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Diabetes, psychotic disorders and antipsychotic therapy: a consensus statement

Tim J R Lambert and Leon H Chapman
Med J Aust 2004; 181 (10): 544-548.

Summary

  • 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.

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  • Tim J R Lambert1
  • Leon H Chapman2

  • 1 Office for Psychiatric Evaluation and Educational Newmedia, University of Melbourne, Royal Melbourne Hospital, VIC.
  • 2 International Diabetes Institute, Melbourne, VIC.

Correspondence: 

Acknowledgements: 

The consensus documents (professional and consumer) were developed with an unrestricted educational grant from Eli Lilly Australia. The company did not participate in any meetings, nor exert any editorial influence on the consensus statements. The co-chairs also thank the consensus group and the external consultants who provided so much of their time to the project. Participants in the project were:

Consensus working group: Mr Simon Bell (pharmacist, Sydney), Dr Nicholas Carr (general practitioner, Melbourne), Dr Leon Chapman (co-chair; diabetologist, Melbourne), Dr Michael D’Emden (endocrinologist, Brisbane), Mr Steven Elsom (mental health nurse, Melbourne), Dr Grace Groom (Mental Health Council of Australia, Canberra), Professor Scott Henderson (psychiatrist, Canberra), Professor Ian Hickie (psychiatrist, Sydney), Associate Professor Linda Hoffman (endocrinologist, Hobart), Associate Professor Tim Lambert (co-chair; psychiatrist, Melbourne), Dr Alan Rosen (psychiatrist, Sydney), Professor Bruce Singh (psychiatrist, Melbourne), Professor Tim Welborn (endocrinologist, Perth), Dr Peter Wynn Owen (psychiatrist, Perth).

Consultant review group: Mr John Bell (pharmacist, Sydney), Dr Elsa Bernardi (psychiatrist, Sydney), Dr Grant Blashki (general practitioner, Melbourne), Professor Vaughan Carr (psychiatrist, Newcastle), Professor David Castle (psychiatrist, Melbourne), Professor Stanley Catts (psychiatrist, Brisbane), Professor Donald Chisholm (endocrinologist, Sydney), Professor Michael Clinton (clinical nurse, Perth), Professor David Copolov (psychiatrist, Melbourne), Ms Linda Fellows (pharmacist, Perth), Mr Tony Fowke (National Consumer and Carer Forum, Perth), Associate Professor Tim Greenaway (endocrinologist, Hobart), Professor Mark Harris (general practitioner, Sydney), Ms Brenda Happell (clinical nurse, Melbourne), Dr Dan Haupt (Washington State University, USA), Ms Barbara Hocking (SANE Australia, Melbourne), Professor Assen Jablensky (psychiatrist, Perth), Professor Jayashri Kulkarni (psychiatrist, Melbourne), Dr Johanna Lammersma (psychiatrist, Adelaide), Ms Janet Meagher (National Consumer and Carer Forum, Sydney), Dr John Newcomer (Washington State University, USA), Professor Saxby Pridmore (psychiatrist, Hobart), Mr Rob Ramjan (Schizophrenia Fellowship of NSW, Sydney), Associate Professor Geoff Riley (psychiatrist, Fremantle), Ms Liz Stewart (National Consumer and Carer Forum, Sydney), Dr Julie Thompson (general practitioner, Moe), Mr Keith Wilson (Mental Health Council of Australia, Fremantle).

Carer and consumer groups: Association of Relatives and Friends of the Mentally Ill (ARAFMI), GROW Self Help/Mutual Help Groups, Australian Mental Health Consumer Network (AMHCN), Carers Australia, Consumers Health Forum, beyondblue: the national depression initiative, state representatives (carer and consumer) from the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia, Western Australia and Tasmania.

Competing interests:

T J R L was paid an honorarium to attend the initial consensus meeting. He has served on advisory boards for Janssen-Cilag, Eli Lilly, Pfizer, Lundbeck, Sanofi, Novartis and Faulding; has received funding for unrestricted research from Eli Lilly, Novartis, Janssen-Cilag, Bristol-Myers Squibb, Pfizer and AstraZeneca; and has received travel assistance to attend meetings from Eli Lilly, Novartis, Janssen-Cilag, AstraZeneca and Bristol-Myers Squibb.

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