People with a psychotic illness, and especially those treated with some of the newer antipsychotic drugs, are at an increased risk of developing diabetes and other metabolic disturbances. Furthermore, it has been estimated that people with diabetes are twice as likely as the general population to suffer from depression.
The chronically mentally ill are a high-risk population for diseases such as diabetes and cardiovascular disease due to a number of factors. These include suboptimal access to medical services, a propensity to smoking, poor diet, sedentary lifestyle and obesity 1 2 .
There is increasing information regarding the association between diabetes and psychotic disorders. However, the true prevalence of diabetes in this population may be underestimated due to inconsistencies in surveillance protocols.
Evidence is also mounting for the association between antipsychotic medication and the development of diabetes, and a link between depression and diabetes has been recognized.
Healthcare professionals should be aware that people with a psychotic illness are at higher risk of developing diabetes and other metabolic disturbances. This risk is derived from a disordered lifestyle, use of antipsychotic medication, and possibly because of intrinsic pathophysiological effects of mental illness. Management of these people has to not only encompass mental illness but general health issues and therefore treatment should be multi-disciplinary.
Medical practitioners need to be aware that drugs used for psychosis have differing risk profiles for weight gain, hyperglycaemia and other metabolic disturbances and therefore careful consideration is required when choosing the best drug for the patient and the likely non-psychiatric consequences of using that drug. It is somewhat concerning that although there has been an increasing number of reports published on the link between antipsychotic drugs and diabetes, a survey of psychiatrists in the USA found that 49% did not recognize diabetes as a potential metabolic complication of atypical antipsychotic medication 3 .
More work is required to explain a possible link between depression and diabetes. As with diabetes and psychosis, the combination of diabetes and depression leads to greater morbidity and mortality than the general population and therefore treatment needs to follow a multi-disciplinary approach.
1.Dixon,L. Postrado,L. Delahanty,J. Fischer,P.J. Lehman,A. The association of medical comorbidity in schizophrenia with poor physical and mental health. J Nerv Ment Dis.1999; 187(8): 496-502
2.Fontaine,K.R. Heo,M. Harrigan,E.P. Shear,C.L. Lakshminarayanan,M. Casey,D.E. Allison,D.B. Estimating the consequences of anti-psychotic induced weight gain on health and mortality rate. Psychiatry Res.2001; 101(3): 277-288
3.Newcomer,J.W. Nasrallah,H.A. Loebel,A.D. The Atypical Antipsychotic Therapy and Metabolic Issues National Survey: practice patterns and knowledge of psychiatrists. J Clin Psychopharmacol.2004; 24 Suppl 1(5): 1-6