Diabetes, psychiatric disorders, and the metabolic effects of antipsychotic medications

Antipsychotic medications are frequently prescribed by nonpsychiatric clinicians, and the use of atypical antipsychotics is increasing. Although these medications have some efficacy and tolerability advantages over the conventional drugs, they have recently been differentially associated with an increased risk of weight gain, diabetes, and hypertriglyceridemia. In the frail geriatric population with diabetes and BPSDs, these medicines have been additionally associated with a possible increased risk of cerebrovascular events and higher mortality rates. In children and adolescents, a working knowledge of child development and recognition of the influence of psychological factors on treatment adherence is critical. Screening for cardiovascular and metabolic risk factors is particularly important when atypical antipsychotics are to be prescribed. This baseline screening should include questions about personal and family history of diabetes risk factors and measurement of blood pressure, fasting glucose, and serum lipids. Diabetes risk reduction, including nutritional and physical activity counseling, control of blood pressure, lowering of cholesterol and triglyceride levels, weight loss, and increased physical activity, can have a positive impact on both diabetes and the psychiatric illnesses and can be successfully utilized in patients with schizophrenia.