Association of diabetes with dyskinesia in older psychosis patients

Abstract

The deleterious effect of diabetes on TD in the absence of any effect of parkinsonism supports preclinical studies of glucose-related dopamine hyperfunction and has implications for the pharmacologic management of psychosis in patients with pre-existing diabetes.

Movement disorders in patients with diabetes mellitus

“…Clinical studies have shown both increased prevalence of TD [65][66][67][68] in diabetic patients or patients with impaired glucose metabolism taking antipsychotic medications and no association [69][70][71] between the two. Most of the atypical antipsychotics can also precipitate hyperglycemia.…”

Tardive dyskinesia and glucid metabolism

“…In 1985, Mukherjee et al (1985) suggested the existence of a link between the onset of tardive dyskinesia and insulin-dependent diabetes, by showing that the frequency of diabetes was higher in a population of patients with tardive dyskinesia than in the general population, and that the glucose tolerance test was abnormal in most of these patients. Several other studies have confirmed these findings, supporting the view that insulin-dependent diabetes (Ganzini et al, 1992;Woerner et al, 1993), glucose intolerance (Schultz et al, 1999) and a previous family history of diabetes (Mukherjee et al, 1989) are risk factors for tardive dyskinesia during neuroleptic treatment, in particular in older patients (Caligiuri et al, 2004). In contrast, three studies failed to show any direct link between tardive dyskinesia and diabetes (Chong et al, 2002;Jeste et al, 1995;Levy et al, 2004;Raja and Azzoni, 2002).…”

“…A role of insulin-dependent diabetes in the onset of tardive dyskinesia has been reported by several authors (Caligiuri et al, 2004;Ganzini et al, 1992;Mukherjee et al, 1985Mukherjee et al, , 1989Woerner et al, 1993) but remains controversial (Jeste et al, 1995;Levy et al, 2004;Raja and Azzoni, 2002) and relies on weak physiopathological evidence. Two authors have observed a non-significant link between glucose intolerance and the occurrence of tardive dyskinesia, suggesting a possible dynamic involvement of glucose levels variations in the onset of this disorder (Chong et al, 2002;Schultz et al, 1999).…”

Clinical Manual of Geriatric Psychopharmacology

“…Tardive dyskinesia is a syndrome of abnormal involuntary movements associated with antipsychotic medication treatment. The syndrome occurs more frequently among elderly patients, women, patients with diabetes (Caligiuri and Jeste 2004), and patients without schizophrenia (Wirshing 2001). In general, the cumulative incidence is related to duration of antipsychotic use.…”

“…Associated speech abnormalities include impaired phonation and intelligibility and slowed rate of speech production (Khan et al 1994). TD occurs more frequently in women, patients with conditions other than schizophrenia (Wirshing 2001), patients with diabetes (Caligiuri and Jeste 2004), and elderly patients, particularly those who are institutionalized (Byne et al 1998). Other risk factors for the development of TD include long duration of antipsychotic use, coadministration of anticholinergic drugs, the presence of an affective disorder, alcohol abuse or dependence, degenerative brain disease, diabetes (Casey 1997;Jeste et al 1995), history of interruption of neuroleptic treatment (van Harten et al 1998), extrapyramidal symptoms (EPS) early in treatment (Woerner et al 1998), presence of negative symptoms (Liddle et al 1993), and high serum ferritin levels (Wirshing et al 1998).…”