have the same effect. Both pharmacological and psychosocial interventions for smoking cessation have been found to be useful in helping people with schizophrenia quit smoking, but the evidence for a lasting effects is poor. Concerns that individuals with severe mental illness might suffer negative mental consequences when quitting smoking seem to have little scientific support.

In a Cochrane review of 21 trials, pharmacological treatment with bupropion, a dopamine agonist, was found to increase smoking abstinence rates in smokers with schizophrenia. Another pharmacological agent, varenicline, a nicotinic receptor partial agonist, could also facilitate smoking cessation, but with possible psychiatric adverse effects. Psychological interventions such as contingent reinforcement might also help people with schizophrenia to quit or reduce smoking in the short-term. At the present time, there are indications that individuals with schizophrenia can stop smoking with appropriate help, although, convincing evidence that such interventions have a long-term benefit is lacking.

Increased cardiorespiratory fitness

Patients with schizophrenia have low levels of physical activity. Increased physical exercise has beneficial effect on several CVD-risk factors such as body weight and blood lipid concentrations and may reduce mortality. Improvement in physical fitness seems possible in schizophrenia and improved physical fitness seems likely to reduce the elevated mortality in this patient group. A Cochrane database review concludes that exercise programs are feasible and may improve mental well-being and overall outcome among patients with schizophrenia, as well as in mental illness in general. Positive results of promoting physical exercise in people with schizophrenia in outpatient and day care settings have also been reported.

The association between high cardiorespiratory fitness specifically (max oxygen uptake – VO max) and low risk of CVD (independently of weight reduction) is established in healthy men and women. Studies have shown that people with schizophrenia have reduced peak oxygen uptake, but are capable of participating in physical exercise programs, which improve their peak oxygen uptake. The effect of the improvement seems to be comparable with effects of physical training in healthy controls and patients with CVD.

Direct control of nutrient uptake and expenditure: diet, exercise, medication, and surgery

Obesity is a condition mainly caused by a relative excess intake of calories versus energy expenditure. A focus on these parameters (diet and activity) is therefore a natural starting point for prevention and treatment. Effective weight management may best be reached by the implementation of several measures in an integrated fashion. As there is a complex interplay between the factors responsible for obesity and the other components of the MetS (e.g., hypertension, dyslipidemia, insulin intolerance), effective interventions will be expected to have effects on several CVD-risk factors. Diet modifications may hold some of the same benefits as physical activity for reducing CVD-risk. Specific diets (e.g., Mediterranean, nut-enriched) may be favorable in achieving effects on different aspects of the MetS.

Studies have shown that weight reduction is possible when applying specific intervention programs for individuals with psychotic disorders. The combined effect of behavioral intervention, nutritional information, and physical exercise was investigated in a study of people with schizophrenia and body mass index (BMI) exceeding 25. The 3-month intervention program showed significant reduction in weight and BMI, which lasted 12 months. Intriguingly, weight reduction was gradual, with increasing weight loss as the program progressed, in contrast to weight reductions patterns in diet programs in healthy individuals, where there is often a larger reduction of weight early on.

People with schizophrenia treated with atypical APs participated in a 1-year multimodal weight control program, comprising nutrition, exercise, and behavioral interventions. Clinically significant reductions in weight and other risk factors for poor somatic health, including hemoglobin A1c were found in the patients who participated in the program. In contrast, patients who did not receive the weight control intervention continued to gain weight. A Cochrane review investigating the effects of 23 randomized controlled trials found that modest weight reduction can be obtained in people with schizophrenia with selective pharmacological and psychological interventions both on diet and activity levels.

For established obesity or MetS, pharmacological and surgical treatment may be needed and constitute important adjunctive measures. Finding safe and effective pharmacological interventions is difficult. Several drugs have been tested for weight reduction. There is evidence for some efficacy for different classes of drugs currently on the market such as, e.g., lipase inhibitors (Orlistat), antidepressants (Lorcaserin, Bupropion), anticonvulsants (Topiramat), and also Metformin for the treatment of comorbid diabetes. However, there are problems with the evidence for sustained effects as most studies have <24 months follow-up. Amphetamine-like appetite suppressants (e.g., phentermin) are now mostly banned in western countries because of the potential for abuse and should probably be avoided in persons vulnerable to psychosis. Sibutramin was withdrawn from the European markets in 2010 because of cardiovascular side effects. There is some evidence that medication and low caloric diet interventions are better than exercise or dietary supplements in maintaining weight loss. Statins may be considered for treatment of dyslipidemia in schizophrenia. Available evidence suggests similar treatment response as in the general population.

New insights in the metabolism of fats have led to investigation of the role of the hormone leptin in weight loss; however, any possible effect seems to be limited only to individuals with a genetic altered metabolism of leptin. Alternative classes of drugs are under investigation for weight reduction in AP-induced weight gain in schizophrenia and may hold promise. Studies in schizophrenia are limited and lack data on long-term effects. However, when other efforts to reduce weight gain have failed, the use of medication, and perhaps especially Metformin, seems to have some support in available evidence from systematic reviews and meta-analyses. However, no medication for obesity has been shown to reduce CVD morbidity or mortality.

Bariatric surgery, where parts of the digestive system are removed or bypassed, seems to provide greater weight reduction and higher rates of remission of type-2 diabetes and MetS compared to non-surgical interventions according to a recent meta-analysis limited to 2 years of follow-up. There are preliminary indications that people with schizophrenia receiving this kind of surgery may have similar outcomes as the general population.

Clinical monitoring

There seems to be a consensus that in patients receiving AP medications, weight, blood glucose, blood pressure, and lipid levels should be assessed at baseline and monitored regularly. American Diabetes Association et al. recommended that weight should be assessed 4, 8, and 12 weeks after initiating or changing AP medication and quarterly thereafter. Blood pressure, blood glucose, and lipid levels were to be checked 3 months after initiating AP therapy. If normal, blood pressure and blood glucose levels should be assessed every year or more frequently, and lipid levels should be measured every 5 years or more frequently. Several countries have implemented national guidelines with similar recommendations, but the compliance with these guidelines is uncertain.

Dealing with the described barriers to adequate somatic health care for people with schizophrenia could include improving availability of personnel skilled in detecting signs of CVD as well as the implementation of routines for checking CVD-risk factors in the mental health care settings. Current evidence makes it relevant to consider implementing such assessments also in people with schizophrenia not receiving AP medication.

If the assessments reveal increased risk factors, several courses of action are possible and should be planned according to the needs of the individual patient. However, important measures will often include change of medication and specific treatment of the present risk factors according to established guidelines for each condition.

Discussion

The present evidence provides a clear picture of an increased mortality rate in schizophrenia, approximately two to three times higher than in the general population. The majority of the increase is due to CVD. This is a serious health care issue that has to be dealt with. The precise origin of the raised vulnerability to CVD in schizophrenia remains elusive and most likely cannot be attributed to a single mechanism. In the interpretation of the findings of increased mortality, there is a problem that very little research is done on drug-naïve patients, and the full role of AP medications in these associations is thus problematic to assess. At present, most authors agree that the causality is multifactorial. Unfortunately, it is difficult with targeted interventions before the mechanisms are better known. However, the current review of the causative factors indicates that there may be several points of action available for the primary prevention of the increased risk for CVD.

Treatment strategies for reducing the risk-increasing behavior are easy to implement with few side effects, and, thus, potentially widely acceptable. However, even though adequate facilities for physical activities are available, and diet and smoking cessation programs are conducted, patients do not necessarily take advantage of them. Motivation is needed for a change in behavior. Many patients are ambivalent or lack motivation to increase their physical activity. Health care professionals are thus challenged to assist patients in their motivational process. The cognitive technique Motivational Interviewing is increasingly being used in areas of medicine where change in the patients’ behavior is important, and the results of pilot studies in cardiology are promising. The Transtheoretical Model of Change describes the motivational process and seems applicable in physical activity programs in severe mental illness populations. There are, however, several other obstacles for lifestyles changes among patients with severe mental illness than the motivational factors. Increased symptom load in general, side effects of medication, socioeconomic problems, staff attitudes, and practical problems related to provision of services also represent barriers. These should be included in intervention programs.

Secondary prevention of CVD would focus on detection of the increased somatic risk factors and ease the access to prevention and treatment. Of interest, there is research on possible future psychiatry-specific forms for biological treatment for the increased CVD-risk associated with APs. The prescription of medication with potential metabolic side effects should only be done after a careful cost–benefit analysis for each individual. Special attention should be paid for drug-naïve patients as well as patients in older age. Psychotropic medication should be followed by a rigorous monitoring of side effects and changes in CVD-risk factors, following established guidelines. Findings that the increase in CVD-risk factors occurs early after start of medication should also guide the monitoring. As the use of APs is not the only risk factor for increased CVD, AP-free patients should also be monitored for somatic risk factors.

The continuous development and implementation of guidelines is important, but the evidence also points to a demand for somatic proficiency in physicians working in psychiatry and that other mental health professionals contribute. As a group, people with schizophrenia do not receive adequate treatment for CVD, and improving somatic treatment and care in these patients is the first goal. Access to somatic health care should be improved by identifying local health care barriers and thereafter reducing them. Such barriers may exist both in the organization of the services as well as in the minds of politicians, directors, professionals, and patients. The European Psychiatric Association has called for increased cooperation and shared care between the different healthcare professionals to screen and treat CVD-risk factors and diabetes. Improved coordination between caretakers and health care professionals is supported by others. To obtain an integrated system of care based on a holistic biopsychosocial patient perspective perhaps a complete transformation and reorganization of the current mental health care systems is needed. Increasing the awareness of CVD-risk factors among psychiatrists and primary care physicians caring for patients with severe mental illness is also called for.

A large fraction of the high mortality in schizophrenia may represent avoidable deaths. To meet this serious challenge, better understanding of the underlying mechanisms and improved CVD prevention and treatment are needed. However, better coordination of the health care system is also needed.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References 193

  1. 1.

    Rossler W Salize HJ Van OJ Riecher-Rossler A Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol (2005 ) 15:399–409

    Not in our library10.1016/j.euroneuro.2005.04.009

  2. 2.

    Hennekens CH Hennekens AR Hollar D Casey DE Schizophrenia and increased risks of cardiovascular disease. Am Heart J (2005 ) 150:1115–21

    Not in our library10.1016/j.ahj.2005.02.007

  3. 3.

    Laursen TM Nordentoft M Mortensen PB Excess early mortality in schizophrenia. Annu Rev Clin Psychol (2014 ) 10:425–48

    Not in our library10.1146/annurev-clinpsy-032813-153657

  4. 4.

    Brown S Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry (1997 ) 171:502–8

    Not in our library10.1192/bjp.171.6.502

  5. 5.

    Bushe CJ Taylor M Haukka J Mortality in schizophrenia: a measurable clinical endpoint. J Psychopharmacol (2010 ) 24:17–25

    Not in our library10.1177/1359786810382468

  6. 6.

    Laursen TM Munk-Olsen T Vestergaard M Life expectancy and cardiovascular mortality in persons with schizophrenia. Curr Opin Psychiatry (2012 ) 25:83–8

    Not in our library10.1097/yco.0b013e32835035ca

  7. 7.

    McGrath J Saha S Chant D Welham J Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. (2008 ) 30:67–76

    Not in our library10.1093/epirev/mxn001

  8. 8.

    Saha S Chant D McGrath J A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry (2007 ) 64:1123–31

    Not in our library10.1001/archpsyc.64.10.1123

  9. 9.

    Crump C Ioannidis JP Sundquist K Winkleby MA Sundquist J Mortality in persons with mental disorders is substantially overestimated using inpatient psychiatric diagnoses. J Psychiatr Res (2013 ) 47:1298–303

    Not in our library10.1016/j.jpsychires.2013.05.034

  10. 10.

    Saha S Whiteford H McGrath J Modelling the incidence and mortality of psychotic disorders: data from the second Australian national survey of psychosis. Aust N Z J Psychiatry (2014 ) 48:352–9

    Not in our library10.1177/0004867413513341

  11. 11.
    Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries · 2013
    No notice
  12. 12.

    Hoye A Jacobsen BK Hansen V Increasing mortality in schizophrenia: are women at particular risk? A follow-up of 1111 patients admitted during 1980-2006 in Northern Norway. Schizophr Res (2011 ) 132:228–32

    Not in our library10.1016/j.schres.2011.07.021

  13. 13.

    Osby U Correia N Brandt L Ekbom A Sparen P Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res (2000 ) 45:21–8

    Not in our library10.1016/s0920-9964(99)00191-7

  14. 14.

    Leucht S Burkard T Henderson J Maj M Sartorius N Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand (2007 ) 116:317–33

    Not in our library10.1111/j.1600-0447.2007.01095.x

  15. 15.

    Tran E Rouillon F Loze JY Casadebaig F Philippe A Vitry F Cancer mortality in patients with schizophrenia: an 11-year prospective cohort study. Cancer (2009 ) 115:3555–62

    Not in our library10.1002/cncr.24383

  16. 16.

    Alstrõm CH Mortality in Mental Hospitals with Special Regard to Tuberculosis. Acta Psychiatrica and Neurologica Scandinavica: Supplementum 4. (1942 ).

    Not in our library

  17. 17.

    Odegard O Mortality in Norwegian mental hospitals 1926-1941. Acta Genet Stat Med (1951 ) 2:141–73

    Not in our library

  18. 18.

    Osborn DP Levy G Nazareth I Petersen I Islam A King MB Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s general practice research database. Arch Gen Psychiatry (2007 ) 64:242–9

    Not in our library10.1001/archpsyc.64.2.242

  19. 19.

    Crump C Sundquist K Winkleby MA Sundquist J Comorbidities and mortality in bipolar disorder: a Swedish national cohort study. JAMA Psychiatry (2013 ) 70:931–9

    Not in our library10.1001/jamapsychiatry.2013.1394

  20. 20.

    Sweeting J Duflou J Semsarian C Postmortem analysis of cardiovascular deaths in schizophrenia: a 10-year review. Schizophr Res (2013 ) 150:398–403

    Not in our library10.1016/j.schres.2013.08.029

  21. 21.
    A Comprehensive Review on Metabolic Syndrome · 2014
    Retracted
  22. 22.

    Birkenaes AB Opjordsmoen S Brunborg C Engh JA Jonsdottir H Ringen PA The level of cardiovascular risk factors in bipolar disorder equals that of schizophrenia: a comparative study. J Clin Psychiatry (2007 ) 68:917–23

    Not in our library10.4088/jcp.v68n0614

  23. 23.

    Heiskanen T Niskanen L Lyytikainen R Saarinen PI Hintikka J Metabolic syndrome in patients with schizophrenia. J Clin Psychiatry (2003 ) 64:575–9

    Not in our library10.4088/jcp.v64n0513

  24. 24.

    McEvoy JP Meyer JM Goff DC Nasrallah HA Davis SM Sullivan L Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the clinical antipsychotic trials of intervention effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res (2005 ) 80:19–32

    Not in our library10.1016/j.schres.2005.07.014

  25. 25.

    Saari KM Lindeman SM Viilo KM Isohanni MK Jarvelin MR Lauren LH A 4-fold risk of metabolic syndrome in patients with schizophrenia: the Northern Finland 1966 Birth Cohort study. J Clin Psychiatry (2005 ) 66:559–63

    Not in our library10.4088/jcp.v66n0503

  26. 26.

    Mitchell AJ Vancampfort D De HA Yu W De HM Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Schizophr Bull (2013 ) 39:295–305

    Not in our library10.1093/schbul/sbs082

  27. 27.

    Miron IC Baroana VC Popescu F Ionica F Pharmacological mechanisms underlying the association of antipsychotics with metabolic disorders. Curr Health Sci J (2014 ) 40:12–7

    Not in our library10.12865/chsj.40.01.02

  28. 28.

    Ryan MC Collins P Thakore JH Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. Am J Psychiatry (2003 ) 160:284–9

    Not in our library10.1176/appi.ajp.160.2.284

  29. 29.

    Jin H Folsom D Sasaki A Mudaliar S Henry R Torres M Increased Framingham 10-year risk of coronary heart disease in middle-aged and older patients with psychotic symptoms. Schizophr Res (2011 ) 125:295–9

    Not in our library10.1016/j.schres.2010.10.029

  30. 30.

    Niskanen LK Hintikka JJ Koivumaa-Honkanen HT Honkalampi KM Haatainen KM Viinamäki H-T Metabolic syndrome and depression: a cross-sectional analysis. J Clin Psychiatry (2006 ) 67:1422–7

    Not in our library10.4088/jcp.v67n0913

  31. 31.

    Taylor V McKinnon MC MacDonald K Jaswal G MacQueen GM Adults with mood disorders have an increased risk profile for cardiovascular disease within the first 2 years of treatment. Can J Psychiatry (2010 ) 55:362–8

    Not in our library10.1177/070674371005500605

  32. 32.

    Allison DB Newcomer JW Dunn AL Blumenthal JA Fabricatore AN Daumit GL Obesity among those with mental disorders: a national institute of mental health meeting report. Am J Prev Med (2009 ) 36:341–50

    Not in our library10.1016/j.amepre.2008.11.020

  33. 33.

    Flier JS Obesity wars: molecular progress confronts an expanding epidemic. Cell (2004 ) 116:337–50

    Not in our library10.1016/s0092-8674(03)01081-x

  34. 34.

    Beary M Hodgson R Wildgust HJ A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications. J Psychopharmacol (2012 ) 26:52–61

    Not in our library10.1177/0269881112440512

  35. 35.

    WHO. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva: World Health Organization (2009 ).

    Not in our library

  36. 36.

    De Leon J Diaz FJ A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res (2005 ) 76:135–57

    Not in our library10.1016/j.schres.2005.02.010

  37. 37.
    Smoking and mental illness: results from population surveys in Australia and the United States · 2009
    No notice
  38. 38.

    Hartz SM Pato CN Medeiros H Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry (2014 ) 71:248–54

    Not in our library10.1001/jamapsychiatry.2013.3726

  39. 39.

    Centers for Disease Contral and Prevention. Cigarette smoking among adults – United States, 2006. Morb Mortal Wkly Rep (2007 ) 56(44):1157–61

    Not in our library

  40. 40.

    Dickerson F Stallings CR Origoni AE Vaughan C Khushalani S Schroeder J Cigarette smoking among persons with schizophrenia or bipolar disorder in routine clinical settings, 1999-2011. Psychiatr Serv (2013 ) 64:44–50

    Not in our library10.1176/appi.ps.201200143

  41. 41.

    Suvisaari J Partti K Perälä J Viertiö S Saarni SE Lönnqvist J Mortality and its determinants in people with psychotic disorder. Psychosom Med (2013 ) 75(1):60–7

    Not in our library10.1097/psy.0b013e31827ad512

  42. 42.

    Callaghan RC Veldhuizen S Jeysingh T Orlan C Graham C Kakouris G Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. J Psychiatr Res (2014 ) 48:102–10

    Not in our library10.1016/j.jpsychires.2013.09.014

  43. 43.

    Compton MT Weiss PS West JC Kaslow NJ The associations between substance use disorders, schizophrenia-spectrum disorders, and axis IV psychosocial problems. Soc Psychiatry Psychiatr Epidemiol (2005 ) 40:939–46

    Not in our library10.1007/s00127-005-0964-4

  44. 44.

    Ringen PA Melle I Birkenaes AB Engh JA Faerden A Vaskinn A The level of illicit drug use is related to symptoms and premorbid functioning in severe mental illness. Acta Psychiatr Scand (2008 ) 118:297–304

    Not in our library10.1111/j.1600-0447.2008.01244.x

  45. 45.

    Moos RH Brennan PL Mertens JR Mortality rates and predictors of mortality among late-middle-aged and older substance abuse patients. Alcohol Clin Exp Res (1994 ) 18:187–95

    Not in our library10.1111/j.1530-0277.1994.tb00902.x

  46. 46.

    Darke S Kaye S McKetin R Duflou J Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev (2008 ) 27:253–62

    Not in our library10.1080/09595230801923702

  47. 47.

    Lee MH Hancox RJ Effects of smoking cannabis on lung function. Expert Rev Respir Med (2011 ) 5:537–46

    Not in our library10.1586/ers.11.40

  48. 48.

    Nawrot TS Perez L Kunzli N Munters E Nemery B Public health importance of triggers of myocardial infarction: a comparative risk assessment. Lancet (2011 ) 377:732–40

    Not in our library10.1016/s0140-6736(10)62296-9

  49. 49.
    Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden · 2013
    No notice
  50. 50.

    Koola MM McMahon RP Wehring HJ Liu F Mackowick KM Warren KR Alcohol and cannabis use and mortality in people with schizophrenia and related psychotic disorders. J Psychiatr Res (2012 ) 46:987–93

    Not in our library10.1016/j.jpsychires.2012.04.019

  51. 51.

    Ringen PA Melle I Birkenaes AB Engh JA Faerden A Jonsdottir H Illicit drug use in patients with psychotic disorders compared with that in the general population: a cross-sectional study. Acta Psychiatr Scand (2008 ) 117:133–8

    Not in our library10.1111/j.1600-0447.2007.01135.x

  52. 52.

    Gold JM Waltz JA Prentice KJ Morris SE Heerey EA Reward processing in schizophrenia: a deficit in the representation of value. Schizophr Bull (2008 ) 34:835–47

    Not in our library10.1093/schbul/sbn068

  53. 53.

    Kapur S Mizrahi R Li M From dopamine to salience to psychosis – linking biology, pharmacology and phenomenology of psychosis. Schizophr Res (2005 ) 79:59–68

    Not in our library10.1016/j.schres.2005.01.003

  54. 54.

    Blum K Braverman ER Holder JM Lubar JF Monastra VJ Miller D Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. J Psychoactive Drugs (2000 ) 32:1–112

    Not in our library10.1080/02791072.2000.10736099

  55. 55.

    Batel P Addiction and schizophrenia. Eur Psychiatry (2000 ) 15:115–22

    Not in our library10.1016/s0924-9338(00)00203-0

  56. 56.

    Wang J Li MD Common and unique biological pathways associated with smoking initiation/progression, nicotine dependence, and smoking cessation. Neuropsychopharmacology (2010 ) 35:702–19

    Not in our library10.1038/npp.2009.178

  57. 57.

    Roick C Fritz-Wieacker AF Matschinger H Riedel-Heller S Frühwald S Health habits of patients with schizophrenia: a general pattern? Soc Psychiatry Psychiatr Epidemiol (2007 ) 42:268–76

    Not in our library10.1007/s00127-007-0164-5

  58. 58.

    Faulkner G Cohn T Remington G Validation of a physical activity assessment tool for individuals with schizophrenia. Schizophr Res (2006 ) 82:225–31

    Not in our library10.1016/j.schres.2005.10.020

  59. 59.

    Townsend N Bhatnagar P Wickramashinge K Scarborough P Foster C Rayner M Physical Activity Statistics. London: British Heart Foundation (2012 ).

    Not in our library

  60. 60.

    Beebe LH Tian L Goodwin A Morris N Swant-Allen S Kuldau J Effects of exercise on the mental and physical health parameters of persons with schizophrenia. Issues Ment Health Nurs (2005 ) 26:661–76

    Not in our library10.1080/01612840590959551

  61. 61.

    Beebe LH Harris RF Description of physical activity in outpatients with schizophrenia spectrum disorders. Int J Ment Health Nurs (2013 ) 22:430–6

    Not in our library10.1111/inm.12008

  62. 62.

    Vancampfort D Probst M Scheewe T Maurissen K Sweers K Knapen J Lack of physical activity during leisure time contributes to an impaired health related quality of life in patients with schizophrenia. Schizophr Res (2011 ) 129:122–7

    Not in our library10.1016/j.schres.2011.03.018

  63. 63.

    McLeod HJ Jaques S Deane FP Base rates of physical activity in Australians with schizophrenia. Psychiatr Rehabil J (2009 ) 32:269–75

    Not in our library10.2975/32.4.2009.269.275

  64. 64.

    Blair SN Kampert JB Kohl HW III Barlow CE Macera CA Paffenbarger RS Jr. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA (1996 ) 276:205–10

    Not in our library10.1001/jama.276.3.205

  65. 65.

    Vancampfort D Knapen J Probst M Scheewe T Remans S De HM A systematic review of correlates of physical activity in patients with schizophrenia. Acta Psychiatr Scand (2011 ) 125:352–62

    Not in our library10.1111/j.1600-0447.2011.01814.x

  66. 66.

    Engh JA Friis S Birkenaes AB Jonsdottir H Klungsoyr O Ringen PA Delusions are associated with poor cognitive insight in schizophrenia. Schizophr Bull (2010 ) 36:830–5

    Not in our library10.1093/schbul/sbn193

  67. 67.

    Faulkner GE Gorczynski PF Cohn TA Psychiatric illness and obesity: recognizing the “obesogenic” nature of an inpatient psychiatric setting. Psychiatr Serv (2009 ) 60:538–41

    Not in our library10.1176/appi.ps.60.4.538

  68. 68.

    Lottenberg AM Afonso MS Lavrador MS Machado RM Nakandakare ER The role of dietary fatty acids in the pathology of metabolic syndrome. J Nutr Biochem (2012 ) 23:1027–40

    Not in our library10.1016/j.jnutbio.2012.03.004

  69. 69.

    Mann JI Nutrition recommendations for the treatment and prevention of type 2 diabetes and the metabolic syndrome: an evidenced-based review. Nutr Rev (2006 ) 64:422–7

    Not in our library10.1111/j.1753-4887.2006.tb00227.x

  70. 70.

    Chiuve SE Fung TT Rimm EB Hu FB McCullough ML Wang M Alternative dietary indices both strongly predict risk of chronic disease. J Nutr (2012 ) 142:1009–18

    Not in our library10.3945/jn.111.157222

  71. 71.

    Hu FB Willett WC Optimal diets for prevention of coronary heart disease. JAMA (2002 ) 288:2569–78

    Not in our library10.1001/jama.288.20.2569

  72. 72.

    Dipasquale S Pariante CM Dazzan P Aguglia E McGuire P Mondelli V The dietary pattern of patients with schizophrenia: a systematic review. J Psychiatr Res (2013 ) 47:197–207

    Not in our library10.1016/j.jpsychires.2012.10.005

  73. 73.

    Volkow ND Wang GJ Baler RD Reward, dopamine and the control of food intake: implications for obesity. Trends Cogn Sci (2011 ) 15:37–46

    Not in our library10.1016/j.tics.2010.11.001

  74. 74.

    Mennella JA Ontogeny of taste preferences: basic biology and implications for health. Am J Clin Nutr (2014 ) 99:704S–11S

    Not in our library10.3945/ajcn.113.067694

  75. 75.

    Mueser KT McGurk SR Schizophrenia. Lancet (2004 ) 363:2063–72

    Not in our library10.1016/s0140-6736(04)16458-1

  76. 76.

    Jarvis GE The social causes of psychosis in North American psychiatry: a review of a disappearing literature. Can J Psychiatry (2007 ) 52:287–94

    Not in our library10.1177/070674370705200503

  77. 77.

    Agerbo E Byrne M Eaton WW Mortensen PB Marital and labor market status in the long run in schizophrenia. Arch Gen Psychiatry (2004 ) 61:28–33

    Not in our library10.1001/archpsyc.61.1.28

  78. 78.

    First MB Tasman A DSM-IV-TR Mental Disorders. Diagnosis, Etiology and Treatment. Chichester: Wiley (2004 ).

    Not in our library

  79. 79.

    Green MF What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry (1996 ) 153:321–30

    Not in our library10.1176/ajp.153.3.321

  80. 80.

    NICE. Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. London: The National Institute for Health and Clinical Excellence. (2011 ).

    Not in our library

  81. 81.

    Rummel-Kluge C Komossa K Schwarz S Hunger H Schmid F Lobos CA Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis. Schizophr Res (2010 ) 123:225–33

    Not in our library10.1016/j.schres.2010.07.012

  82. 82.

    Allison DB Casey DE Antipsychotic-induced weight gain: a review of the literature. J Clin Psychiatry (2001 ) 62(Suppl 7):22–31

    Not in our library

  83. 83.

    Nasrallah HA Metabolic findings from the CATIE trial and their relation to tolerability. CNS Spectr (2006 ) 11(7 Suppl 7):32–9

    Not in our library10.1017/s1092852900026663

  84. 84.

    Smith RC Lindenmayer JP Bark N Warner-Cohen J Vaidhyanathaswamy S Khandat A Clozapine, risperidone, olanzapine, and conventional antipsychotic drug effects on glucose, lipids, and leptin in schizophrenic patients. Int J Neuropsychopharmacol (2005 ) 8:183–94

    Not in our library10.1017/s1461145705005110

  85. 85.

    De Leon J Susce MT Johnson M Hardin M Pointer L Ruano G A clinical study of the association of antipsychotics with hyperlipidemia. Schizophr Res (2007 ) 92:95–102

    Not in our library10.1016/j.schres.2007.01.015

  86. 86.

    Perez-Iglesias R Crespo-Facorro B Martinez-Garcia O Ramirez-Bonilla ML Alvarez-Jimenez M Pelayo-Teran JM Weight gain induced by haloperidol, risperidone and olanzapine after 1 year: findings of a randomized clinical trial in a drug-naive population. Schizophr Res (2008 ) 99:13–22

    Not in our library10.1016/j.schres.2007.10.022

  87. 87.

    Meduna LJ Gerty FJ Urse VG Biochemical disturbances in mental disorders. Arch Neurol Psychiatry (1942 ) 47:38–52

    Not in our library10.1001/archneurpsyc.1942.02290010048004

  88. 88.

    Raphael TP Parsons JP Blood sugar studies in dementia praecox and manic depressive insanity. Arch Neurol Psychiatry (1921 ) 5:687–709

    Not in our library10.1001/archneurpsyc.1921.02180300052005

  89. 89.

    Maudsley H The Pathology of Mind. 3rd ed London: MacMillan (1879 ). 113 p.

    Not in our library

  90. 90.

    Planansky K Changes in weight in patients receiving a tranquilizing drug. Psychiatr Q (1958 ) 32:289–303

    Not in our library10.1007/bf01561635

  91. 91.

    Kroeze WK Hufeisen SJ Popadak BA Renock SM Steinberg S Ernsberger P H1-histamine receptor affinity predicts short-term weight gain for typical and atypical antipsychotic drugs. Neuropsychopharmacology (2003 ) 28:519–26

    Not in our library10.1038/sj.npp.1300292

  92. 92.

    Kim SF Huang AS Snowman AM Teuscher C Snyder SH From the cover: antipsychotic drug-induced weight gain mediated by histamine H1 receptor-linked activation of hypothalamic AMP-kinase. Proc Natl Acad Sci U S A (2007 ) 104:3456–9

    Not in our library10.1073/pnas.0611417104

  93. 93.

    Birkenaes AB Birkeland KI Friis S Opjordsmoen S Andreassen OA Hormonal markers of metabolic dysregulation in patients with severe mental disorders after olanzapine treatment under real-life conditions. J Clin Psychopharmacol (2009 ) 29:109–16

    Not in our library10.1097/jcp.0b013e31819b95fc

  94. 94.

    Dieset I Hope S Ueland T Bjella T Agartz I Melle I Cardiovascular risk factors during second generation antipsychotic treatment are associated with increased C-reactive protein. Schizophr Res (2012 ) 140:169–74

    Not in our library10.1016/j.schres.2012.06.040

  95. 95.

    Birkenaes AB Birkeland KI Engh JA Faerden A Jonsdottir H Ringen PA Dyslipidemia independent of body mass in antipsychotic-treated patients under real-life conditions. J Clin Psychopharmacol (2008 ) 28:132–7

    Not in our library10.1097/jcp.0b013e318166c4f7

  96. 96.

    Vik-Mo AO Birkenaes AB Ferno J Jonsdottir H Andreassen OA Steen VM Increased expression of lipid biosynthesis genes in peripheral blood cells of olanzapine-treated patients. Int J Neuropsychopharmacol (2008 ) 11:679–84

    Not in our library10.1017/s1461145708008468

  97. 97.

    Khan A Faucett J Morrison S Brown WA Comparative mortality risk in adult patients with schizophrenia, depression, bipolar disorder, anxiety disorders, and attention-deficit/hyperactivity disorder participating in psychopharmacology clinical trials. JAMA Psychiatry (2013 ) 70:1091–9

    Not in our library10.1001/jamapsychiatry.2013.149

  98. 98.

    Tiihonen J Lonnqvist J Wahlbeck K Klaukka T Niskanen L Tanskanen A 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet (2009 ) 374:620–7

    Not in our library10.1016/s0140-6736(09)60742-x

  99. 99.

    Kiviniemi M Suvisaari J Koivumaa-Honkanen H Hakkinen U Isohanni M Hakko H Antipsychotics and mortality in first-onset schizophrenia: prospective Finnish register study with 5-year follow-up. Schizophr Res (2013 ) 150:274–80

    Not in our library10.1016/j.schres.2013.07.043

  100. 100.

    Weinmann S Read J Aderhold V Influence of antipsychotics on mortality in schizophrenia: systematic review. Schizophr Res (2009 ) 113:1–11

    Not in our library10.1016/j.schres.2009.05.018

  101. 101.

    De Hert M Correll CU Cohen D Do antipsychotic medications reduce or increase mortality in schizophrenia? A critical appraisal of the FIN-11 study. Schizophr Res (2010 ) 117:68–74

    Not in our library10.1016/j.schres.2009.12.029

  102. 102.

    Straus SM Bleumink GS Dieleman JP van der Lei J ‘t Jong GW Kingma JH Antipsychotics and the risk of sudden cardiac death. Arch Intern Med (2004 ) 164:1293–7

    Not in our library10.1001/archinte.164.12.1293

  103. 103.

    Reilly JG Ayis SA Ferrier IN Jones SJ Thomas SH Thioridazine and sudden unexplained death in psychiatric in-patients. Br J Psychiatry (2002 ) 180:515–22

    Not in our library10.1192/bjp.180.6.515

  104. 104.

    Ray WA Chung CP Murray KT Hall K Stein CM Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med (2009 ) 360:225–35

    Not in our library10.1056/nejmoa0806994

  105. 105.

    Manu P Kane JM Correll CU Sudden deaths in psychiatric patients. J Clin Psychiatry (2011 ) 72:936–41

    Not in our library10.4088/jcp.10m06244gry

  106. 106.

    Petersen L Sorensen TI Studies based on the Danish Adoption Register: schizophrenia, BMI, smoking, and mortality in perspective. Scand. J Public Health (2011 ) 39:191–5

    Not in our library10.1177/1403494810396560

  107. 107.

    Andreassen OA Djurovic S Thompson WK Schork AJ Kendler KS O’Donovan MC Improved detection of common variants associated with schizophrenia by leveraging pleiotropy with cardiovascular-disease risk factors. Am J Hum Genet (2013 ) 92:197–209

    Not in our library10.1016/j.ajhg.2013.01.001

  108. 108.

    Andreassen OA McEvoy LK Thompson WK Wang Y Reppe S Schork AJ Identifying common genetic variants in blood pressure due to polygenic pleiotropy with associated phenotypes. Hypertension (2014 ) 63:819–26

    Not in our library10.1161/hypertensionaha.113.02077

  109. 109.

    Chen S Broqueres-You D Yang G Wang Z Li Y Wang N Relationship between insulin resistance, dyslipidaemia and positive symptom in Chinese antipsychotic-naive first-episode patients with schizophrenia. Psychiatry Res (2013 ) 210:825–9

    Not in our library10.1016/j.psychres.2013.08.056

  110. 110.

    Harris LW Guest PC Wayland MT Umrania Y Krishnamurthy D Rahmoune H Schizophrenia: metabolic aspects of aetiology, diagnosis and future treatment strategies. Psychoneuroendocrinology (2013 ) 38:752–66

    Not in our library10.1016/j.psyneuen.2012.09.009

  111. 111.

    Vestri HS Maianu L Moellering DR Garvey WT Atypical antipsychotic drugs directly impair insulin action in adipocytes: effects on glucose transport, lipogenesis, and antilipolysis. Neuropsychopharmacology (2007 ) 32:765–72

    Not in our library10.1038/sj.npp.1301142

  112. 112.

    Hahn M Chintoh A Giacca A Xu L Lam L Mann S Atypical antipsychotics and effects of muscarinic, serotonergic, dopaminergic and histaminergic receptor binding on insulin secretion in vivo: an animal model. Schizophr Res (2011 ) 131:90–5

    Not in our library10.1016/j.schres.2011.06.004

  113. 113.

    Stunes AK Reseland JE Hauso O Kidd M Tommeras K Waldum HL Adipocytes express a functional system for serotonin synthesis, reuptake and receptor activation. Diabetes Obes Metab (2011 ) 13:551–8

    Not in our library10.1111/j.1463-1326.2011.01378.x

  114. 114.

    Mondelli V Cattaneo A Belvederi MM Di FM Handley R Hepgul N Stress and inflammation reduce brain-derived neurotrophic factor expression in first-episode psychosis: a pathway to smaller hippocampal volume. J Clin Psychiatry (2011 ) 72:1677–84

    Not in our library10.4088/jcp.10m06745

  115. 115.

    Bradley AJ Dinan TG A systematic review of hypothalamic-pituitary-adrenal axis function in schizophrenia: implications for mortality. J Psychopharmacol (2010 ) 24:91–118

    Not in our library10.1177/1359786810385491

  116. 116.

    Miller BJ Buckley P Seabolt W Mellor A Kirkpatrick B Meta-analysis of cytokine alterations in schizophrenia: clinical status and antipsychotic effects. Biol Psychiatry (2011 ) 70:663–71

    Not in our library10.1016/j.biopsych.2011.04.013

  117. 117.

    Potvin S Stip E Sepehry AA Gendron A Bah R Kouassi E Inflammatory cytokine alterations in schizophrenia: a systematic quantitative review. Biol Psychiatry (2008 ) 63:801–8

    Not in our library10.1016/j.biopsych.2007.09.024

  118. 118.

    Corrado E Rizzo M Coppola G Fattouch K Novo G Marturana I An update on the role of markers of inflammation in atherosclerosis. J Atheroscler Thromb (2010 ) 17:1–11

    Not in our library10.5551/jat.2600

  119. 119.

    Leonard BE Schwarz M Myint AM The metabolic syndrome in schizophrenia: is inflammation a contributing cause? J Psychopharmacol (2012 ) 26:33–41

    Not in our library10.1177/0269881111431622

  120. 120.

    Bradford DW Kim MM Braxton LE Marx CE Butterfield M Elbogen EB Access to medical care among persons with psychotic and major affective disorders. Psychiatr Serv (2008 ) 59:847–52

    Not in our library10.1176/appi.ps.59.8.847

  121. 121.

    Kilbourne AM McCarthy JF Welsh D Blow F Recognition of co-occurring medical conditions among patients with serious mental illness. J Nerv Ment Dis (2006 ) 194:598–602

    Not in our library10.1097/01.nmd.0000230637.21821.ec

  122. 122.

    Mitchell AJ Lord O Malone D Differences in the prescribing of medication for physical disorders in individuals with v. without mental illness: meta-analysis. Br J Psychiatry (2012 ) 201:435–43

    Not in our library10.1192/bjp.bp.111.094532

  123. 123.

    Salsberry PJ Chipps E Kennedy C Use of general medical services among Medicaid patients with severe and persistent mental illness. Psychiatr Serv (2005 ) 56:458–62

    Not in our library10.1176/appi.ps.56.4.458

  124. 124.
    Patterns of primary care and mortality among patients with schizophrenia or diabetes: a cluster analysis approach to the retrospective study of healthcare utilization · 2009
    Not checked
  125. 125.

    Roberts L Roalfe A Wilson S Lester H Physical health care of patients with schizophrenia in primary care: a comparative study. Fam Pract (2007 ) 24:34–40

    Not in our library10.1093/fampra/cml054

  126. 126.

    Mitchell AJ Lord O Do deficits in cardiac care influence high mortality rates in schizophrenia? A systematic review and pooled analysis. J Psychopharmacol (2010 ) 24:69–80

    Not in our library10.1177/1359786810382056

  127. 127.

    Hippisley-Cox J Parker C Coupland C Vinogradova Y Inequalities in the primary care of patients with coronary heart disease and serious mental health problems: a cross-sectional study. Heart (2007 ) 93:1256–62

    Not in our library10.1136/hrt.2006.110171

  128. 128.

    Marchand WE Occurrence of painless myocardial infarction in psychotic patients. N Engl J Med (1955 ) 253:51–5

    Not in our library10.1056/nejm195507142530202

  129. 129.

    Rosenthal SH Porter KA Coffey B Pain insensitivity in schizophrenia. Case report and review of the literature. Gen Hosp Psychiatry. (1990 ) 12:319–22

    Not in our library10.1016/0163-8343(90)90050-m

  130. 130.

    Potvin S Marchand S Hypoalgesia in schizophrenia is independent of antipsychotic drugs: a systematic quantitative review of experimental studies. Pain (2008 ) 138:70–8

    Not in our library10.1016/j.pain.2007.11.007

  131. 131.

    Hooley JM Delgado ML Pain insensitivity in the relatives of people with schizophrenia. Schizophr Res (2001 ) 47:265–73

    Not in our library10.1016/s0920-9964(00)00064-5

  132. 132.

    Bickerstaff LK Harris SC Leggett RS Cheah KC Pain insensitivity in schizophrenic patients a surgical dilemma. Arch Surg. (1988 ) 123:49–51

    Not in our library10.1001/archsurg.1988.01400250059010

  133. 133.

    Wylie KP Tregellas JR The role of the insula in schizophrenia. Schizophr Res (2010 ) 123:93–104

    Not in our library10.1016/j.schres.2010.08.027

  134. 134.

    Daumit GL Crum RM Guallar E Ford DE Receipt of preventive medical services at psychiatric visits by patients with severe mental illness. Psychiatr Serv (2002 ) 53:884–7

    Not in our library10.1176/appi.ps.53.7.884

  135. 135.

    Rasanen S Hakko H Viilo K Meyer-Rochow VB Moring J Excess mortality among long-stay psychiatric patients in Northern Finland. Soc Psychiatry Psychiatr Epidemiol (2003 ) 38:297–304

    Not in our library10.1007/s00127-003-0635-2

  136. 136.

    Hart C Gruer L Bauld L Does smoking reduction in midlife reduce mortality risk? Results of 2 long-term prospective cohort studies of men and women in Scotland. Am J Epidemiol (2013 ) 178:770–9

    Not in our library10.1093/aje/kwt038

  137. 137.

    Gerber Y Myers V Goldbourt U Smoking reduction at midlife and lifetime mortality risk in men: a prospective cohort study. Am J Epidemiol (2012 ) 175:1006–12

    Not in our library10.1093/aje/kwr466

  138. 138.

    Bennett ME Wilson AL Genderson M Saperstein AM Smoking cessation in people with schizophrenia. Curr Drug Abuse Rev (2013 ) 6:180–90

    Not in our library10.2174/18744737112059990011

  139. 139.

    Hahn B Harvey AN Concheiro-Guisan M Huestis MA Holcomb HH Gold JM A test of the cognitive self-medication hypothesis of tobacco smoking in schizophrenia. Biol Psychiatry (2013 ) 74:436–43

    Not in our library10.1016/j.biopsych.2013.03.017

  140. 140.

    Ragg M Gordon R Ahmed T Allan J The impact of smoking cessation on schizophrenia and major depression. Australas Psychiatry (2013 ) 21:238–45

    Not in our library10.1177/1039856213486213

  141. 141.

    Tsoi DT Porwal M Webster AC Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database Syst Rev (2013 ) 2:CD007253

    Not in our library10.1002/14651858.cd007253

  142. 142.

    Pagels P Raustorp A Archer T Lidman U Alricsson M Influence of moderate, daily physical activity upon body composition and blood lipid profile in Swedish adults. J Phys Act Health (2011 ) 9:867–74

    Not in our library10.1123/jpah.9.6.867

  143. 143.

    Lavie CJ Thomas RJ Squires RW Allison TG Milani RV Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clin Proc (2009 ) 84:373–83

    Not in our library10.1016/s0025-6196(11)60548-x

  144. 144.

    Dodd KJ Duffy S Stewart JA Impey J Taylor N A small group aerobic exercise programme that reduces body weight is feasible in adults with severe chronic schizophrenia: a pilot study. Disabil Rehabil (2011 ) 33:1222–9

    Not in our library10.3109/09638288.2010.526162

  145. 145.

    Gorczynski P Faulkner G Exercise therapy for schizophrenia. Cochrane Database Syst Rev (2010 ) 5:CD004412

    Not in our library10.1002/14651858.cd004412.pub2

  146. 146.

    Wildgust HJ Beary M Are there modifiable risk factors which will reduce the excess mortality in schizophrenia? J Psychopharmacol (2010 ) 24:37–50

    Not in our library10.1177/1359786810384639

  147. 147.

    Porsdal V Beal C Kleivenes OK Martinsen EW Lindstrom E Nilsson H The Scandinavian Solutions for Wellness study – a two-arm observational study on the effectiveness of lifestyle intervention on subjective well-being and weight among persons with psychiatric disorders. BMC Psychiatry (2010 ) 10:42

    Not in our library10.1186/1471-244x-10-42

  148. 148.

    Beebe LH Smith K Burk R McIntyre K Dessieux O Tavakoli A Effect of a motivational intervention on exercise behavior in persons with schizophrenia spectrum disorders. Community Ment Health J (2011 ) 47:628–36

    Not in our library10.1007/s10597-010-9363-8

  149. 149.

    Daumit GL Dalcin AT Jerome GJ Young DR Charleston J Crum RM A behavioral weight-loss intervention for persons with serious mental illness in psychiatric rehabilitation centers. Int J Obes (Lond) (2011 ) 35:1114–23

    Not in our library10.1038/ijo.2010.224

  150. 150.

    Ganguli R Behavioral therapy for weight loss in patients with schizophrenia. J Clin Psychiatry (2007 ) 68(Suppl 4):19–25

    Not in our library

  151. 151.

    Methapatara W Srisurapanont M Pedometer walking plus motivational interviewing program for Thai schizophrenic patients with obesity or overweight: a 12-week, randomized, controlled trial. Psychiatry Clin Neurosci (2011 ) 65:374–80

    Not in our library10.1111/j.1440-1819.2011.02225.x

  152. 152.

    Kodama S Saito K Tanaka S Maki M Yachi Y Asumi M Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA (2009 ) 301:2024–35

    Not in our library10.1001/jama.2009.681

  153. 153.

    Heggelund J Nilsberg GE Hoff J Morken G Helgerud J Effects of high aerobic intensity training in patients with schizophrenia: a controlled trial. Nord J Psychiatry (2011 ) 65:269–75

    Not in our library10.3109/08039488.2011.560278

  154. 154.

    Scheewe TW Backx FJ Takken T Jorg F van Strater AC Kroes AG Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial. Acta Psychiatr Scand (2013 ) 127:464–73

    Not in our library10.1111/acps.12029

  155. 155.

    Schwingshackl L Hoffmann G Comparison of the long-term effects of high-fat v. low-fat diet consumption on cardiometabolic risk factors in subjects with abnormal glucose metabolism: a systematic review and meta-analysis. Br J Nutr (2014 ) 111:2047–58

    Not in our library10.1017/s0007114514000464

  156. 156.

    Esposito K Kastorini CM Panagiotakos DB Giugliano D Mediterranean diet and metabolic syndrome: an updated systematic review. Rev Endocr Metab Disord (2013 ) 14:255–63

    Not in our library10.1007/s11154-013-9253-9

  157. 157.

    Bueno NB de Melo IS de Oliveira SL da Rocha AT Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr (2013 ) 110:1178–87

    Not in our library10.1017/s0007114513000548

  158. 158.

    Lee SJ Choi EJ Kwon JS A naturalistic multicenter trial of a 12-week weight management program for overweight and obese patients with schizophrenia or schizoaffective disorder. J Clin Psychiatry (2008 ) 69:555–62

    Not in our library10.4088/jcp.v69n0406

  159. 159.

    Melamed Y Stein-Reisner O Gelkopf M Levi G Sivan T Ilievici G Multi-modal weight control intervention for people with persistent mental disorders. Psychiatr Rehabil J (2008 ) 31:194–200

    Not in our library10.2975/31.3.2008.194.200

  160. 160.

    Menza M Vreeland B Minsky S Gara M Radler DR Sakowitz M Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program. J Clin Psychiatry (2004 ) 65:471–7

    Not in our library10.4088/jcp.v65n0404

  161. 161.

    Faulkner G Cohn T Remington G Interventions to reduce weight gain in schizophrenia. Cochrane Database Syst Rev (2007 ) 1:CD005148

    Not in our library10.1002/14651858.cd005148.pub2

  162. 162.

    Powers PS Cloak NL Psychopharmacologic treatment of obesity and eating disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am (2012 ) 21:831–59

    Not in our library10.1016/j.chc.2012.07.003

  163. 163.

    Smith SM Meyer M Trinkley KE Phentermine/topiramate for the treatment of obesity. Ann Pharmacother (2013 ) 47:340–9

    Not in our library10.1345/aph.1r501

  164. 164.

    Johansson K Neovius M Hemmingsson E Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr (2014 ) 99:14–23

    Not in our library10.3945/ajcn.113.070052

  165. 165.

    Vincenzi B Borba CP Gray DA Copeland PM Wang X Fan X An exploratory study examining lipid-lowering medications in reducing fasting serum lipids in people with schizophrenia treated with atypical antipsychotics. Ann Clin Psychiatry (2013 ) 25:141–8

    Not in our library

  166. 166.

    Heymsfield SB Greenberg AS Fujioka K Dixon RM Kushner R Hunt T Recombinant leptin for weight loss in obese and lean adults: a randomized, controlled, dose-escalation trial. JAMA (1999 ) 282:1568–75

    Not in our library10.1001/jama.282.16.1568

  167. 167.

    Korner J Conroy R Febres G McMahon DJ Conwell I Karmally W Randomized double-blind placebo-controlled study of leptin administration after gastric bypass. Obesity (Silver Spring) (2013 ) 21:951–6

    Not in our library10.1002/oby.20433

  168. 168.

    Amrami-Weizman A Maayan R Gil-Ad I Pashinian A Fuchs C Kotler M The effect of reboxetine co-administration with olanzapine on metabolic and endocrine profile in people with schizophrenia. Psychopharmacology (Berl) (2013 ) 230:23–7

    Not in our library10.1007/s00213-013-3199-1

  169. 169.

    Tek C Guloksuz S Srihari VH Reutenauer EL Investigating the safety and efficacy of naltrexone for anti-psychotic induced weight gain in severe mental illness: study protocol of a double-blind, randomized, placebo-controlled trial. BMC Psychiatry (2013 ) 13:176

    Not in our library10.1186/1471-244x-13-176

  170. 170.

    Das C Mendez G Jagasia S Labbate LA Second-generation antipsychotic use in schizophrenia and associated weight gain: a critical review and meta-analysis of behavioral and pharmacologic treatments. Ann Clin Psychiatry (2012 ) 24:225–39

    Not in our library10.1093/schbul/sbu030

  171. 171.

    Mizuno Y Suzuki T Nakagawa A Yoshida K Mimura M Fleischhacker WW Pharmacological strategies to counteract antipsychotic-induced weight gain and metabolic adverse effects in schizophrenia: a systematic review and meta-analysis. Schizophr Bull (2014 ).

    Not in our library10.1093/schbul/sbu030

  172. 172.

    Maayan L Vakhrusheva J Correll CU Effectiveness of medications used to attenuate antipsychotic-related weight gain and metabolic abnormalities: a systematic review and meta-analysis. Neuropsychopharmacology (2010 ) 35:1520–30

    Not in our library10.1038/npp.2010.21

  173. 173.

    Yanovski SZ Yanovski JA Long-term drug treatment for obesity: a systematic and clinical review. JAMA (2014 ) 311:74–86

    Not in our library10.1001/jama.2013.281361

  174. 174.

    Gloy VL Briel M Bhatt DL Kashyap SR Schauer PR Mingrone G Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ (2013 ) 347:f5934

    Not in our library10.1136/bmj.f5934

  175. 175.

    Hamoui N Kingsbury S Anthone GJ Crookes PF Surgical treatment of morbid obesity in schizophrenic patients. Obes Surg (2004 ) 14:349–52

    Not in our library10.1381/096089204322917873

  176. 176.

    American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. J Clin Psychiatry (2004 ) 2:267–72

    Not in our library10.4088/jcp.v65n0219

  177. 177.

    Morrato EH Newcomer JW Kamat S Baser O Harnett J Cuffel B Metabolic Screening After the American Diabetes Association’s Consensus Statement on Antipsychotic Drugs and Diabetes. Diabetes Care (2009 ) 32:1037–42

    Not in our library10.2337/dc08-1720

  178. 178.

    Miller WR Rollnick S Ten things that motivational interviewing is not. Behav Cogn Psychother (2009 ) 37:129–40

    Not in our library10.1017/s1352465809005128

  179. 179.

    Emmons KM Rollnick S Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med (2001 ) 20:68–74

    Not in our library10.1016/s0749-3797(00)00254-3

  180. 180.

    Britt E Hudson SM Blampied NM Motivational interviewing in health settings: a review. Patient Educ Couns (2004 ) 53:147–55

    Not in our library10.1016/s0738-3991(03)00141-1

  181. 181.

    Levensky ER Forcehimes A O’Donohue WT Beitz K Motivational interviewing: an evidence-based approach to counseling helps patients follow treatment recommendations. Am J Nurs (2007 ) 107:50–8

    Not in our library10.1097/01.naj.0000292202.06571.24

  182. 182.

    Thompson DR Chair SY Chan SW Astin F Davidson PM Ski CF Motivational interviewing: a useful approach to improving cardiovascular health? J Clin Nurs (2011 ) 20:1236–44

    Not in our library10.1111/j.1365-2702.2010.03558.x

  183. 183.

    Gorczynski P Faulkner G Greening S Cohn T Exploring the construct validity of the transtheoretical model to structure physical activity interventions for individuals with serious mental illness. Psychiatr Rehabil J (2010 ) 34:61–4

    Not in our library10.2975/34.1.2010.61.64

  184. 184.

    Roberts SH Bailey JE Incentives and barriers to lifestyle interventions for people with severe mental illness: a narrative synthesis of quantitative, qualitative and mixed methods studies. J Adv Nurs (2011 ) 67:690–708

    Not in our library10.1111/j.1365-2648.2010.05546.x

  185. 185.

    Burghardt KJ Ellingrod VL Detection of metabolic syndrome in schizophrenia and implications for antipsychotic therapy: is there a role for folate? Mol Diagn Ther (2013 ) 17:21–30

    Not in our library10.1007/s40291-013-0017-8

  186. 186.

    Hasan A Falkai P Wobrock T Lieberman J Glenthoj B Gattaz WF World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. World J Biol Psychiatry (2013 ) 14:2–44

    Not in our library10.3109/15622975.2012.739708

  187. 187.

    Mitchell AJ Delaffon V Vancampfort D Correll CU De HM Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med (2012 ) 42:125–47

    Not in our library10.1017/s003329171100105x

  188. 188.

    Gaebel W Riesbeck M Wobrock T Schizophrenia guidelines across the world: a selective review and comparison. Int Rev Psychiatry (2011 ) 23:379–87

    Not in our library10.3109/09540261.2011.606801

  189. 189.

    Perez-Iglesias R Martinez-Garcia O Pardo-Garcia G Amado JA Garcia-Unzueta MT Tabares-Seisdedos R Course of weight gain and metabolic abnormalities in first treated episode of psychosis: the first year is a critical period for development of cardiovascular risk factors. Int J Neuropsychopharmacol (2014 ) 17:41–51

    Not in our library10.1017/s1461145713001053

  190. 190.

    De Hert M Dekker JM Wood D Kahl KG Holt RI Moller HJ Cardiovascular disease and diabetes in people with severe mental illness position statement from the European psychiatric association (EPA), supported by the European association for the study of diabetes (EASD) and the European society of cardiology (ESC). Eur Psychiatry (2009 ) 24:412–24

    Not in our library10.1016/j.eurpsy.2009.01.005

  191. 191.

    Casey DA Rodriguez M Northcott C Vickar G Shihabuddin L Schizophrenia: medical illness, mortality, and aging. Int J Psychiatry Med (2011 ) 41:245–51

    Not in our library10.2190/pm.41.3.c

  192. 192.

    Vreeland B Bridging the gap between mental and physical health: a multidisciplinary approach. J Clin Psychiatry (2007 ) 68(Suppl 4):26–33

    Not in our library

  193. 193.

    Crompton D Groves A McGrath J What can we do to reduce the burden of avoidable deaths in those with serious mental illness? Epidemiol Psichiatr Soc (2010 ) 19(1):4–7

    Not in our library

Cited by papers we hold 3

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.