From the New York Times: In Diabetes, One More Burden for the Mentally Ill focuses on the link between increasing rates of diabetes (as high as 20%) in people with some mental illnesses following the widespread adoption of atypical antipsychotic drugs such as olanzapine (Zyprexa), clozapine (Clozaril) and risperidone (Risperidal).

This isn’t new news, however. In 2004, the American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity raised the alarm in a joint consensus statement. It outlined risks and a protocol for psychiatrists to perform baseline testing and monitoring for metabolic dysfunction.

Unfortunately, the shift hasn’t happened. The article Schizophrenia Pt’s Go Untreated For Comorbidities reveals some disturbing statistics:

42% of the 1,460 patients in the CATIE trial [a recent major study of people with schizophrenia] already met the criteria for metabolic syndrome when they entered the study. Some very likely had the syndrome because of previous treatment for schizophrenia, Dr. Nasrallah said, but others had it as a comorbid condition.

Treatment rates for other conditions were “shockingly low,” he told reporters:
* 40% of patients with frank diabetes were not under treatment.
* 65% of those with hypertension were not getting any anti-hypertensive drugs.
* 90% of those with high cholesterol and triglycerides were not being treated.

Although the atypicals are purported to have a lower risk of other troubling side effects such as tardive dyskinesia (an often-irreversible movement disorder), some appear to carry a high incidence of weight gain, diabetes and other metabolic dysfunctions. But while antipsychotics carry serious risks, they may be the most effective treatment for psychosis. Balancing risks and choosing a drug is a difficult process for physicians and consumers.

Atypical antipsychotics are used as mood stabilizers and to treat mania in bipolar disorders. Olanzapine (Zyprexa) was the first to be FDA-approved for mania, quetiapine (Seroquel) is favored for bipolar depression, and aripriprizole (Abilify) is increasingly used as a mood stabilizer. One wonders – with the rising popularity of atypical antipsychotics, will the mortality rate for people with bipolar disorders mirror the trend found with schizophrenia?

Or will mental health professionals move to treat brain and body together?

In the NYT, Dr. David Hellerstein suggests innovation:

“Instead of having the patient lie down and you say, ‘So tell me why you fight with your brother,’ you could say to the patient, ‘Let’s take a walk around the block while you tell me about why you fight with your brother.’ “