Diabetes

The association between diabetes and schizophrenia is discussed at length in Chapter 6 of this volume. Nonetheless, it bears noting that despite the fact that diabetes increases with age and affects about 20% of the geriatric population (Marsh 1997), the prevalence rate of diabetes among schizophrenia patients versus persons without psychiatric illness seems to be consistently higher only in younger and middle-aged groups, with differences in the geriatric population less apparent.Jeste et al. (1996) found no significant difference in the prevalence of diabetes when comparing a group of middle-aged and elderly schizophrenic patients with individuals with other psychiatric disorders. Similar results were found in a study of older schizophrenic persons in New York City, in which self-reported rates of diabetes were nearly identical between schizophrenic persons (20%) and the comparison community group (19%) (C.I. Cohen, unpublished data). Two studies (Mukheijee 1995) of VA inpatients and outpatients have confirmed the increasing prevalence of diabetes among schizophrenic persons as they age, with rates of 0% and 1.6% among those under 40, and 25% and 50% in those 70 years and above, for inpatients and outpatients, respectively. In another study, conducted in Italy, Mukherjee et al. (1996) studied a sample of 95 schizophrenic patients and found that the prevalence of diabetes increased from 0% in those younger than 50 years to 12.9% in those age 50-59 years, 18.9% in those age 6069 years, and 16.7% in the 70-74 age group.

Although antipsychotic medication, particularly the atypical agents olanzapine and clozapine, may have an impact on glucose tolerance, the Patient Outcomes Research Team (PORT) study concluded that the risk of developing diabetes in schizophrenic patients exceeded the general population's risk even before the widespread use of the newer agents (Dixon et al. 2000). Similarly, Mukherjee et al. (1996) observed, "More critically it bears emphasizing that high rates of insulin resistance and impaired glucose tolerance had been noted in schizophrenia patients before the introduction of neuroleptics" (p. 71).

With respect to treatment, the PORT study, based on data from 719 schizophrenic outpatients (mean age 43 years and approximately 17% above age 55), found that 86% of schizophrenia patients who reported having diabetes mellitus said they were receiving treatment for it (Dixon et al. 1999). This is consistent with data from the study of older schizophrenic persons in New York City that was cited earlier, in which 85% of persons with diabetes reported receiving treatment for this disorder.

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