Question:
New onset diabetes from treatment with atypical anti-psychotic medications ?
I'm looking for information on new onset diabetes arising from treatment
with atypical anti-psychotic medications such as Zyprexa, Risperdal,
Clozaril, Seroquel, etc.
This is for a pharmacy college project. Any information, contacts, or links
would be greatly appreciated!
Answer:
You bring up an interesting topic. I'll post what I've been able to
find in a quick search using Google ( www.Google.com ) in the hopes
that you'll format your results into ASCII and upload them to the
diabetes groups.
I also may have screwed up in my search because I'm used to AAA
meaning Abdominal Aortic Aneurysm, not Atypical Antipsychotic Agents.
(Can't pass up a chance for a good joke - What's the greatest problem
facing medicine today? The finite number of 2, 3, and 4 letter
acronyms. Ok, I think it's hysterical....)
Since I'm mostly writing for the folks in the diabetes forums, you'll
pardon me if I take the time to explain to them what we're talking
about.
Schizophrenia and related disorders are difficult to treat. The
disease itself leaves the patient with the illusion that they are very
clear thinking. Even with the best drugs, the patients tend to
complain that treatment leaves them feeling "thick headed." There are
some other really nasty side effects, including tardive diskinesia,
neuroleptic malignant syndrome, parkinson-like effects, etc. Now,
you'll understand how bad a disease schizophrenia can be when you
consider that they still use these drugs! Man, if you think being a
diabetic sucked.... The effects are so bad that the folks in the
mental and medical health fields have a nickname for them -
"shitnizines." (See, most of the drugs end in "zine".)
A couple years ago, they found a drug called Clozapine (aka Clozaril).
I'll forego the laundry jokes. Schizophrenics put on this drug
reported that it was if they had "woken up." The drug was a miracle
cure, until someone noticed the occupance of agranulocytosis.
Agranulocytosis is such bad news that patients developing it were
removed from the drug, despite the lack of a clear alternative. If
you've ever read "Flowers for Algernon," then you can imagine the hell
these patients were sentenced to. Many wished to continue the drug
despite the fact that it would kill them, but the medical community
refused.
Other Atypical Anti-psychotic Agents have been developed, but nothing
with the success of Clozapine. You can see why everyone wants to find
the new wonder drug.
Well, it seems that there are some case reports of diabetes and
diabetic ketoacidosis (DKA) popping up with the newer drugs. Is this
just bad luck, or are the drugs causing the problems (or at least
turning potential Type IIs into actual Type IIs)? That's the $64
billion question - quite possibly literally.
Even the 'zines have a tendency to cause diabetes - they seem to
encourage weight gain. Now, if you've been paying attention to my
rants or just about anything on diabetes, you'll understand the
correlation.
Primary Psychiatry, May 2000, Vol 7, No 5 has a review of the problem.
There are several research programs that are taking AAA patients and
checking insulin sensitivity. Those found to be diabetic or IGT
(Impaired Glucose Tolerance) will be helped onto a different med if it
is discovered during the test. Then again, if you're one of the folks
who'd rather die than go off the Clozapine, diabetes may, in fact, be
an acceptable risk.
This research is important. While you'd think it wouldn't matter much
to diabetics, it actually might. See, schizophrenia is thought to
pretty much show up during the late teens to young adult age group. If
it happens when you're 40, they don't call it schizophrenia any more.
But it does happen, and the treatment for the adult onset is the same
as for schizophrenia. Also, with Type IIs developing in 12 year olds,
there may be a dramatic need to find out if these drugs will make
diabetes worse.
BTW: I didn't describe schizophrenia to the diabetic folks. It's not
multiple personality disorder as it is commonly portrayed in the media
and a certain Jim Carey movie. (Yes, I know, MPD is not a specific
diagnosis in DSM-4. This article's already long - you want 10 more
pages?) Schizophrenics are the ones that hear voices. They rarely see
things. Often they will interpret events as having personal meaning
for the person- the weather man on the TV reports rain tomorrow, so
that means I have to collect cans in the neighborhood. Delusions are
common, with a particular subtype including paranoid delusions. For
example, some believe that the 4th Invader fleet on Mars have set up
Eli Lilly and the Psychiatrists in an attempt to enslave mankind using
psychoactive drugs. Again, you can see why compliance is such an issue
with these patients. Most schizophrenics are non-violent, but the
violent ones get the press. Often, it's used as a defense excuse.
David Berkowitz, the Son of Sam, admitted to an FBI profiler that the
schtick about the dog was complete crap. Schizophrenics can become
agitated. Output as well as input functions of the brain can be messed
up. "Clanging speech" is characteristic. It's a speech pattern
where...heck, I can't describe it. It's incredibly hard to understand
what they are attempting to say when they are clanging. Word sounds -
onomatopoeia, alliteration, rhyme are often more important than
meaning.
Like I said, if you think being a diabetic sucks, this one has us beat
hands down. The worst thing is, there are no great treatments. As an
article in the Pittsburgh Post Gazette today points out, with the
destruction of the adolescent intake units in most psych hospitals,
these young patients are mostly funneled into juvenile detention
facilities where they receive neither proper medical nor psychological
help.
