Metabolic Syndrome is primarily associated with which class of antipsychotics?

• A. FGAs
• B. SGAs
• C. Anticholinergics
• D. Benzodiazepines

Answer: (B)

Metabolic syndrome is a cluster of risks—central obesity, insulin resistance or high fasting glucose, dyslipidemia, and hypertension. The second-generation (atypical) antipsychotics are most strongly linked to these metabolic changes. Olanzapine and clozapine carry the highest risk of weight gain, elevated triglycerides, and impaired glucose tolerance, while other agents like risperidone and quetiapine also increase metabolic risk to varying degrees. The underlying mechanism involves receptor effects such as antagonism at histamine H1 and serotonin 5-HT2C receptors, which can boost appetite and reduce insulin sensitivity, promoting weight gain and metabolic abnormalities. By contrast, first-generation antipsychotics tend to cause movement-related side effects (EPS) more than metabolic disturbances. Anticholinergics and benzodiazepines are not antipsychotics in the same sense and do not drive this metabolic cluster. So, the class most associated with metabolic syndrome is the second-generation antipsychotics.