Schizophrenia is a complex neuropsychiatric disorder characterized by significant cognitive, emotional, and behavioral disturbances. Recent research has highlighted the critical role of metabolic dysregulation in the pathophysiology of schizophrenia, with particular focus on the relationship between metabolic abnormalities and the brain-gut axis. This review explores the intricate connections between metabolism and schizophrenia, emphasizing how alterations in metabolic processes, including insulin resistance, obesity, and lipid dysregulation, contribute to the disorder's clinical presentation. We examine the impact of antipsychotic medications on metabolism, particularly second-generation antipsychotics, which are associated with significant metabolic side effects. Additionally, we discuss emerging therapeutic strategies targeting metabolic dysfunction, such as pharmacological interventions (e.g., metformin, GLP-1 receptor agonists), nutritional approaches (e.g., omega-3 fatty acids, probiotics), and lifestyle modifications (e.g., exercise). Understanding the molecular mechanisms underlying these metabolic disturbances, including mitochondrial dysfunction, oxidative stress, and epigenetic alterations, is critical for developing more effective, personalized treatment approaches for individuals with schizophrenia. This review also highlights the need for an integrated approach that addresses both psychiatric symptoms and metabolic comorbidities to improve patient outcomes and quality of life.