Diabetes, Psychiatric Disorders, and the Metabolic Effects of Antipsychotic Medications

Diabetes is considered to be one of the most psychologically demanding of the chronic medical illnesses and is often associated with several psychiatric disorders. Antipsychotic medications, first introduced in the 1950s, are a vital component of the medical management of several of these psychiatric disorders. These medications are often prescribed by nonpsychiatric physicians. During the period 1997–2000, according to a large U.S. survey, nearly 1% of all health care visits resulted in an antipsychotic prescription, and almost one-third of these prescriptions were written by nonpsychiatrists.1 The use of newer “atypical” antipsychotics, in particular risperidone and olanzapine, increased during this period, whereas the use of conventional antipsychotics decreased. This article will review the atypical, or second-generation, antipsychotics and their current uses. The relationship between diabetes and two of the most frequent indications for the use of these medications (schizophrenia and behavioral and psychological symptoms of dementia) will be examined. Additionally, this article will explore the complex association between antipsychotic medications and obesity, hyperglycemia, and dyslipidemias.