By Eulalee Thompson, Staff Reporter THE NEWS is not good for patients with major mental illnesses statistics indicate that they suffer a higher incidence of chronic diseases and tend to die earlier than other persons in the general population. Dr. Gillian Lowe, child and adolescent psychiatrist, said that this is a concern among psychiatrists.
"(They) die on average 10 to 20 years earlier than persons in the general population. This is due in part to suicides but also due to cardiovascular diseases such as coronary artery disease, type 2 diabetes in particular, and also obesity, some forms of cancer, respiratory illness and substance abuse," she said.
One of the chronic diseases, diabetes mellitus, in recent years, is becoming increasingly more prevalent among persons suffering major mental illness. Type 2 diabetes is common in nine to 14 per cent of patients with schizophrenia and bipolar disorder and in about 7.8 per cent of the general population. These statistics point to a greater prevalence of diabetes mellitus among patients with major mental illnesses when compared to the general population.
Dr. Lowe said that the possible associated factors have been the subject of further, more detailed research. One theory tenuously links the development of diabetes to the psychotropic agents given to mentally-ill persons to help control their condition.
"There have been various and confusing data on the relative risks for diabetes associated with different psychotropic agents. So, 'why is there so much difference in the findings and the interpretation?' 'Is there a consistent pattern emerging?' or 'Is the whole hyperglycaemia/psychotropic connection just a house of cards?" she asked as she recently presented a paper entitled 'Current trends in metabolic disorders in schizophrenia' at the Medical Association of Jamaica's symposium.
Dr. Lowe pointed to warnings by the U.S. Food and Drug Administration (FDA) linking treatment with atypical antipsychotic drugs to an increased risk of developing diabetes mellitus, especially insulin-resistant diabetes. However, reports of abnormalities in carbohydrate metabolism and suggestions of a relationship between diabetes mellitus and schizophrenia, Dr. Lowe states, were noted in articles written by Maudsley (founder of the Maudsley Institute in London) in 1897, long before the advent of antipsychotic agents.
How then can one support the argument of the prevalence of diabetes mellitus among mentally-ill persons? Dr. Lowe believes that the association may be found in the lifestyles of persons living with major mental illnesses.
"It is true that people with mental illness tend to have lifestyles which may not be conducive to what we call healthy; in terms that they are not the most conscientious people with diet, and many of them do not exercise. Smoking is also an issue. A lot of patients with schizophrenia do smoke and the
reason for that is that it is a form of
anxiolytic...it decreases the anxiety
associated with the psychosis. The nicotine in cigarette causes an increase in free fatty acids in the blood stream as well as an increase in glucose level,"
she said.
Many mentally-ill patients, who are not well controlled, are also stressed,
Dr. Lowe said, and the natural body response to stress is an increase in glucocorticoids as well as adrenalin which also will eventually lead to increase in the free fatty acids and glucose level in the blood.
Some medications such as Thiazide, diuretics, corticosteroids, theophylline, also carry side effects linked to increase glucose levels in the blood stream; antipsychotics also affect the patient's weight. Some patients experience increased craving, she said, primarily for carbohydrates, and nocturnal binge
eating which plays a role in the development of obesity linked to development of diabetes type 2.
The missing link in the diabetes-schizophrenia saga could therefore
be more unhealthy lifestyle factors smoking, obesity, stress, inadequate
exercise rather than atyopical
antipsychotic drugs.
Are you mentally ill and diabetic? Send comments and questions to eulalee.thompson@gleanerjm.com.
