January 06, 2005

Olanzapine, Clozapine and Diabetes

Two Atypical Anti-psychotic Drugs May Be Associated With An Increased Risk Of Diabetes For Patients With Schizophrenia

CHICAGO -- Patients treated with the atypical anti-psychotic agents clozapine and olanzapine may be at an increased risk for insulin resistance, which is a major risk factor for diabetes mellitus, according to a study in the January issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

"Compared with the general population, life expectancy in patients with schizophrenia is shorter by as much as 20 percent, attributable to higher rates of suicide, accidental deaths, and natural causes such as cardiovascular disease, infectious disease, and endocrine disorders," according to background information in the article. "Recently, the newer 'atypical' antipsychotic agents have been linked to several forms of morbidity, including obesity; hyperlipidemia; type 2 diabetes mellitus; and diabetic ketoacidosis [a severe complication of diabetes]."

David C. Henderson, M.D., from Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues, evaluated 36 non-obese outpatients with schizophrenia or schizoaffective disorder who were treated with clozapine, olanzapine, or another medication, risperidone. Participants were given a diet to follow to maintain body weight and were told to fast for 12 hours prior to undergoing a frequently sampled intravenous glucose tolerance test.

"Both nonobese clozapine- and olanzapine-treated groups displayed significant insulin resistance and impairment of glucose effectiveness compared with risperidone-treated subjects," the researchers found.

In conclusion, the authors write: "Psychiatrists and primary care professionals should be aware that patients treated with clozapine and olanzapine may be at increased risk for insulin resistance, even if not obese. Insulin resistance is associated with hyperlipidemia, hypertension, and cardiovascular disease and over time may increase the risk for diabetes mellitus in vulnerable individuals. Patients treated with these agents should be routinely screened, counseled to reduce risk, and provided early interventions."

(Arch Gen Psychiatry. 2005;62:19–28. Available post-embargo at archgenpsychiatry.com)

Editor's Note: This study was supported by a grant from the National Institutes of Health General Clinical Research Center, Bethesda, Md.; a Young Investigator Award from the National Alliance for Research of Schizophrenia and Depression, Great Neck, N.Y. (Dr. Henderson); and an Investigator-Initiated Independent Research Grant from Janssen Pharmaceutica, Beerse, Belgium.

Souce: JAMA (Journal of the American Medical Association) Press Release


Thank you, this was an interesting and informative read. I am a mental health nurse in Australia. My son was diagnosed with schizophrenia arou 3 yrs ago. He is presently on clozapine and after much expression of concerns to his primary carers, he had a glucose tollerance test and came back as being positive for diabetes. I feel strongly that more should occur early in treatment to minimise the risk of developing diabetes. Sadly this is often not the case Regards Kevin

Posted by: kevin murphy at May 26, 2005 10:28 PM

I have been on Eli Lilly's Olanzipine or Zyrexa-the brand name, for many years and only recently got off it due to the risk of diabetes. No matter how much I could get in one of the many lawsuits against Eli Lilly, it is not worth it to get diabetes. I lived in a house once with a diabetic. I am now on risperdal and may try seroquel.

Posted by: Michael Terry at August 8, 2005 06:05 PM

my teenage son took Zyprexa for about two years between 2003 and 2005. Shortly after discontinuing it, he showed symptoms of hypoglycaemia, which he still suffers from. I want Eli Lilly to pay for that. By the way, he had been diagnosed a bipolar disorder, of which there is no symptom now, although he does not take any drug.

Posted by: raffaella at February 17, 2007 05:50 AM

I would like to know if there have been any reports on people taking clozapine that have pre existing epilepsy

Posted by: bev at December 2, 2007 01:47 PM

Speaking in Tongues, Mumbling Out Loud, and Incoherent Speech

Some fun and stereotyping, by some comedians and the public, is made out of the fact that some psychiatric diagnosed people, sometimes speak or shout to themselves or others incoherently, mumble out loud, or speak in tongues. These matters are very little understood by psychiatrists, other mental health professionals, and the public, from experience, and from sensitive and subtle interaction, introspection, and observation. I sometimes speak or mumble out loud to myself or others, things that seem incoherent, or speak in very abstract, metaphorical, language or tongues, but there are very important and clear reasons behind why I and others do this.

A while ago, I was round a friend's flat, and he asked me a few questions about emotions and thoughts. I did have the immediate answers to his questions, but I didn't want to articulate them in a usual or normal way, partly because I wanted him to also think for himself, and to engage and connect with me in that process. I gave him some suggestions and subtle pointers, but at the time, and on this occasion, he didn't respond to, connect, or pick up on them.

Often when psychiatric diagnosed people speak seemingly incoherently, they are wanting others to respond or connect to the suggestions and subtle pointers they are making, and part of both understanding and interacting with their communication, acquires an awareness or basic skill in connecting to and improvising upon this. Much of the thinking and communication of psychiatric diagnosed people, when they seem to think or speak incoherently, is similar to the way that a person takes notes in studying, as thematic reminders, and are therefore condensed elements of details and huge chunks of information.

So as a way of thinking through the questions out loud, and expressing the answers to my friend, I went through a series of ideas and metaphors in my speech, which sort of answered his questions, but in a very creative, roundabout, or seemingly abstract way. The next day, he commented that I was talking nonsense that evening (although he apologised afterwards for saying so), but I was very aware of what I was saying and what it meant, at the time and afterwards, although I admit that the creative, imaginative, or emotional passion, took over a more logical, or purely rational, way of communicating or reasoning.

It's often assumed by psychiatrists, mental health professionals, and the public, that if speech seems very incoherent, then it must therefore be unstructured, disjointed, rambling, and fragmented, and without logical connection and meaning, but sometimes the seemingly incoherent speech, can be due to an over-fluidity, and over-structuring of thoughts and emotions; without articulating and focusing on one thought, statement, or feeling at a time. It's also the case, that just because a person's thoughts or speech lack logical connection and meaning, this doesn't mean that their emotions are disorganised and disconnected, as there may well be a lot of emotional congruity and connectivity, as sentient and feeling beings.

It's also assumed, that because a person is speaking seemingly incoherently, that this must be due to a so-called thought disorder, when there may actually be a lot of content and structure of thought behind the speech, although the person has a communication problem, or chooses to communicate it in a different way. Seemingly incoherent speech, is therefore more of a problem or deviation of communication, rather than it being an actual thought disorder, and which can be rectified by communication and social skills.

Speaking in tongues, mumbling out loud, and speaking seemingly incoherently, are often secondary mental health problems, or rather, ways of coping with primary mental health problems. Sometimes this can involve talking or having a dialogue with oneself, or with hearing voices, but it can also be a way of avoiding the rational thought-control of the voices or of other people, because if the psychiatric diagnosed person speaks in meaningless statements, this can disrupt the voices rational dominance and control, and fragment or distract the voices from the conscious mind. Speaking in this way, can also be a strategy in trying to avoid or escape from being observed, objectified, controlled, exploited, and manipulated by one-sided inquisition.

Peter H. Donnelly

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