In patients treated with the medications, the rate of diabetes was 10.4 percent, half of what was reported in the group that received no medication, and slightly more than twice the rate reported in the general population.
The second study also found that the incidence of hypertension in the treated patients was 15.6 percent, compared to 7.2 percent in the general population, while hypertension in the untreated population was nearly twice as prevalent.
"When you effectively treat schizophrenia and bipolar disorder, you reduce most of these other metabolic risk factors," said Bellnier.
"While the incidence of diabetes has actually gone up in the general population since the 1940s and 1950s, our study shows it has gone down significantly in patients being treated with antipsychotic medications, so these antipsychotic drugs may actually have a protective effect," he said.According to Bellnier, it is possible that hypercortisolemia, the elevated levels of cortisol -- the hormone secreted by the adrenal gland in response to stress -- may contribute to metabolic syndrome in severely mentally ill patients. "When you effectively treat these disorders and therefore reduce the psychotic and manic episodes associated with the elevation of cortisol, then you may also be protecting them from diabetes," he said.
According to the study's authors, one metabolic disturbance did increase with the use of antipsychotic medications and that was the incidence of patients considered overweight.
While untreated patients had an incidence of "overweight" of 28.2 percent, versus 21.8 percent in the general population at that time, the incidence of "overweight" in the treated population was 68.6 percent, compared to 37 percent in the general population at that time.
Bellnier said this striking statistic provides strong evidence of a connection between the use of multiple psychotrophics, such as antipsychotics, antidepressants, mood stabilizers and anticonvulsants, and the incidence of overweight in severely mentally ill patients.
Still, he noted, this single metabolic disturbance does not account for the incidence of diabetes among these patients. "Obesity alone does not explain it. You can be heavy for years and not develop diabetes," he said.
Based on their findings, the UB researchers conclude that psychiatric care should be modified to include routine screening for diabetes, hypertension and obesity.
"An enormous amount of energy has been wasted in trying to blame one drug over another as the cause of this higher risk," said Bellnier. "What we need to do now is to raise the bar a little in caring for these patients so that they now receive the same routine screening for diabetes and related conditions that the general population receives."
According to Bellnier, advocates for the mentally ill have, for good reason, focused primarily on good psychiatric care.
"But we've moved into an era where that care is available," said Bellnier. "These patients are predisposed to metabolic disturbances and they deserve the same care that everyone else gets. And ultimately, when they start getting preventive care or treatment for these conditions, instead of emergency care because their diabetes has never been treated, there will be a major economic benefit to the health-care system as well."
Last updated 12/27/05
