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Objectives: In this study, we intended to determine the prevalence of hyperuricemia and explore its clinical and biochemical correlates in patients with schizophrenia under risperidone treatment. Methods: In this cross-sectional study, we included 189 adult patients with schizophrenia receiving stable risperidone monotherapy for at least six months. We collected their demographic, anthropometric, and laboratory data. Hyperuricemia was defined as serum uric acid > 6 mg/dL in women and > 7 mg/dL in men. Metabolic syndrome was diagnosed using modified Adult Treatment Panel III criteria. Correlations and multivariate linear regression analyses were done to identify the independent predictors of blood uric acid levels. Results: Hyperuricemia was observed in 31.2% of participants, and 34.9% met criteria for metabolic syndrome. Patients with blood hyperuricemia had significantly higher diastolic blood pressure (p < 0.05), blood triglyceride levels (p < 0.01), and blood prolactin levels (p < 0.001), significantly lower blood high-density lipoprotein cholesterol (HDL-C) levels (p < 0.05), and significantly more frequent metabolic syndrome (p < 0.05) than those without hyperuricemia. In multivariate regression, significantly lower blood HDL-C levels (p < 0.001), higher blood triglyceride levels (p < 0.05), elevated blood prolactin levels (p < 0.01), and male sex (p < 0.05) were the independent predictors of uric acid levels, accounting for 21.3% of its variance. Conclusion: Hyperuricemia was common among patients with schizophrenia under risperidone treatment and was independently associated with lipid abnormalities, prolactin elevation, and male sex. The novel finding of a prolactin–uric acid relationship underscores the interconnected nature of antipsychotic side effects and metabolic dysregulation.