This narrative review examines the shared and unique characteristics of metabolic syndrome (MetS) in psychotic disorders (PSD), including schizophrenia, bipolar disorder, and schizoaffective disorder. The review highlights the elevated risk of MetS in PSD patients, which can reduce their life expectancy by nearly 20%. Key factors contributing to MetS development in PSD patients include unhealthy lifestyle factors, genetic predisposition, pro-inflammatory state, drug consumption, antipsychotic medication, and psychotic symptoms. The review emphasizes the importance of early identification and management of cardio-metabolic risk in PSD patients, noting the challenges in screening and monitoring, especially in younger patients. It also discusses the interplay between chronic inflammation, MetS, and obesity, and the role of antipsychotic medications in increasing the risk of MetS. The review concludes by advocating for a multidisciplinary approach to managing MetS in PSD patients, including lifestyle interventions, pharmacological treatments, and collaborative care between mental health and metabolic specialists. The authors call for further research to develop targeted interventions and personalized treatment approaches to improve physical health and overall well-being in this vulnerable population.This narrative review examines the shared and unique characteristics of metabolic syndrome (MetS) in psychotic disorders (PSD), including schizophrenia, bipolar disorder, and schizoaffective disorder. The review highlights the elevated risk of MetS in PSD patients, which can reduce their life expectancy by nearly 20%. Key factors contributing to MetS development in PSD patients include unhealthy lifestyle factors, genetic predisposition, pro-inflammatory state, drug consumption, antipsychotic medication, and psychotic symptoms. The review emphasizes the importance of early identification and management of cardio-metabolic risk in PSD patients, noting the challenges in screening and monitoring, especially in younger patients. It also discusses the interplay between chronic inflammation, MetS, and obesity, and the role of antipsychotic medications in increasing the risk of MetS. The review concludes by advocating for a multidisciplinary approach to managing MetS in PSD patients, including lifestyle interventions, pharmacological treatments, and collaborative care between mental health and metabolic specialists. The authors call for further research to develop targeted interventions and personalized treatment approaches to improve physical health and overall well-being in this vulnerable population.