Prevalence of Diabetes Mellitus Among Outpatients With Severe Mental Disorders Receiving Atypical Antipsychotic Drugs

Lamberti, J. Steven; Crilly, John; Maharaj, Kumar; Olson, David P.; Wiener, Karen; Dvorin, Stephen; Costea, G. Oana; Bushey, Margaret P.; Dietz, Marci B.

doi:10.4088/jcp.v65n0517

Cited by 64 publications

(42 citation statements)

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“…The basic mechanisms behind these metabolic irregularities have not been fully elucidated, but it appears that antipsychotic medications could play an important role (Newcomer, 2005). Moreover, high rates of obesity and type II diabetes mellitus, observed in drug-naive/free patients (Mukherjee et al, 1996;Allison et al, 1999a;Thakore et al, 2002;Ryan et al, 2003Ryan et al, , 2004 before Kohen, 2004) and after the advent of antipsychotics and in nonschizophrenic blood relatives (Dynes, 1969;Mukherjee et al, 1989;Cheta et al, 1990;Martins et al, 2001;Lamberti et al, 2004), were potentially attributed to genetic factors (Stone et al, 2004), illness neurobiology (Thakore, 2005) and to unhealthy lifestyle (Brown et al, 1999). The interpretability of the preneuroleptic era data (reviewed in Kohen, 2004) is, however, limited by flaws in epidemiological methodology including lack of evaluation of and adjustments for adiposity, lifestyle, and anthropometric measures together with inconsistent diagnostic criteria for schizophrenia and glucose/insulin abnormalities Newcomer, 2005).…”

Section: Weight Status Of Drug Naive/free Schizophrenic Patientsmentioning

confidence: 99%

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Elman

Borsook

Lukas

2006

Neuropsychopharmacol

134

142

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Obesity is highly prevalent among patients with schizophrenia and is associated with detrimental health consequences. Although excessive consumption of fast food and pharmacotherapy with such second-generation antipsychotic agents (SGAs) as clozapine and olanzapine has been implicated in the schizophrenia/obesity comorbidity, the pathophysiology of this link remains unclear. Here, we propose a mechanism based on brain reward function, a relevant etiologic factor in both schizophrenia and overeating. A comprehensive literature search on neurobiology of schizophrenia and of eating behavior was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) energy homeostasis, (2) food reward and hedonics, (3) reward function in schizophrenia, and (4) metabolic effects of the SGAs. A mesolimbic hyperdopaminergic state may render motivational/incentive reward system insensitive to low salience/palatability food. This, together with poor cognitive control from hypofunctional prefrontal cortex and enhanced hedonic impact of food, owing to exaggerated opioidergic drive (clinically manifested as pain insensitivity), may underlie unhealthy eating habits in patients with schizophrenia. Treatment with SGAs purportedly improves dopamine-mediated reward aspects, but at the cost of increased appetite and worsened or at least not improved opiodergic capacity. These effects can further deteriorate eating patterns. Pathophysiological and therapeutic implications of these insights need further validation via prospective clinical trials and neuroimaging studies. INTRODUCTIONObesity has reached pandemic proportions and it is rapidly surpassing smoking as a number one killer in the industrialized world (Sturm, 2002;Skidmore and Yarnell, 2004). Its annual cost to the American society is staggering, and is estimated to be around $117 billion owing to related illnesses and loss of productivity (National Institute of Diabetes and Digestive and Kidney Diseases, 2005).In schizophrenia, obesity is twice as prevalent as in the general public, afflicting over half this patient population (Allison et al, 1999a;Dixon et al, 2000; American Diabetes Association, 2004;Marder et al, 2004;Wirshing, 2004). Besides negative psychosocial impacts (distorted selfesteem and societal stigmatization) and medications noncompliance, schizophrenics appear to be particularly susceptible to the detrimental medical sequelae of obesity such as the 'Metabolic Syndrome', which is a cluster of cardiovascular risk factors, including abdominal adiposity, insulin resistance, impaired, glucose tolerance, dyslipidemia, and hypertension (McKee et al, 1986;Mukherjee et al, 1996;Brown et al, 2000;Haupt and Newcomer, 2002;Ryan and Thakore, 2002;Ryan et al, 2003;Holt et al, 2004;Kohen, 2004;Marder et al, 2004;Lieberman et al, 2005).Excessive body weight gain (BWG) could be attributed to a constellation of endocrine, molecular, genetic, demographic, and lifestyle-related factors. Provided that a common tra...

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Section: Weight Status Of Drug Naive/free Schizophrenic Patientsmentioning

confidence: 99%

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Elman

Borsook

Lukas

2006

Neuropsychopharmacol

134

142

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“…However, most of them demonstrate elevated diabetes prevalence rates as compared with the general population, with odds estimated to be two to fine times elevated. 4 Particularly, prevalence estimations of diabetes among patients with schizophrenia in the USA range from 14.2% in a retrospective cohort study, 5 18.7% in a cross-sectional study conducted in 819 patients with schizophrenia, 6 to 23.3% in another cross-sectional with 2231 patients, 7 with an alarming trend of increase over time (6.9% in 1997 to 14.5% in 2004). 8 In the European populations, prevalence is evaluated 15% in the Netherlands, 9 14.8% in a case-control study conducted in Sweden with 2.058.408 patients, 10 22% in a cross-sectional study in Finland, 11 whereas the prevalence of diabetes among patients with schizophrenia in the UK is estimated to be 11.3%.…”

Section: Prevalence Of Type 2 Diabetes Among Patients With Schizophreniamentioning

confidence: 99%

Schizophrenia and type 2 diabetes mellitus

et al. 2018

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S chizophrenia is associated with increased risk for type 2 diabetes mellitus, resulting in elevated cardiovascular risk and limited life expectancy, translated into a weighted average of 14.5 years of potential life lost and an overall weighted average life expectancy of 64.7 years. The exact prevalence of type 2 diabetes among people with schizophrenia varies across studies and ranges 2-5fold higher than in the general population, whereas the aetiology is complex and multifactorial. Besides common diabetogenic factors, applied similarly in the general population, such as obesity, hyperlipidemia, smoking, hypertension, poor diet and limited physical activity, the co-occurrence of schizophrenia and diabetes is also attributed to unique conditions. Specifically, excessive sedentary lifestyle, social determinants, adverse effects of antipsychotic drugs and limited access to medical care are considered aggravating factors for diabetes onset and low quality of diabetes management. Schizophrenia itself is further proposed as causal factor for diabetes, given the observed higher prevalence of diabetes in young patients, newly diagnosed with schizophrenia and unexposed to antipsychotics. Furthermore, studies support genetic predisposition to diabetes among people with schizophrenia, suggesting shared genetic risk and disclosing a number of overlapped risk loci. Therefore, special attention should be paid in preventing diabetes in people with schizophrenia, through intervention in all possible modifiable risk factors. Implementation of careful antipsychotic prescription, provision of adequate motivation for balanced diet and physical activity and facilitating access to primary health care, could serve in reducing diabetes prevalence. On the other hand, increasing calls are made for early diagnosis of diabetes, application of the appropriate anti-diabetic therapy and strict inspection of therapy adherence, to limit the excess mortality due to cardiovascular events in people with schizophrenia. Moreover, population health programs could help counseling and preventing diabetes risk, additionally to early screening and diagnosis set, aiming to reduce disparities in populations. Finally, mental health-care providers might greatly promote offered health services to patients with schizophrenia, through a holistic individualized approach, considering additionally the physical health of the patients and working closely, preventively and therapeutically, in collaboration with the physicians and diabetologists.

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“…8 Indeed, a family history of diabetes mellitus confers the greatest relative risk of treatment-emergent diabetes mellitus. 9 These observations suggest, therefore, that genetic factors might be important. 9,10 How should we manage patients with severe psychiatric disorders who are at risk of developing diabetes mellitus?…”

Section: Competing Interestsmentioning

confidence: 94%

“…9 These observations suggest, therefore, that genetic factors might be important. 9,10 How should we manage patients with severe psychiatric disorders who are at risk of developing diabetes mellitus? Effective control of the underlying psychiatric illness remains a top priority, and physicians should select suitable agents in order to accomplish this goal.…”

Section: Competing Interestsmentioning

confidence: 94%

The role of antipsychotic agents in the development of diabetes mellitus

Dagogo‐Jack

2008

Nat Rev Endocrinol

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Prevalence of Diabetes Mellitus Among Outpatients With Severe Mental Disorders Receiving Atypical Antipsychotic Drugs

Cited by 64 publications

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Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Schizophrenia and type 2 diabetes mellitus

The role of antipsychotic agents in the development of diabetes mellitus

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