Diabetes, psychotic disorders and antipsychotic therapy: a consensus statement

Abstract

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.

Elevated Prevalence of Obesity, Metabolic Syndrome, and Cardiovascular Risk Factors in Bipolar Disorder

“…For patients treated with SGAs, more frequent metabolic monitoring has been proposed. Published recommendations for monitoring patients on SGAs vary with the more widely cited recommendation for fasting lipids at a minimum of baseline, 12 weeks, and every five years in addition to fasting glucose, blood pressure and waist circumference obtained at a minimum of baseline, 12 weeks, and annually thereafter (43, 44). Even more frequent monitoring of weight has been recommended (45).…”

Screening for the metabolic syndrome in community psychiatric patients prescribed antipsychotics: a quality improvement programme

“…From recent guidelines and consensus statements (17,(21)(22)(23), we derived an evidence-based audit standard that reflected minimum acceptable clinical practice. From recent guidelines and consensus statements (17,(21)(22)(23), we derived an evidence-based audit standard that reflected minimum acceptable clinical practice.…”

Let's get physical

“…This is due largely to the association of mental illness and a higher prevalence of physically debilitating and life‐limiting conditions such as diabetes, chronic obstructive pulmonary disease, cancer, cardio vascular disease, hypertension, osteoporosis, human immunodeficiency virus (HIV), and hepatitis C (Connolly & Kelly 2005; Howard et al . 2007b; Lambert & Chapman 2004; Lambert et al . 2003; Muir‐Cochrane 2006).…”

“…Lambert and Chapman (2004) stated that a lack of attention to appropriate physical health‐care needs has contributed significantly to increased premature deaths in people with mental illnesses. The WFMH (2004) report asserted that many mental health clinicians have little training in physical care.…”