Psychotic illness and its treatment are associated with an increased rate of diabetes and worsening blood sugar control.
The newer, second-generation antipsychotic agents are more likely to produce this effect than the first-generation agents, but both contribute to the problem.
The effect is usually related to insulin resistance through weight gain, but other mechanisms may exist.
Diabetic ketoacidosis is rare.
Management of psychosis takes priority over concerns about the potential metabolic sequelae of treatment, but the prevalence of the latter requires that all patients taking antipsychotic agents be actively screened and treated.
Patients treated with antipsychotic agents need baseline and regular checks, including weight, blood glucose and lipid levels and blood pressure.
Management of psychosis with its attendant medical problems requires a multidisciplinary approach, with primary health practitioners playing a central role.
Mortality and medical morbidity is higher in those with psychosis than expected; preventive measures, combined with early detection and treatment of hyperglycaemia and other metabolic problems, is a key public health issue.
- 1. Lambert T, Velakoulis D, Pantelis C. Medical comorbidity in schizophrenia. Med J Aust 2003; 178 (9 Suppl 5): S67-S70. <MJA full text>
- 2. Newcomer J, Haupt D, Fucetola R, et al. Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia. Arch Gen Psychiatry 2002; 59: 337-345.
- 3. Gianfrancesco F, Grogg A, Mahmoud R, et al. Differential effects of risperidone, olanzapine, clozapine, and conventional antipsychotics on type 2 diabetes: findings from a large health plan database. J Clin Psychiatry 2002; 63: 920-930.
- 4. Henderson D, Ettinger E. Schizophrenia and diabetes. Int Rev Neurobiol 2002; 51: 481-501.
- 5. Livingstone C, Rampes H. Atypical antipsychotic drugs and diabetes. Practical Diabetes Int 2003; 20: 327-331.
- 6. Thonnard-Neumann E. Phenothiazines and diabetes in hospitalized women. Am J Psychiatry 1968; 124: 978-982.
- 7. McKee H, D’Arcy P, Wilson P. Diabetes and schizophrenia — a preliminary study. J Clin Hosp Pharmacol 1986; 11: 297-299.
- 8. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1999.
- 9. Silverstone T, Smith G, Goodall E. Prevalence of obesity in patients receiving depot antipsychotics. Br J Psychiatry 1988; 153: 214-217.
- 10. Sernyak MJ, Leslie DL, Alarcon RD, et al. Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia. Am J Psychiatry 2002 ;159: 561-566.
- 11. Glatthaar C, Welborn TA, Stenhouse NS, Garcia-Webb P. Diabetes and impaired glucose tolerance. A prevalence estimate based on the Busselton 1981 survey. Med J Aust 1985; 143: 436-440.
- 12. Dunstan D, Zimmet P, Welborn T, et al. The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 2002; 25: 829-834.
- 13. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27: 596-601.
- 14. Lambert T, Castle D. Pharmacological approaches to the management of schizophrenia. Med J Aust 2003; 178 (9 Suppl 5): S57-S61. <MJA full text>
- 15. Koller E, Cross J, Doraiswamy P, Schneider B. Risperidone-associated diabetes mellitus: A pharmacovigilance study. Pharmacotherapy 2003; 23: 735-744.
- 16. Allison D, Mentore J, Heo M, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 1999; 156: 1686-1696.
- 17. Lambert T. Hares and tortoises: long-term antipsychotic-associated weight gain. In: 7th Biennial Australian Schizophrenia Conference; 24-26 Oct 2002; Sydney, NSW.
- 18. Meltzer H. Putting metabolic side effects into perspective: Risks versus benefits of atypical antipsychotics. J Clinical Psychiatry 2001; 62 Supplement 27: 35-39.
- 19. Fadel J, Bubser M, Deutch A. Differential activation of orexin neurons by antipsychotic drugs associated with weight gain. J Neuroscience 2002; 22: 6742-6746.
- 20. Thakore J, Mann J, Vlahos A, et al. Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia. Int J Obesity 2002; 26: 137-141.
- 21. Murray C, Lopez A, editors. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press, 1996.
- 22. Knapp M. Costs of schizophrenia. Br J Psychiatry 1997; 171: 509-518.
- 23. Access Economics. Schizophrenia: costs. An analysis of the burden of schizophrenia and related suicide in Australia. Melbourne: SANE Australia; 2002.
- 24. Groom G, Hickie I, Davenport T. Out of hospital, out of mind: a report detailing mental health services in Australia in 2002 and community priorities for national mental health policy for 2003-2008. Canberra: Mental Health Council of Australia; 2003.
- 25. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1999. Available at: www.health.gov.au/nhmrc/publications/pdf/cp30.pdf (accessed 2004).
- 26. Ryan M, Thakore J. Physical consequences of schizophrenia and its treatment: the metabolic syndrome. Life Sci 2002; 71: 239-257.
- 27. Tuomilehto J, Lindstrom J, Eriksson J, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-1350.
- 28. American Diabetes Association. Implications of the United Kingdom Prospective Diabetes Study. Diabetes Care 2000; 23 Supplement 1: S27-S31.
- 29. Aquila R. Management of weight gain in patients with schizophrenia. J Clin Psychiatry 2002; 63 Suppl 4: 33-36.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.