Simone is a 64-year-old African American female with a 25-year history of schizophrenia who had been hospitalized ∼10 times. Simone's last psychiatric hospitalization occurred 2 years prior to this presentation. She had been living in a supervised residence facility in a rural community with other patients and was generally adherent to her medications with encouragement by staff at her residence. Her psychotic symptoms had improved but had not disappeared. She continued to have persistent delusions that the Federal Bureau of Investigation was keeping her under surveillance because of information she supposedly had about national security. She continued to smoke 1 pack of cigarettes/day despite being told that she was developing chronic obstructive pulmonary disease. She stopped abusing alcohol, principally because of a lack of funds and lack of access to a liquor store. Simone was obese, with a body mass index (BMI) of 30 kg/m2. She was hypertensive, with a blood pressure of 140 over 95, and had mild abnormalities in her metabolic variables. She enjoyed fatty foods and never refused a meal.

Simone's case is not an unusual presentation for someone with schizophrenia. Psychiatric and somatic comorbidities in patients with schizophrenia are quite common. There is justifiable concern regarding long-term impact of treatments on metabolic variables, and metabolic comorbidities are often encountered.