Immunological characteristics of diabetes in schizophrenia

Abstract

To the Editor In 1899, Henry Maudsley, the first psychiatrist to link diabetes to psychiatric illness, wrote that “diabetes is a disease which often shows itself in families in which insanity prevails” [1]. With this observation, Maudsley suggested that patients with schizophrenia are genetically predisposed to diabetes. The introduction of chlorpromazine (in 1953) and, more recently, the atypical antipsychotics was followed by an increase in the number of cases of new-onset diabetes and the worsening of glycaemic control in cases of existing diabetes in patients with schizophrenia [2]. These findings suggest an iatrogenic, rather than a genetic, origin of diabetes in schizophrenia, in the form of antipsychoticinduced weight gain. However, this debate has not, as yet, been settled. In general, diabetes associated with schizophrenia is classified as type 2 diabetes. However, there are two arguments against this classification. The first argument is the rapid onset of schizophrenia-associated diabetes: over 80% of patients who develop diabetes do so within 6 months of initiating antipsychotic therapy [2]. With such a rapid onset, weight gain is unlikely to be the main stimulus for the development of the diabetes. A prospective randomised trial comparing the classical antipsychotic haloperidol with the three atypicals clozapine, olanzapine and risperidone found no relationship between glucose change and weight gain at endpoint, thereby confirming the independence of these two measures [3]. The second argument is the dramatic clinical presentation of diabetes in schizophrenia. There is an enhanced risk of metabolic complications, such as ketosis, acidosis and ketoacidosis, which are associated with a mortality rate of 26.5% [4–6]. These features are suggestive of type 1 diabetes or latent autoimmune diabetes of adults (LADA) rather than type 2 diabetes. Type 1 diabetes and LADA are characterised by diabetes-related antibodies, i.e. antibodies against insulin, GAD and insulinoma antigen 2 (IA2), which are found in over 80% of type 1 diabetic subjects and in fewer than 5% of the general population [7, 8]. The aim of this study was to determine the prevalence of the three diabetes-related antibodies in schizophrenic patients, thereby establishing whether autoimmune phenomena play a role in diabetes associated with schizophrenia. Patients (81 men [68.1%], 38 women [31.9%]; mean age 41.5 years [SD=10.9, range 19–65]) gave informed consent to participate in the study, which was approved by the Ethics Committee of the University of Utrecht. The psychiatric diagnosis was based on the shortened version of the D. Cohen Rivierduinen, Geestelijke GezondheidsZorg (GGZ) Duin en Bollenstreek, Voorhout, The Netherlands

DOI: 10.1007/s00125-005-1879-z

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@article{Cohen2005ImmunologicalCO, title={Immunological characteristics of diabetes in schizophrenia}, author={Dan Cohen and Manou R. Batstra and Christine C. Gispen-de Wied}, journal={Diabetologia}, year={2005}, volume={48}, pages={1941-1942} }