Potential explanations for the “antipsychotic paradox” include antipsychotic-related reductions of stress-linked cortisol levels and inflammation, improved healthy lifestyle behaviours, and a reduction in healthcare disparities between patients with and without schizophrenia.2 Further, antipsychotics are associated with increased adherence to medical and psychiatric care, which may override cardiometabolic risk associated with these treatments.2 This increased access to medical care may allow signs and symptoms to be identified sooner, resulting in timely diagnosis and treatment. In schizophrenia, there is a reduced substance abuse and suicide risk in individuals using antipsychotics vs those who are not.2

Evidence for the protective effects of antipsychotics is not consistently available across regions, with limited data available from South America, Eastern Europe, the Middle East and South-East Asia, highlighting a need for further research in these regions.1,4

References:

1.Correll CU, Solmi M, Croatto G, et al. Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry 2022; 21: 248–271.

2.Solmi M & Correll CU. The antipsychotic paradox: Lessons regarding determinants of premature mortality. Eur Neuropsychopharmacol 2022; 62: 1–3.

3.Solmi M, Croatto G, Gupta A, et al. Effects of antipsychotic treatment on cardio-cerebrovascular related mortality in schizophrenia: A subanalysis of a systematic review and meta-analysis with meta-regression of moderators. Eur Neuropsychopharmacol 2024; 88: 6–20.

4.Solmi M, Croatto G, Fornaro M, et al. Regional differences in mortality risk and in attenuating or aggravating factors in schizophrenia: a systematic review and meta-analysis. Eur Neuropsychopharmacol 2024; 80: 55–69.