Comparative Effects of 18 Antipsychotics on Metabolic Function in Patients with Schizophrenia, Predictors of Metabolic Dysregulation, and Association with Psychopathology: A Systematic Review and Network Meta-Analysis
Open accessAbstract
BACKGROUND: Antipsychotic treatment is associated with metabolic disturbance. However, the degree to which metabolic alterations occur in treatment with different antipsychotics is unclear. Predictors of metabolic dysregulation are poorly understood and the association between metabolic change and change in psychopathology is uncertain. We aimed to compare and rank antipsychotics on the basis of their metabolic side-effects, identify physiological and demographic predictors of antipsychotic-induced metabolic dysregulation, and investigate the relationship between change in psychotic symptoms and change in metabolic parameters with antipsychotic treatment. METHODS: We searched MEDLINE, EMBASE, and PsycINFO from inception until June 30, 2019. We included blinded, randomised controlled trials comparing 18 antipsychotics and placebo in acute treatment of schizophrenia. We did frequentist random-effects network meta-analyses to investigate treatment-induced changes in body weight, BMI, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, and glucose concentrations. We did meta-regressions to examine relationships between metabolic change and age, sex, ethnicity, baseline weight, and baseline metabolic parameter level. We examined the association between metabolic change and psychopathology change by estimating the correlation between symptom severity change and metabolic parameter change. FINDINGS: (0·90 to 1·25) for olanzapine; for total-cholesterol from -0·09 mmol/L (-0·24 to 0·07) for cariprazine to 0·56 mmol/L (0·26-0·86) for clozapine; for LDL cholesterol from -0·13 mmol/L (-0.21 to -0·05) for cariprazine to 0·20 mmol/L (0·14 to 0·26) for olanzapine; for HDL cholesterol from 0·05 mmol/L (0·00 to 0·10) for brexpiprazole to -0·10 mmol/L (-0·33 to 0·14) for amisulpride; for triglycerides from -0·01 mmol/L (-0·10 to 0·08) for brexpiprazole to 0·98 mmol/L (0·48 to 1·49) for clozapine; for glucose from -0·29 mmol/L (-0·55 to -0·03) for lurasidone to 1·05 mmol/L (0·41 to 1·70) for clozapine. Greater increases in glucose were predicted by higher baseline weight (p=0·0015) and male sex (p=0·0082). Non-white ethnicity was associated with greater increases in total cholesterol (p=0·040) compared with white ethnicity. Improvements in symptom severity were associated with increases in weight (r=0·36, p=0·0021), BMI (r=0·84, p<0·0001), total-cholesterol (r=0·31, p=0·047), and LDL cholesterol (r=0·42, p=0·013), and decreases in HDL cholesterol (r=-0·35, p=0·035). INTERPRETATION: Marked differences exist between antipsychotics in terms of metabolic side-effects, with olanzapine and clozapine exhibiting the worst profiles and aripiprazole, brexpiprazole, cariprazine, lurasidone, and ziprasidone the most benign profiles. Increased baseline weight, male sex, and non-white ethnicity are predictors of susceptibility to antipsychotic-induced metabolic change, and improvements in psychopathology are associated with metabolic disturbance. Treatment guidelines should be updated to reflect our findings. However, the choice of antipsychotic should be made on an individual basis, considering the clinical circumstances and preferences of patients, carers, and clinicians. FUNDING: UK Medical Research Council, Wellcome Trust, National Institute for Health Research Oxford Health Biomedical Research Centre.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Antipsychotic drugs produce metabolic side effects with a different extent depending on their type.
“Antipsychotic drugs produce metabolic side effects with a different extent depending on their type.”
From Lipids in Psychiatric Disorders: Functional and Potential Diagnostic Role as Blood Biomarkers (2024) · cites this paper as [131]
Neuroleptic therapy affects lipid homeostasis.
“Among others, neuroleptic therapy affects lipid homeostasis [130,131].”
From Lipids in Psychiatric Disorders: Functional and Potential Diagnostic Role as Blood Biomarkers (2024) · cites this paper as [131]
Typical and atypical antipsychotics increase the levels of cholesterol, TG, and LDL.
“In particular, it was shown that typical and atypical antipsychotics increase the levels of cholesterol, TG, and LDL.”
From Lipids in Psychiatric Disorders: Functional and Potential Diagnostic Role as Blood Biomarkers (2024) · cites this paper as [131]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
Conducting Meta-Analyses in <i>R</i> with the <b>metafor</b> Package
Viechtbauer, W. (2010) · Journal of Statistical Software · doi:10.18637/jss.v036.i03 · Cited by 20,464 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575 · see citing works
Stone, N. J., Robinson, J. G., Lichtenstein, A. H., Bairey Merz, C. N., Blum, C. B., Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D. M., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437738.63853.7a · Cited by 7,081 · see citing works
Obesity and the risk of heart failure
Kenchaiah, S., Evans, J. C., Levy, D., Wilson, P. W. F., Benjamin, E. J., Larson, M. G., Kannel, W. B., & Vasan, R. S. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa020245 · Cited by 3,093 · see citing works
Scientists rise up against statistical significance
Amrhein, V., Greenland, S., & McShane, B. (2019) · Nature · doi:10.1038/d41586-019-00857-9 · Cited by 2,983 · see citing works
Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies
Higgins, J. P. T., Jackson, D., Barrett, J. K., Lu, G., Ades, A. E., & White, I. R. (2012) · Research Synthesis Methods · doi:10.1002/jrsm.1044 · Cited by 2,098 · see citing works
Saha, S., Chant, D., & McGrath, J. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.10.1123 · Cited by 2,065 · see citing works
CINeMA: an approach for assessing confidence in the results of a network meta-analysis
Nikolakopoulou, A., Higgins, J. P. T., Papakonstantinou, T., Chaimani, A., Del Giovane, C., Egger, M., & Salanti, G. (2020) · PLOS Medicine · doi:10.1371/journal.pmed.1003082 · Cited by 1,935 · see citing works
Huhn, M., Nikolakopoulou, A., Schneider-Thoma, J., Krause, M., Samara, M., Peter, N., Arndt, T., Bäckers, L., Rothe, P., Cipriani, A., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31135-3 · Cited by 1,753 · see citing works
Ranking treatments in frequentist network meta-analysis works without resampling methods
Rücker, G., & Schwarzer, G. (2015) · BMC Medical Research Methodology · doi:10.1186/s12874-015-0060-8 · Cited by 1,732 · see citing works
Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., Thapa‐Chhetri, N., Fornaro, M., Gallicchio, D., Collantoni, E., et al. (2017) · World Psychiatry · doi:10.1002/wps.20420 · Cited by 1,729 · see citing works
Evaluating the quality of evidence from a network meta-analysis
Salanti, G., Del Giovane, C., Chaimani, A., Caldwell, D. M., & Higgins, J. P. T. (2014) · PLoS ONE · doi:10.1371/journal.pone.0099682 · Cited by 1,402 · see citing works
Tiihonen, J., Lönnqvist, J., Wahlbeck, K., Klaukka, T., Niskanen, L., Tanskanen, A., & Haukka, J. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60742-x · Cited by 1,354 · see citing works
Vancampfort, D., Stubbs, B., Mitchell, A. J., De Hert, M., Wampers, M., Ward, P. B., Rosenbaum, S., & Correll, C. U. (2015) · World Psychiatry · doi:10.1002/wps.20252 · Cited by 1,271 · see citing works
Mitchell, A. J., Vancampfort, D., Sweers, K., van Winkel, R., Yu, W., & Binder, M. D. (2011) · Schizophrenia Bulletin · doi:10.1093/schbul/sbr148 · Cited by 1,087 · see citing works
Hypertriglyceridemia as a cardiovascular risk factor
Austin, M. A., Hokanson, J. E., & Edwards, K. L. (1998) · The American Journal of Cardiology · doi:10.1016/s0002-9149(98)00031-9 · Cited by 1,066 · see citing works
Weight, Weight Change, and Coronary Heart Disease in Women: Risk Within the 'Normal' Weight Range
Willett, W. C. (1995) · JAMA · doi:10.1001/jama.1995.03520300035033 · Cited by 924 · see citing works
Network meta‐analysis, electrical networks and graph theory
Rücker, G. (2012) · Research Synthesis Methods · doi:10.1002/jrsm.1058 · Cited by 730 · see citing works
Cipriani, A., Barbui, C., Salanti, G., Rendell, J., Brown, R., Stockton, S., Purgato, M., Spineli, L. M., Goodwin, G. M., & Geddes, J. R. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60873-8 · Cited by 637 · see citing works
Impaired Glucose Homeostasis in First-Episode Schizophrenia
Pillinger, T., Beck, K., Gobjila, C., Donocik, J. G., Jauhar, S., & Howes, O. D. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.3803 · Cited by 464 · see citing works
GetReal in network meta-analysis: a review of the methodology
Efthimiou, O., Debray, T. P. A., van Valkenhoef, G., Trelle, S., Panayidou, K., Moons, K. G. M., Reitsma, J. B., Shang, A., Salanti, G., & on behalf of GetReal Methods Review Group (2016) · Research Synthesis Methods · doi:10.1002/jrsm.1195 · Cited by 401 · see citing works
Self-citationHildrum, B., Mykletun, A., Hole, T., Midthjell, K., & Dahl, A. A. (2007) · BMC Public Health · doi:10.1186/1471-2458-7-220 · Cited by 361 · see citing works
Kaar, S., Natesan, S., McCutcheon, R., & Howes, O. (2020) · Neuropharmacology · doi:10.1016/j.neuropharm.2019.107704 · Cited by 348 · see citing works
Cooper, S. J., Reynolds, G. P., order):, W. E. C.-A. (. A., Barnes, T., England, E., Haddad, P., Heald, A., Holt, R., Lingford-Hughes, A., Osborn, D., et al. (2016) · Journal of Psychopharmacology · doi:10.1177/0269881116645254 · Cited by 292 · see citing works
Sex Differences in the Metabolic Syndrome: Implications for Cardiovascular Health in Women
Pradhan, A. D. (2013) · Clinical Chemistry · doi:10.1373/clinchem.2013.202549 · Cited by 283 · see citing works
Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management
Manu, P., Dima, L., Shulman, M., Vancampfort, D., Hert, M. D., & Correll, C. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12445 · Cited by 281 · see citing works
Are Weight Gain and Metabolic Side Effects of Atypical Antipsychotics Dose Dependent?
Simon, V., van Winkel, R., & Binder, M. D. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08r04392 · Cited by 239 · see citing works
Pillinger, T., D’Ambrosio, E., McCutcheon, R., & Howes, O. D. (2019) · Molecular Psychiatry · doi:10.1038/s41380-018-0058-9 · Cited by 230 · see citing works
Self-citationChanges in Triglyceride Levels Over Time and Risk of Type 2 Diabetes in Young Men
Tirosh, A., Shai, I., Bitzur, R., Kochba, I., Tekes-Manova, D., Israeli, E., Shochat, T., & Rudich, A. (2008) · Diabetes Care · doi:10.2337/dc08-0825 · Cited by 226 · see citing works
König, J., Krahn, U., & Binder, H. (2013) · Statistics in Medicine · doi:10.1002/sim.6001 · Cited by 208 · see citing works
Umbricht, D., Pollack, S. Z., & Kane, J. (1994) · PubMed · Cited by 180 · see citing works
Cholesterol and triglyceride levels in first-episode psychosis: systematic review and meta-analysis
Pillinger, T., Beck, K., Stubbs, B., & Howes, O. D. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.117.200907 · Cited by 170 · see citing works
Riley, R. D., Thompson, J. R., & Abrams, K. R. (2007) · Biostatistics · doi:10.1093/biostatistics/kxm023 · Cited by 167 · see citing works
Raben, A., Marshe, V. S., Chintoh, A. F., Gorbovskaya, I., Müller, D. J., & Hahn, M. (2018) · Frontiers in Neuroscience · doi:10.3389/fnins.2017.00741 · Cited by 114 · see citing works
Network Meta-Analysis using Frequentist Methods
Rücker, G., Schwarzer, G., Krahn, U., & König, J. (2015) · Cited by 106 · see citing works
Preclinical models of antipsychotic drug-induced metabolic side effects
Boyda, H. N., Tse, L., Procyshyn, R. M., Honer, W. G., & Barr, A. M. (2010) · Trends in Pharmacological Sciences · doi:10.1016/j.tips.2010.07.002 · Cited by 104 · see citing works
The association between weight change and symptom reduction in the CATIE schizophrenia trial
Hermes, E. D. A., Nasrallah, H. A., Davis, V. G., Meyer, J. M., McEvoy, J. P., GOFF, D. C., Thomas, S., Stroup, T. S., Swartz, M. S., Lieberman, J. A., et al. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.01.022 · Cited by 86 · see citing works
Howes, O. D., Bhatnagar, A., Gaughran, F., Amiel, S. A., Murray, R. M., & Pilowsky, L. S. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.2.361 · Cited by 80 · see citing works
Characteristics and prevalence of the metabolic syndrome among three ethnic groups in Canada
Liu, J., Hanley, A. J., Young, T. K., Harris, S. B., & Zinman, B. (2005) · International Journal of Obesity · doi:10.1038/sj.ijo.0803179 · Cited by 74 · see citing works
Assessing Confidence in the Results of Network Meta-Analysis (Cinema)Preprint
Nikolakopoulou, A., Higgins, J. P. T., Papakonstantinou, T., Chaimani, A., Giovane, C. D., Egger, M., & Salanti, G. (2019) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/597047 · Cited by 49 · see citing works
The dark side of the force: Multiplicity issues in network meta‐analysis and how to address them
Efthimiou, O., & White, I. R. (2019) · Research Synthesis Methods · doi:10.1002/jrsm.1377 · Cited by 39 · see citing works
Nasrallah, H. A., Newcomer, J. W., Risinger, R. C., Du, Y., Zummo, J., Bose, A., Stankovic, S., Silverman, B. L., & Ehrich, E. W. (2016) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.15m10467 · Cited by 34 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Jauhar, S., Johnstone, M., & Mckenna, P. (2022) · The Lancet · doi:10.1016/s0140-6736(21)01730-x · Cited by 9 · see citing works
Correll, C. U., Solmi, M., Croatto, G., Schneider, L. K., Rohani-Montez, S. C., Fairley, L., Smith, N., Bitter, I., Gorwood, P. A. P. M., Taipale, H. T., et al. (2022) · World Psychiatry · doi:10.1002/wps.20994 · Cited by 717 · see citing works
Atypical Antipsychotics and Metabolic Syndrome: From Molecular Mechanisms to Clinical Differences
Carli, M., Kolachalam, S., Longoni, B., Pintaudi, A. M., Baldini, M., Aringhieri, S., Fasciani, I., Annibale, P., Maggio, R., & Scarselli, M. (2021) · Pharmaceuticals · doi:10.3390/ph14030238 · Cited by 252 · see citing works
Sabé, M., Pillinger, T., Kaiser, S., Chen, C., Taipale, H. T., Tanskanen, A. J., Tiihonen, J., Leucht, S., Correll, C. U., & Solmi, M. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104608 · Cited by 215 · see citing works
Mazereel, V., Detraux, J., Vancampfort, D., van Winkel, R., & Binder, M. D. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.573479 · Cited by 205 · see citing works
Roessner, V., Eichele, H., Stern, J. S., Skov, L., Rizzo, R., Debes, N. M., Nagy, P., Cavanna, A. E., Termine, C., Ganos, C., et al. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01899-z · Cited by 211 · see citing works
Bueno, H., Deaton, C., Farrero, M., Forsyth, F., Braunschweig, F., Buccheri, S., Dragan, S. R., Gevaert, S., Held, C., Kurpas, D., et al. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehaf191 · Cited by 209 · see citing works
Efficacy and safety of clozapine in psychotic disorders—a systematic quantitative meta-review
Wagner, E. M., Siafis, S., Fernando, P., Falkai, P., Honer, W. G., Roeh, A., Siskind, D. J., Leucht, S., & Hasan, A. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01613-2 · Cited by 185 · see citing works
The schizophrenia syndrome, circa 2024: What we know and how that informs its nature
Tandon, R., Nasrallah, H. A., Akbarian, S., Carpenter, W. T., DeLisi, L. E., Gäebel, W., Green, M. F., Gur, R. E., Heckers, S., Kane, J. M., et al. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.11.015 · Cited by 196 · see citing works
Correll, C. U., Agid, O., Crespo‐Facorro, B., de Bartolomeis, A., Fagiolini, A. M., Seppälä, N., & Howes, O. D. (2022) · CNS Drugs · doi:10.1007/s40263-022-00932-2 · Cited by 163 · see citing works
Sethi, S., Wakeham, D. E., Ketter, T. A., Hooshmand, F., Bjornstad, J., Richards, B. J., Westman, E. C., Krauss, R. M., & Saslow, L. R. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.115866 · Cited by 158 · see citing works
Correll, C. U., Martin, A. L., Patel, C. A., Benson, C. J., Goulding, R., Sliwa, J. K., Joshi, K., Schiller, E., & Kim, E. (2022) · Schizophrenia · doi:10.1038/s41537-021-00192-x · Cited by 153 · see citing works
Malhi, G. S., Bell, E., Boyce, P., Bassett, D., Berk, M., Bryant, R., Gitlin, M., Hamilton, A., Hazell, P., Hopwood, M., et al. (2020) · Bipolar Disorders · doi:10.1111/bdi.13036 · Cited by 152 · see citing works
The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients
Danan, A., Westman, E. C., Saslow, L. R., & Ede, G. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.951376 · Cited by 151 · see citing works
Pillinger, T., Howes, O. D., Correll, C. U., Leucht, S., Huhn, M., Schneider‐Thoma, J., Gaughran, F., Jauhar, S., McGuire, P. K., Taylor, D. M., et al. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00262-6 · Cited by 149 · see citing works
Antipsychotic-Induced Weight Gain: Dose-Response Meta-Analysis of Randomized Controlled Trials
Wu, H., Siafis, S., Hamza, T., Schneider‐Thoma, J., Davis, J. M., Salanti, G., & Leucht, S. (2022) · Schizophrenia Bulletin · doi:10.1093/schbul/sbac001 · Cited by 131 · see citing works
Dragioti, E., Radua, J., Solmi, M., Gosling, C. J., Oliver, D., Lascialfari, F., Ahmed, M., Cortese, S., Estradé, A., Arrondo, G., et al. (2023) · World Psychiatry · doi:10.1002/wps.21068 · Cited by 130 · see citing works
Bajaj, M. S., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Early, K. B., ChallaSivaKanaka, S., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc26-s005 · Cited by 178 · see citing works
Psychotropic Drug–Related Weight Gain and Its Treatment
McIntyre, R. S., Kwan, A. T. H., Rosenblat, J. D., Teopiz, K. M., & Mansur, R. B. (2024) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20230922 · Cited by 119 · see citing works
Antidepressants- and antipsychotics-induced hepatotoxicity
Todorović, N., Đorđević, J., Pejić, S., Đorđević, N. O., & Pajović, S. B. (2021) · Archives of Toxicology · doi:10.1007/s00204-020-02963-4 · Cited by 119 · see citing works
Krystal, J. H., Kane, J. M., Correll, C. U., Walling, D. P., Leoni, M. J., Duvvuri, S., Patel, S., Chang, I., Iredale, P., Frohlich, L., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01990-0 · Cited by 115 · see citing works
Raben, A., Marshe, V. S., Chintoh, A. F., Gorbovskaya, I., Müller, D. J., & Hahn, M. (2018) · Frontiers in Neuroscience · doi:10.3389/fnins.2017.00741 · Cited by 114 · see citing works
Leucht, S., Priller, J., & Davis, J. M. (2024) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20240738 · Cited by 117 · see citing works
Burschinski, A., Schneider-Thoma, J., Chiocchia, V., Schestag, K., Wang, D., Siafis, S., Bighelli, I., Wu, H., Hansen, W.-P., Priller, J., et al. (2023) · World Psychiatry · doi:10.1002/wps.21036 · Cited by 102 · see citing works
Dedic, N., Dworak, H., Zeni, C. M., Rutigliano, G., & Howes, O. D. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms222413185 · Cited by 101 · see citing works
The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children
Libowitz, M. R., & Nurmi, E. L. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.623681 · Cited by 99 · see citing works
Lobo, M. C., Whitehurst, T., Kaar, S. J., & Howes, O. D. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.11.032 · Cited by 93 · see citing works
INTEGRATE: international guidelines for the algorithmic treatment of schizophrenia
McCutcheon, R. A., Pillinger, T., Varvari, I., Halstead, S., Ayinde, O. O., Crossley, N. A., Correll, C. U., Hahn, M., Howes, O. D., Kane, J. M., et al. (2025) · The Lancet Psychiatry · doi:10.1016/s2215-0366(25)00031-8 · Cited by 94 · see citing works
Rognoni, C., Bertolani, A., & Jommi, C. (2021) · Clinical Drug Investigation · doi:10.1007/s40261-021-01000-1 · Cited by 94 · see citing works
Bernardo, M., Rico‐Villademoros, F., García‐Rizo, C., Rojo, R., & Gómez‐Huelgas, R. (2021) · Advances in Therapy · doi:10.1007/s12325-021-01689-8 · Cited by 87 · see citing works
Schnurr, P. P., Hamblen, J. L., Wolf, J., Coller, R., Collie, C. F., Fuller, M. A., Holtzheimer, P. E., Kelly, U. A., Lang, A. J., McGraw, K., et al. (2024) · Annals of Internal Medicine · doi:10.7326/m23-2757 · Cited by 92 · see citing works
Solmi, M., Tiihonen, J., Lähteenvuo, M., Tanskanen, A. J., Correll, C. U., & Taipale, H. T. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbab087 · Cited by 82 · see citing works
Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications
Zhang, S., Xu, M. Y., Liu, Z., Feng, J., & Ma, Y. (2020) · World Journal of Psychiatry · doi:10.5498/wjp.v10.i6.125 · Cited by 78 · see citing works
Energy metabolism in childhood neurodevelopmental disorders
Oyarzábal, A., Musokhranova, U., Barros, L. F., & García‐Cazorla, À. (2021) · EBioMedicine · doi:10.1016/j.ebiom.2021.103474 · Cited by 76 · see citing works
Laszlovszky, I., Barabássy, Á., & Németh, G. (2021) · Advances in Therapy · doi:10.1007/s12325-021-01797-5 · Cited by 75 · see citing works
Guan, F., Ni, T., Zhu, W., Williams, L. K., Cui, L., Li, M., Tubbs, J. D., Sham, P. C., & Gui, H. (2021) · Molecular Psychiatry · doi:10.1038/s41380-021-01201-2 · Cited by 75 · see citing works
Siskind, D. J., Gallagher, E., Winckel, K., Hollingworth, S., Kisely, S. R., Firth, J., Correll, C. U., & Marteene, W. (2020) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaa191 · Cited by 75 · see citing works
Cernea, S., Dima, L., Correll, C. U., & Manu, P. (2020) · Drugs · doi:10.1007/s40265-020-01393-x · Cited by 74 · see citing works
Correll, C. U., Angelov, A. S., Miller, A., Weiden, P. J., & Brannan, S. K. (2022) · Schizophrenia · doi:10.1038/s41537-022-00320-1 · Cited by 72 · see citing works
Robinson, D. J., Hanson, K., Jain, A. B., Kichler, J. C., Mehta, G., Melamed, O. C., Vallis, M., Bajaj, H. S., Barnes, T., Gilbert, J., et al. (2023) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2023.04.009 · Cited by 73 · see citing works
Comparative Tolerability of Dopamine D2/3 Receptor Partial Agonists for Schizophrenia
Keks, N. A., Hope, J., Schwartz, D., McLennan, H., Copolov, D., & Meadows, G. N. (2020) · CNS Drugs · doi:10.1007/s40263-020-00718-4 · Cited by 71 · see citing works
Clozapine resistant schizophrenia: Newer avenues of management
Chakrabarti, S. (2021) · World Journal of Psychiatry · doi:10.5498/wjp.v11.i8.429 · Cited by 71 · see citing works
Data-Driven Taxonomy for Antipsychotic Medication: A New Classification System
McCutcheon, R. A., Harrison, P. J., Howes, O. D., McGuire, P. K., Taylor, D. M., & Pillinger, T. (2023) · Biological Psychiatry · doi:10.1016/j.biopsych.2023.04.004 · Cited by 70 · see citing works
Understanding the Effects of Antipsychotics on Appetite Control
Mukherjee, S., Skrede, S., Milbank, E., Andriantsitohaina, R., López, M., & Fernø, J. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2021.815456 · Cited by 68 · see citing works
Semaglutide Treatment of Antipsychotic-Treated Patients With Schizophrenia, Prediabetes, and Obesity
Ganeshalingam, A. A., Uhrenholt, N. G., Arnfred, S., Gæde, P., Düring, S. W., Stenager, E. N., Bünger, N., Pedersen, A. K., Bilenberg, N., & Frystyk, J. (2025) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2025.2332 · Cited by 68 · see citing works
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
Impaired cholesterol metabolism, neurons, and neuropsychiatric disorders
Cheon, S. Y. (2023) · Experimental Neurobiology · doi:10.5607/en23010 · Cited by 67 · see citing works
Suetani, S., Honarparvar, F., Siskind, D. J., Hindley, G., Veronese, N., Vancampfort, D., Allen, L., Solmi, M., Lally, J., Gaughran, F., et al. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2021.08.022 · Cited by 64 · see citing works
Carolan, A., Hynes-Ryan, C., Agarwal, S. M., Bourke, R., Cullen, W., Gaughran, F., Hahn, M. K., Krivoy, A., Lally, J., Leucht, S., et al. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbae205 · Cited by 70 · see citing works
Chang, S.-C., Goh, K. K., & Lu, M. (2021) · World Journal of Psychiatry · doi:10.5498/wjp.v11.i10.696 · Cited by 67 · see citing works
New Advances in the Pharmacology and Toxicology of Lithium: A Neurobiologically Oriented Overview
Bortolozzi, A. A., Fico, G., Berk, M., Solmi, M., Fornaro, M., Quevedo, J., Zarate, C. A., Kessing, L. V., Vieta, E., & Carvalho, A. F. (2024) · Pharmacological Reviews · doi:10.1124/pharmrev.120.000007 · Cited by 61 · see citing works
Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations
Stogios, N., Humber, B. E., Agarwal, S. M., & Hahn, M. (2023) · Current Psychiatry Reports · doi:10.1007/s11920-023-01458-0 · Cited by 60 · see citing works
Veronese, M., Santangelo, B., Jauhar, S., D’Ambrosio, E., Demjaha, A., Salimbeni, H., Jin, H., McCrone, P., Turkheimer, F., & Howes, O. D. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-00866-7 · Cited by 58 · see citing works
Systems biology approaches to study lipidomes in health and disease
Alves, M. A., Lamichhane, S., Dickens, A. M., McGlinchey, A. J., Ribeiro, H. C., Sen, P., Wei, F., Hyötyläinen, T., & Orešič, M. (2020) · Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids · doi:10.1016/j.bbalip.2020.158857 · Cited by 59 · see citing works
Torres, N. G., Rocha-González, I., Alameda, L., Gangoso, A. R., Vilches, A., Canal‐Rivero, M., Crespo‐Facorro, B., & Ruíz-Veguilla, M. (2021) · Psychological Medicine · doi:10.1017/s0033291721002853 · Cited by 59 · see citing works
Identification and treatment of individuals with childhood-onset and early-onset schizophrenia
Correll, C. U., Arango, C., Fagerlund, B., Galderisi, S., Kas, M. J., & Leucht, S. (2024) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2024.02.005 · Cited by 63 · see citing works
Pillinger, T., Arumuham, A., McCutcheon, R. A., D’Ambrosio, E., Basdanis, G., Branco, M., Carr, R., Finelli, V., Furukawa, T. A., Gee, S., et al. (2025) · The Lancet · doi:10.1016/s0140-6736(25)01293-0 · Cited by 64 · see citing works
The beneficial metabolic actions of prolactin
Macotela, Y., Ruíz‐Herrera, X., Vázquez-Carrillo, D. I., Ramírez‐Hernández, G., de la Escalera, G. M., & Clapp, C. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1001703 · Cited by 60 · see citing works
Bioque, M., González-Rodríguez, A., García‐Rizo, C., Cobo, J., Monreal, J. A., Usall, J., Soria, V., & Labad, J. (2020) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110130 · Cited by 58 · see citing works
Højlund, M., Andersen, K., Ernst, M. T., Correll, C. U., & Hallas, J. (2022) · World Psychiatry · doi:10.1002/wps.21010 · Cited by 59 · see citing works
Zhou, J., Li, M., Wang, X., He, Y., Xia, Y., Sweeney, J. A., Kopp, R. F., Liu, C., & Chen, C. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.674273 · Cited by 56 · see citing works
The Kilim plot: A tool for visualizing network meta‐analysis results for multiple outcomes
Seo, M., Furukawa, T. A., Veroniki, A. A., Pillinger, T., Tomlinson, A., Salanti, G., Cipriani, A., & Efthimiou, O. (2020) · Research Synthesis Methods · doi:10.1002/jrsm.1428 · Cited by 55 · see citing works
Prestwood, T. R., Asgariroozbehani, R., Wu, S., Agarwal, S. M., Logan, R. W., Ballon, J. S., Hahn, M., & Freyberg, Z. (2021) · Behavioural Brain Research · doi:10.1016/j.bbr.2020.113101 · Cited by 58 · see citing works
Antipsychotic-Induced Metabolic Syndrome: A Review
Akinola, S., Tardif, I., & Leclerc, J. (2023) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2023.0003 · Cited by 60 · see citing works
Achtyes, E. D., Hopkins, S. C., Dedic, N., Dworak, H., Zeni, C. M., & Koblan, K. S. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01580-3 · Cited by 54 · see citing works
Stogios, N., Smith, E., Bowden, S., Tran, V., Asgariroozbehani, R., McIntyre, W. B., Remington, G. J., Siskind, D. J., Agarwal, S. M., & Hahn, M. (2021) · Neuropsychopharmacology · doi:10.1038/s41386-021-01163-7 · Cited by 53 · see citing works
Up-to-date expert opinion on the safety of recently developed antipsychotics
Orsolini, L., Berardis, D. D., & Volpe, U. (2020) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2020.1795126 · Cited by 52 · see citing works
Carswell, C., Brown, J. V. E., Lister, J., Ajjan, R., Alderson, S. L., Balogun-Katung, A., Bellass, S., Double, K., Gilbody, S. M., Hewitt, C. E., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04117-5 · Cited by 55 · see citing works
Yin, B., Cai, Y. A., Teng, T., Wang, X., Liu, X., Li, X., Wang, J., Wu, H., He, Y., Ren, F., et al. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02886-z · Cited by 50 · see citing works
Bak, M., Drukker, M., Cortenraad, S. A. M., Vandenberk, E., & Gülöksüz, S. (2021) · PLoS ONE · doi:10.1371/journal.pone.0244944 · Cited by 50 · see citing works
Perry, B. I., Osimo, E. F., Upthegrove, R., Mallikarjun, P. K., Yorke, J., Štochl, J., Pérez, J., Zammit, S., Howes, O. D., Jones, P. B., et al. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00114-0 · Cited by 48 · see citing works
Jawad, M. Y., Meshkat, S., Tabassum, A., Mckenzie, A., Vincenzo, J. D. D., Guo, Z., Musavi, N. B., Phan, L., Ceban, F., Kwan, A. T. H., et al. (2022) · CNS Spectrums · doi:10.1017/s1092852922001043 · Cited by 48 · see citing works
Fabiano, N., Wong, S., Zhou, C., Correll, C. U., Højlund, M., & Solmi, M. (2024) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2024.11.013 · Cited by 47 · see citing works
Clinically Relevant Interactions between Atypical Antipsychotics and Anti-Infective Agents
Spina, E., Barbieri, M. A., Cicala, G., & de Leon, J. (2020) · Pharmaceuticals · doi:10.3390/ph13120439 · Cited by 41 · see citing works
Heinonen, E. W., Forsberg, L., Nörby, U., Wide, K., & Källén, K. (2022) · CNS Drugs · doi:10.1007/s40263-022-00908-2 · Cited by 64 · see citing works
Wagner, E. M., Siskind, D. J., Falkai, P., Howes, O. D., Correll, C. U., Lee, J., Honer, W. G., Kane, J. M., Fernández-Egea, E., Barnes, T. R. E., et al. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbad030 · Cited by 45 · see citing works
Fagiolini, A. M., Alcalá, J. Á., Aubel, T., Bieńkiewicz, W., Bogren, M., Gago, J., Cerveri, G., Colla, M., Francisco Collazos, D., Cuomo, A., et al. (2020) · Annals of General Psychiatry · doi:10.1186/s12991-020-00305-3 · Cited by 45 · see citing works
Contrasting Typical and Atypical Antipsychotic Drugs
Meltzer, H. Y., & Gadaleta, E. (2021) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20200051 · Cited by 45 · see citing works
Zhang, Y., Ren, R., Yang, L., Zhang, H., Shi, Y., Shi, J., Sanford, L. D., Lü, L., Vitiello, M. V., & Tang, X. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101687 · Cited by 43 · see citing works
Werner, M. C. F., Wirgenes, K. V., Haram, M., Bettella, F., Lunding, S. H., Rødevand, L. N., Hjell, G., Agartz, I., Djurovic, S., Melle, I. S., et al. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.03.006 · Cited by 43 · see citing works
Wand, T., Glover, S., & Paul, D. (2021) · International Journal of Mental Health Nursing · doi:10.1111/inm.12947 · Cited by 46 · see citing works
Second-generation antipsychotics and metabolic syndrome: a role for mitochondria
Mortimer, K. R. H., Katshu, M. Z. U. H., & Chakrabarti, L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1257460 · Cited by 41 · see citing works
Rogdaki, M., McCutcheon, R. A., D'Ambrosio, E., Mancini, V., Watson, C. J., Fanshawe, J. B., Carr, R., Telesia, L., Martini, M. G., Philip, A., et al. (2024) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(24)00098-1 · Cited by 41 · see citing works
Nuclear Receptor PXR in Drug-Induced Hypercholesterolemia
Karpale, M., Hukkanen, J., & Hakkola, J. (2022) · Cells · doi:10.3390/cells11030313 · Cited by 40 · see citing works
Effects of Antipsychotic Drugs: Cross Talk Between the Nervous and Innate Immune System
Dinesh, A. A., Islam, J., Khan, J., Turkheimer, F., & Vernon, A. C. (2020) · CNS Drugs · doi:10.1007/s40263-020-00765-x · Cited by 39 · see citing works
Development of rat metabolic syndrome models: A review
Gunawan, S., Aulia, A., & Soetikno, V. (2021) · Veterinary World · doi:10.14202/vetworld.2021.1774-1783 · Cited by 39 · see citing works
Sneller, M. H., de Boer, N., Everaars, S., Schuurmans, M., Gülöksüz, S., Cahn, W., & Luykx, J. J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.625935 · Cited by 41 · see citing works
Rački, V., Marcelić, M., Štimac, I., Petrić, D., & Kučić, N. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22094399 · Cited by 38 · see citing works
De, R., Smith, E. C. C., Navagnanavel, J., Au, E., Maksyutynska, K., Papoulias, M., Singh, R., Panganiban, K. J., Humber, B., Mohr, G. H., et al. (2025) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13758 · Cited by 39 · see citing works
Sass, M. R., Danielsen, A. A., Köhler‐Forsberg, O., Storgaard, H., Knop, F. K., Nielsen, M. Ø., Sjödin, A. M., Mors, O. N., Correll, C. U., Ekstrøm, C. T., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-068652 · Cited by 41 · see citing works
Asenapine: an atypical antipsychotic with atypical formulations
Musselman, M. A., Faden, J., & Citrome, L. (2021) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253211035269 · Cited by 38 · see citing works
Lang, X., Liu, Q., Fang, H.-L., Zhou, Y., Forster, M. T., Li, Z., & Zhang, X. (2021) · Psychopharmacology · doi:10.1007/s00213-021-05983-9 · Cited by 41 · see citing works
The Future of Pharmacogenomics: Integrating Epigenetics, Nutrigenomics, and Beyond
Shaman, J. A. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14121121 · Cited by 37 · see citing works
The psychological journey of weight gain in psychosis
Waite, F., Langman, A., Mulhall, S., Głogowska, M., Hartmann‐Boyce, J., Aveyard, P. N., Lennox, B., Oxford Cognitive Approaches to Psychosis Patient Advisory Group, Kabir, T., & Freeman, D. H. (2022) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12386 · Cited by 34 · see citing works
Crosstalk between Schizophrenia and Metabolic Syndrome: The Role of Oxytocinergic Dysfunction
Goh, K. K., Chen, C. Y.-A., Wu, T., Chen, C.-H., & Lu, M. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23137092 · Cited by 37 · see citing works
Lipids in Psychiatric Disorders: Functional and Potential Diagnostic Role as Blood Biomarkers
Zorkina, Y., Ushakova, V., Ochneva, A., Tsurina, A., Abramova, O., Savenkova, V., Goncharova, A., Alekseenko, I., Morozova, I., Riabinina, D., et al. (2024) · Metabolites · doi:10.3390/metabo14020080 · Cited by 36 · see citing works
Wang, Y., Wang, D., Cheng, J., Fang, X., Chen, Y., Yu, L., Ren, J., Tian, Y., & Zhang, C. (2021) · Journal of Psychopharmacology · doi:10.1177/02698811211035391 · Cited by 36 · see citing works
Therapeutic use of melatonin in schizophrenia: A systematic review
Duan, C., Jenkins, Z., & Castle, D. J. (2021) · World Journal of Psychiatry · doi:10.5498/wjp.v11.i8.463 · Cited by 36 · see citing works
Hasan, A., Falkai, P., Lehmann, I., & Gäebel, W. (2020) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2020.0412 · Cited by 37 · see citing works
Emerging Treatments in Schizophrenia
Correll, C. U., Abi‐Dargham, A., & Howes, O. D. (2022) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.su21024ip1 · Cited by 36 · see citing works
- Authors
- Pillinger, T., McCutcheon, R. A., Vano, L., Mizuno, Y., Arumuham, A., Hindley, G., Beck, K., Natesan, S., Efthimiou, O., Cipriani, A., & Howes, O. D.
- Affiliations
- King's College London (GB)
- University of Bern (CH)
- Oxford Health NHS Foundation Trust (GB)
- Corresponding author
- Pillinger, Toby
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 7
- Issue
- 1
- Pages
- 64-77
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC7029416
- OpenAlex
- W2982167270
- Cited by
- 1,090
- References
- 46
- Citations by year
- 2026: 213 · 2025: 204 · 2024: 172 · 2023: 163 · 2022: 145 · 2021: 129 · 2020: 58 · 2019: 1 · 2018: 1
- FWCI
- 14.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Open Access CRIS of the University of Bern
- Funders
- Medical Research Council (MC-A656-5QD30)
- Brain and Behavior Research Foundation
- National Institute for Health and Care Research
- South London and Maudsley NHS Foundation Trust
- King's College London (200102/Z/15/Z)
- Royal College of Psychiatrists
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (180083)
- Wellcome Trust (094849/Z/10/Z)
- NIHR Oxford Biomedical Research Centre (BRC-1215-20005)
- Maudsley Charity (666)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- antipsychotic drugs, schizophrenia, metabolic dysfunction, antipsychotic-induced metabolic side effects, body weight, body mass index, lipid profile, cholesterol, triglycerides, blood glucose, psychopathology, olanzapine, clozapine, cariprazine, brexpiprazole, amisulpride, atypical antipsychotics
- MeSH terms
- Blood Glucose, Humans, Schizophrenia, Antipsychotic Agents, Weight Gain, Body Mass Index, Randomized Controlled Trials as Topic, Lipid Metabolism
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 ›
Are you an author, or do you see a problem with this page? Request a review
