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Review: Newer antipsychotic agents, carbohydrate metabolism and cardiovascular risk

Division of Medicine and Therapeutics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK

Ciara Kelly

Department of Psychological Medicine, Gartnavel Royal Hospital, University of Glasgow, UK

Andrew Gallagher

Diabetes Centre, Macquaker Building, Victoria Infirmary, Glasgow, UK

John R Petrie

Division of Medicine and Therapeutics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK, johnp{at}memo.dundee.ac.uk

With widespread use of `atypical' antipsychotics for the treatment of psychiatric disorders, attention has focused on their association with obesity, diabetes and risk factors for cardiovascular disease. People with schizophrenia are more likely to develop diabetes than the general population, with antipsychotics appearing to add to this risk. The exact mechanism(s) by which antipsychotics cause hyperglycaemia, diabetic ketoacidosis and aggravation of pre-existing diabetes remain uncertain. Plausible mechanisms have been postulated for the promotion of obesity by these agents, with resultant insulin resistance and type 2 diabetes in some patients. Whatever the mechanism, careful consideration of potential risks and benefits is required in prescribing: people with schizophrenia are often exposed to antipsychotic agents in the long term and frequently have co-existing cardiovascular risk factors (smoking, poor diet, physical inactivity, social deprivation). Regular monitoring of body weight, blood glucose and serum lipids may help clinical management.

Key Words: antipsychotics • diabetes • dyslipidaemia • insulin resistance • metabolic syndrome • obesity.

The British Journal of Diabetes & Vascular Disease, Vol. 4, No. 5, 303-309 (2004)
DOI: 10.1177/14746514040040050301


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