This review explores the shared and unique characteristics of metabolic syndrome (MetS) in psychotic spectrum disorders (PSD), emphasizing the need for early identification and management to mitigate long-term cardio-metabolic risks. MetS is a cluster of risk factors, including obesity, hypertension, dyslipidemia, and insulin resistance, associated with increased cardiovascular disease, type 2 diabetes, and mortality. PSD includes conditions such as schizophrenia, schizoaffective disorder, and bipolar disorder, and individuals with these disorders face a higher risk of MetS, which can significantly reduce life expectancy. Antipsychotic medications are a major contributor to MetS, with certain drugs like clozapine and olanzapine increasing the risk of weight gain and metabolic complications. MetS may also precede antipsychotic treatment in some PSD patients, suggesting a potential independent link between PSD and MetS. Inflammation and metabolic dysregulation are closely linked, with chronic inflammation playing a key role in the pathophysiology of both MetS and PSD. Environmental and lifestyle factors, such as poor diet, smoking, and sedentary behavior, further contribute to the risk of MetS in PSD patients. These factors, combined with the effects of antipsychotic medications, create a complex interplay that increases the likelihood of MetS in this population. MetS is associated with various adverse outcomes, including cardiovascular disease, diabetes, and cognitive decline, and is a significant risk factor for psychiatric readmissions. Managing MetS in PSD patients requires a multidisciplinary approach, including lifestyle modifications, pharmacological interventions, and regular monitoring. Lifestyle changes such as improved diet, increased physical activity, and smoking cessation are crucial. Pharmacological treatments, including antihypertensives, lipid-lowering agents, and diabetes medications, may be necessary in some cases. However, the use of antipsychotics must be carefully managed to minimize metabolic complications. Early identification and management of MetS in PSD patients are essential to reduce long-term cardio-metabolic risks. This review highlights the importance of a transdiagnostic approach, which considers shared characteristics across different PSDs, and emphasizes the need for personalized and comprehensive care. Future research should focus on developing targeted interventions and improving the understanding of MetS in PSD populations.This review explores the shared and unique characteristics of metabolic syndrome (MetS) in psychotic spectrum disorders (PSD), emphasizing the need for early identification and management to mitigate long-term cardio-metabolic risks. MetS is a cluster of risk factors, including obesity, hypertension, dyslipidemia, and insulin resistance, associated with increased cardiovascular disease, type 2 diabetes, and mortality. PSD includes conditions such as schizophrenia, schizoaffective disorder, and bipolar disorder, and individuals with these disorders face a higher risk of MetS, which can significantly reduce life expectancy. Antipsychotic medications are a major contributor to MetS, with certain drugs like clozapine and olanzapine increasing the risk of weight gain and metabolic complications. MetS may also precede antipsychotic treatment in some PSD patients, suggesting a potential independent link between PSD and MetS. Inflammation and metabolic dysregulation are closely linked, with chronic inflammation playing a key role in the pathophysiology of both MetS and PSD. Environmental and lifestyle factors, such as poor diet, smoking, and sedentary behavior, further contribute to the risk of MetS in PSD patients. These factors, combined with the effects of antipsychotic medications, create a complex interplay that increases the likelihood of MetS in this population. MetS is associated with various adverse outcomes, including cardiovascular disease, diabetes, and cognitive decline, and is a significant risk factor for psychiatric readmissions. Managing MetS in PSD patients requires a multidisciplinary approach, including lifestyle modifications, pharmacological interventions, and regular monitoring. Lifestyle changes such as improved diet, increased physical activity, and smoking cessation are crucial. Pharmacological treatments, including antihypertensives, lipid-lowering agents, and diabetes medications, may be necessary in some cases. However, the use of antipsychotics must be carefully managed to minimize metabolic complications. Early identification and management of MetS in PSD patients are essential to reduce long-term cardio-metabolic risks. This review highlights the importance of a transdiagnostic approach, which considers shared characteristics across different PSDs, and emphasizes the need for personalized and comprehensive care. Future research should focus on developing targeted interventions and improving the understanding of MetS in PSD populations.