The impact of pharmacological and non‐pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta‐review of meta‐analyses of randomized controlled trials
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We summarized and compared meta‐analyses of pharmacological and non‐pharmacological interventions targeting physical health outcomes among people with schizophrenia spectrum disorders. Major databases were searched until June 1, 2018. Of 3,709 search engine hits, 27 meta‐analyses were included, representing 128 meta‐analyzed trials and 47,231 study participants. While meta‐analyses were generally of adequate or high quality, meta‐analyzed studies were less so. The most effective weight reduction interventions were individual lifestyle counseling (standardized mean difference, SMD=–0.98) and exercise interventions (SMD=–0.96), followed by psychoeducation (SMD=–0.77), aripiprazole augmentation (SMD=–0.73), topiramate (SMD=–0.72), d‐fenfluramine (SMD=–0.54) and metformin (SMD=–0.53). Regarding waist circumference reduction, aripiprazole augmentation (SMD=–1.10) and topiramate (SMD=–0.69) demonstrated the best evidence, followed by dietary interventions (SMD=–0.39). Dietary interventions were the only to significantly improve (diastolic) blood pressure (SMD=–0.39). Switching from olanzapine to quetiapine or aripiprazole (SMD=–0.71) and metformin (SMD=–0.65) demonstrated best efficacy for reducing glucose levels, followed by glucagon‐like peptide‐1 receptor agonists (SMD=–0.39), dietary interventions (SMD=–0.37) and aripiprazole augmentation (SMD=–0.34), whereas insulin resistance improved the most with metformin (SMD=–0.75) and rosiglitazone (SMD=–0.44). Topiramate had the greatest efficacy for triglycerides (SMD=–0.68) and low‐density lipoprotein (LDL)‐cholesterol (SMD=–0.80), whereas metformin had the greatest beneficial effects on total cholesterol (SMD=–0.51) and high‐density lipoprotein (HDL)‐cholesterol (SMD=0.45). Lifestyle interventions yielded small effects for triglycerides, total cholesterol and LDL‐cholesterol (SMD=–0.35 to –0.37). Only exercise interventions increased exercise capacity (SMD=1.81). Despite frequent physical comorbidities and premature mortality mainly due to these increased physical health risks, the current evidence for pharmacological and non‐pharmacological interventions in people with schizophrenia to prevent and treat these conditions is still limited and more larger trials are urgently needed.
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The AMSTAR+ has six additional items on the content validity of included meta-analyses, with scores ranging from 0 to 8, where >4 indicates high quality.
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From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [25]
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Croatto, G., Vancampfort, D., Miola, A., Olivola, M., Fiedorowicz, J. G., Firth, J., Alexinschi, O., Gaina, M. A., Makkai, V., Soares, F. C., et al. (2023) · Molecular Psychiatry · doi:10.1038/s41380-022-01770-w · Cited by 66 · see citing works
Self-citationSiskind, D., Baker, A., Arnautovska, U., Warren, N., Russell, A., DeMonte, V., Halstead, S., Iyer, R., Korman, N., McKeon, G., et al. (2025) · The Lancet Psychiatry · doi:10.1016/s2215-0366(25)00129-4 · Cited by 62 · see citing works
Self-citationKorman, N., Fox, H., Skinner, T., Dodd, C., Suetani, S., Chapman, J., Parker, S., Dark, F., Collins, C., Rosenbaum, S., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00319 · Cited by 27 · see citing works
Self-citationPsychosocial therapies in severe mental illness: update on evidence and recommendations
Gühne, U., Weinmann, S., Riedel-Heller, S. G., & Becker, T. (2020) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000618 · Cited by 19 · see citing works
Chen, H., Cao, T., Zhang, B., & Cai, H. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1097284 · Cited by 18 · see citing works
- Authors
- Vancampfort, D., Firth, J., Correll, C. U., Solmi, M., Siskind, D., De Hert, M., Carney, R., Koyanagi, A., Carvalho, A. F., Gaughran, F., & Stubbs, B.
- Affiliations
- KU Leuven (BE)
- The University of Melbourne (AU)
- Hofstra University (US)
- University of Padua (IT)
- The University of Queensland (AU)
- University Psychiatric Centre KU Leuven Kortenberg Belgium
- University of Manchester (GB)
- Instituto de Salud Carlos III (ES)
- Centre for Addiction and Mental Health Toronto Ontario Canada
- King's College London (GB)
- ORCID
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2019-01-02
- Volume
- 18
- Issue
- 1
- Pages
- 53-66
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC6313230
- OpenAlex
- W2907830451
- Cited by
- 227
- References
- 68
- Citations by year
- 2026: 10 · 2025: 37 · 2024: 32 · 2023: 29 · 2022: 28 · 2021: 41 · 2020: 28 · 2019: 22
- FWCI
- 23.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Lirias (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- National Institute for Health Research (ICA‐CL‐2017‐03‐001)
- Maudsley Charity
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- schizophrenia, physical health, weight loss, lifestyle counseling, exercise intervention, psychoeducation, topiramate, metformin, dietary intervention, antipsychotic switching, olanzapine, quetiapine, insulin resistance, dyslipidemia, blood pressure, glycemic control, cardiovascular risk
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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