Metabolic syndrome is an important cause of morbidity among patients with severe mental illnesses. A case of a patient with postpartum psychosis where treatment with olanzapine was followed by vision impairment, metabolic syndrome, and liver dysfunction is presented.

A 35-year old woman was admitted to our clinic 6 days after delivery. She was convinced that she influenced her baby through the posture of her body, and presented with some other acute psychotic symptoms. She was treated with olanzapine and a good remission of symptoms was achieved. After 2 years the treatment was discontinued and she relapsed. She was treated with olanzapine and she remitted once again. A year later she noticed visual problems. Upon ophthalmologist’s suggestion her blood was tested and the tests revealed elevated blood glucose, liver enzymes, and hyperlipidemia. Olanzapine was immediately discontinued and arypiprazole was introduced, along with oral antidiabetic and hypolipidemic therapy. After a week blood glucose dropped significantly. In the next two months all pathologic lab values were normalized. Hypolipidemic and oral antidiabetic therapy was consequently discontinued. The patient is still taking arypiprazole and she is in good remission.

Increased awareness of risks associated with metabolic syndrome, and optimal monitoring and management are required to minimize cardiovascular and other risk factors associated with the syndrome. Antipsychotic tretment should be chosen very carefully in order to avoid the development or aggravation of metabolic syndrome. In the presented case, metabolic syndrome appeared after years of treatment with olanzapine.