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No. 3 (2026)

ORIRGINAL RESEARCH

Comparative assessment of metabolic risk between chlorpromazine, haloperidol, clozapine, risperidone, olanzapine, and quetiapine in the treatment of patients with schizophrenia

https://doi.org/10.48612/psyph/t8a4-afvx-xku8

Published 2026-10-02

  • E.G. Kornetova
    • ,
  • S.A. Galkin
    • ,
  • I.A. Mednova
    • ,
  • V.A. Sorokina
    • ,
  • A.S. Yakovlev
    • ,
  • S.A. Ivanova
    • ,
  • A.N. Kornetov

E.G. Kornetova
Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences

S.A. Galkin
Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences

I.A. Mednova
Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences

V.A. Sorokina
Kuzbass Clinical Psychiatric Hospital

A.S. Yakovlev
Kemerovo State Medical University

S.A. Ivanova
Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences

A.N. Kornetov
Kemerovo State Medical University; Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences

Abstract

Relevance. Schizophrenia is one of the most severe mental disorders and requires long-term, often lifelong, antipsychotic therapy. Long-term use of antipsychotics
is associated with the development of metabolic disorders that increase the risk of diseases of the cardiovascular system, reducing the life expectancy of patients by
10-20 years. In recent years, researchers’ attention has shifted from controlling exclusively psychopathological symptoms to ensuring long-term somatic well-being,
which requires clarifying the comparative metabolic risks of various antipsychotics.

The aim — to conduct a comparative assessment of the metabolic risk of using chlorpromazine, haloperidol, clozapine, risperidone, olanzapine and quetiapine in the
treatment of patients with schizophrenia.

Materials and methods. The study included 277 patients with schizophrenia receiving monotherapy with the aforementioned medications. The total duration of
monotherapy in the study group was 7 [3; 16] years. Anthropometric (abdominal obesity) and laboratory parameters (concentrations of glucose, triglycerides, and
high-density lipoproteins), as well as blood pressure, were assessed. Metabolic syndrome was diagnosed using the 2005 International Diabetes Federation criteria.

Results. Statistically significant differences were found between antipsychotics in the incidence of abdominal obesity (p = 0.006) and hyperglycemia (p = 0.046).
The highest integrated risk was recorded for clozapine (metabolic syndrome — 43.1 %, abdominal obesity — 66.7 %) and olanzapine (lipid metabolism disorders). An
unexpectedly high risk of hyperglycemia was observed with chlorpromazine (38.5 %), which is comparable to the risk with clozapine therapy (31.4 %). Haloperidol and
risperidone demonstrated a low risk.

Conclusion. Variability in metabolic risks has been confirmed, both between generations and within antipsychotic classes. These findings support the need for a personalized approach to treatment selection and regular metabolic monitoring in all patients with schizophrenia, including those receiving conventional antipsychotics.

Keywords

schizophrenia, metabolic risks, abdominal obesity, dyslipidemia, hyperglycemia, antipsychotics, therapy

PDF (Русский)

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