Acute Psychosis and Type 2 Diabetes Mellitus: Should Screening Guidelines Be Revised?

Bauer, Leah K.; Wulsin, Lawson R.; Guadagno, G

doi:10.4088/pcc.10br01006

Cited by 4 publications

(4 citation statements)

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“…Recent studies found that the disruption of glucose-insulin homeostasis may presage psychosis ( 49 ), and that insulin resistance is related to pre-psychotic symptoms in young individuals before the onset of clinical psychosis ( 50 ). One case report linked hyperglycemia to psychotic symptoms, and a case series showed that poor blood glucose management may have been connected to psychosis ( 51 , 52 ), particularly as increased insulin is associated with mood alteration ( 53 ). Psychiatric patients have a high prevalence of hyperglycemia and diabetes, late diagnosis, poor somatic management ( 54 , 55 ) and non-adherence to somatic treatment ( 56 ), which may lead to psychosis or relapse and readmission.…”

Section: Discussionmentioning

confidence: 99%

Metabolic disturbances are risk factors for readmission to psychiatric hospitals in non-smokers but not in smokers: results from a Swiss psychiatric cohort and in first-episode psychosis patients

Laaboub,

Locatelli,

Grosu

et al. 2024

Front. Psychiatry

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BackgroundPsychiatric patients are at high risk of readmission, and a high body mass index has previously been shown as a risk factor. We sought to replicate this finding and 1) to prospectively assess the association of metabolic syndrome and its five components with readmission in psychiatric hospitals and 2) to identify other clinical and sociodemographic predictors of readmission.MethodsBetween 2007 and 2019, data on 16727 admissions of 7786 adult and elderly patients admitted to the Department of Psychiatry of the Lausanne University Hospital, were collected. Metabolic syndrome was defined according to the International Diabetes Federation definition. Cox frailty models were used to investigate the associations between readmission and metabolic disturbances.ResultsA total of 2697 (35%) patients were readmitted to our psychiatric hospital. Novel risk factors for readmission in non-smokers were identified, including being overweight (HR=1.26; 95%CI=[1.05; 1.51]) or obese (HR=1.33; 95%CI=[1.08; 1.62]), displaying hypertriglyceridemia (HR=1.21; 95%CI=[1.04; 1.40]) and metabolic syndrome (HR=1.26; 95%CI=[1.02; 1.55]). Central obesity and hyperglycemia increased the risk of readmission when considering the Health of the Nation Outcome Scales variable. In first-episode psychosis patients, obesity (HR=2.23; 95%CI=[1.14; 4.30]) and high-density lipoprotein hypocholesterolemia (HR=1.90; 95%CI=[1.14; 3.20]) doubled the risk of readmission.ConclusionThe observed interaction between smoking and metabolic variables are compatible with a ceiling effect; metabolic variables increase the risk of readmission in non-smokers but not in smokers who are already at higher risk. Future studies should determine whether better metabolic monitoring and treatment can reduce readmission risk.

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Section: Discussionmentioning

confidence: 99%

Metabolic disturbances are risk factors for readmission to psychiatric hospitals in non-smokers but not in smokers: results from a Swiss psychiatric cohort and in first-episode psychosis patients

Laaboub,

Locatelli,

Grosu

et al. 2024

Front. Psychiatry

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“…Lopes et al [ 9 ] reported a case of an 80-year-old woman with delirium and psychotic symptoms associated with hyperglycemia from poorly controlled type 2 diabetes mellitus (T2DM). On a related note, Bauer et al [ 10 ] presented a case series of six patients who were diagnosed with T2DM after being admitted for acute psychosis. The exact mechanism that relates psychotic episodes to hyperglycemia is still unknown, highlighting the need for further research.…”

Section: Discussionmentioning

confidence: 99%

Psychosis Associated With Hyperglycemia in a Female Patient With Type 1 Diabetes Mellitus: A Case Report

Garikana,

Mathew,

Hollowell

2024

Cureus

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This paper presents the case of a 22-year-old woman who was hospitalized multiple times with episodes of psychosis co-occurring with hyperglycemia. Her psychosis was characterized by auditory hallucinations, visual hallucinations, and disorganized speech and behavior. The patient has a prior medical history of type 1 diabetes mellitus (T1DM) and Graves' disease and was non-adherent to diabetic diet and medications. The patient is a Somalian refugee who moved to the United States (US) a year ago. We explore the relatively unique observation of hyperglycemia-induced psychosis in the patient, specifically in the context of autoimmune disorders. We also discuss some of the complexities associated with the cultural aspects of mental health and diabetes management in refugee communities and their implications in clinical practice.

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“…Poor lifestyle [3,[9][10][11] and second generation antipsychotic medication are known to favor the development of the metabolic syndrome and T2D [5,12,13]. Therefore, the screening for glucose abnormalities has been advocated to prevent their development and complications [14][15][16]. It is estimated that, among ISMI, up to 70 % of T2D cases are not diagnosed compared to 23-30 % in the general population [3].…”

Section: Introductionmentioning

confidence: 99%

Can HbA1c be Used to Screen for Glucose Abnormalities Among Adults with Severe Mental Illness?

Romain

Letendre

Akrass

et al. 2017

Exp Clin Endocrinol Diabetes

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Prediabetes and type 2 diabetes are highly prevalent among individuals with serious mental illness and increased by antipsychotic medication. Although widely recommended, many obstacles prevent these patients from obtaining a proper screening for dysglycemia. Currently, glycated hemoglobin (HbA1c), fasting glucose, and 2-hour glucose levels from the oral glucose tolerance test are used for screening prediabetes and type 2 diabetes. The objective of this study was to investigate if HbA1c could be used as the only screening test among individuals with serious mental illness. Cross sectional study comparing the sensitivity of HbA1c, fasting glucose, and 2-h oral glucose tolerance test to detect dysglycemias in serious mental illness participants referred for metabolic complications. A total of 84 participants (43 female; aged: 38.5±12.8 years; BMI: 35.0±6.8 kg/m²) was included. Regarding prediabetes, 44, 44 and 76% were identified by HbA1c, fasting glucose, and 2 h- oral glucose tolerance test respectively and for type 2 diabetes, 60, 53 and 66% were identified by HbA1c, fasting glucose and 2 h-oral glucose tolerance test. The overlap between the 3 markers was low (8% of participants for prediabetes and 26% for Type 2 diabetes). Sensitivity of HbA1c were moderate (range 40-62.5%), while its specificity was excellent (92-93%). The present study indicates a low agreement between HbA1c, fasting glucose and 2-h oral glucose tolerance test. It appears that these markers do not identify the same participants. Thus, HbA1c may not be used alone to detect all glucose abnormalities among individuals with serious mental illness.

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Acute Psychosis and Type 2 Diabetes Mellitus: Should Screening Guidelines Be Revised?

Cited by 4 publications

References 0 publications

Metabolic disturbances are risk factors for readmission to psychiatric hospitals in non-smokers but not in smokers: results from a Swiss psychiatric cohort and in first-episode psychosis patients

Metabolic disturbances are risk factors for readmission to psychiatric hospitals in non-smokers but not in smokers: results from a Swiss psychiatric cohort and in first-episode psychosis patients

Psychosis Associated With Hyperglycemia in a Female Patient With Type 1 Diabetes Mellitus: A Case Report

Can HbA1c be Used to Screen for Glucose Abnormalities Among Adults with Severe Mental Illness?

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