Objective: To analyze the liver ultrasound status and risk factors of long-term use of antipsychotics in patients with mental illness. Methods: From May 2023 to March 2024, 169 patients with chronic schizophrenia who had a history of antipsychotic drugs for more than one year and received regular liver ultrasound examination were selected as study subjects. According to the liver ultrasound status, the patients were divided into normal group (n=106) and abnormal group (n=63). The distribution conditions of ultrasound characteristics in abnormal group were analyzed. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors affecting abnormal liver ultrasound. Results: In abnormal group, 51 cases (80.95%) showed gradual acoustic attenuation of echo intensity in terms of echo characteristics of liver parenchyma, and 49 cases (77.78%) had thickened and enhanced liver echo, and 38 cases (60.32%) showed diffuse echogenic enhancement and density. In terms of abnormal intrahepatic vascular system, 42 cases (66.67%) had vascular thinning and blurred course. In terms of gallbladder-related changes, 29 cases (46.03%) had rough gallbladder wall, and 34 cases (53.97%) had gallbladder wall thickening≥0.4cm, and 15 cases (23.81%) had strong echo mass or punctate strong echo in the cystic cavity area. Univariate analysis of occurrence of abnormal liver ultrasound in patients with chronic schizophrenia after long-term use of antipsychotics, there were significant differences in age, education level, concurrent hypertension, concurrent hyperlipidemia, drinking history, duration of medication and number of medication type between the two groups (P<0.05). Multivariate analysis showed that age, concurrent hyperlipidemia, duration of medication, number of medication type, and type of medication were independent risk factors (P<0.05). Conclusion: There are many risk factors for abnormal liver ultrasound in patients with mental disorders who have long-term use of antipsychotics. Age, concurrent hyperlipidemia, duration of medication, number of medication type, and type of medication are independent risk factors. Clinical attention should be paid to elderly patients, patients with hyperlipidemia, patients with long-term medication, and patients with combined medication. The risk of liver injury should be reduced by strengthening liver ultrasound monitoring, and optimizing medication regimen and metabolic intervention measures.