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Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC)

Published online by Cambridge University Press:  16 April 2020

M. De Hert
University Psychiatric, Centre Catholic University, Leuven campus Kortenberg, Leuvensesteenweg 517, 3070Kortenberg, Belgium
J.M. Dekker
University Psychiatric, Centre Catholic University, Leuven campus Kortenberg, Leuvensesteenweg 517, 3070Kortenberg, Belgium
D. Wood
National Heart and Lung Institute Cardiovascular Science, Imperial College, Charing Cross Campus, W6 8RPLondon, United Kingdom
K.G. Kahl
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neubergstrasse. 1, 30625Hannover, Germany
R.I.G. Holt
Endocrinology & Metabolism, Developmental Origins of Health and Disease, School of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
H.-J. Möller
Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336Munich, Germany
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People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors; obesity, smoking, diabetes, hypertension and dyslipidaemia. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain or worsen other metabolic cardiovascular risk factors. Patients may have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) published this statement with the aim of improving the care of patients suffering from severe mental illness. The intention is to initiate cooperation and shared care between the different healthcare professionals and to increase the awareness of psychiatrists and primary care physicians caring for patients with severe mental illness to screen and treat cardiovascular risk factors and diabetes.

Copyright © Elsevier Masson SAS 2009

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Allison, D.B.Mentore, J.L.Heo, M.Chandler, L.P.Cappelleri, J.C.Infante, al.Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 1999;156(11):16861696Google ScholarPubMed
Allison, D.B.Newcomer, J.W.Dunn, A.L.Blumenthal, J.A.Fabricatore, A.N.Daumit, al.Obesity among those with mental disorders: a National Institute of Mental Health meeting report. Am J Prev Med 2009;36(4):341350CrossRefGoogle ScholarPubMed
Álvarez-Jiménez, M.Hetrick, S.González-Blanch, C.Gleeson, J.McGorry, P.Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2008;193:101107CrossRefGoogle ScholarPubMed
American Association of Clinical Endocrinologists 2007. Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus. AACE Diabetes Mellitus Guidelines. Endocr Pract 2007;13(Suppl. 1):368.Google Scholar
American Diabetes Association Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Diabetes Care 2004;27:596601CrossRefGoogle Scholar
American Diabetes Association Standards of medical care in diabetes - 2009. Diabetes Care 2009;32(Suppl. 1):S13S61CrossRefGoogle Scholar
American Diabetes Association Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2009;32(Suppl. 1):S63S67Google Scholar
Angst, F.Stassen, H.H.Clayton, P.J.Angst, J.Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord 2002;68(2-3):167181CrossRefGoogle ScholarPubMed
Arango, C.Bobes, J.Aranda, P.Carmena, R.Garcia-Garcia, M.Rejas, al.A comparison of schizophrenia outpatients treated with antipsychotics with and without metabolic syndrome: Findings from the CLAMORS study. Schizophr Res 2008;104(1-3):112CrossRefGoogle ScholarPubMed
Barnett, A.H.Mackin, P.Chaudhry, I.Farooqi, A.Gadsby, R.Heald, al.Minimising metabolic and cardiovascular risk in schizophrenia. J Psychopharmacol 2007;21(4):357373CrossRefGoogle Scholar
Bech, P.Vendsborg, P.J.Rafaelson, O.J.Lithium maintenance treatment of manic-melancholic patients: its role in the daily routine. Acta Psychiatr Scand 1976;53:7081CrossRefGoogle ScholarPubMed
Berken, G.H.Weinstein, D.O.Stern, W.C.Weight gain: a side effect of tricyclic antidepressants. J Affect Disord 1984;7:133138CrossRefGoogle ScholarPubMed
Bjorntorp, P.Stress and cardiovascular disease. Acta Physiol Scand Suppl 1997;640:144148Google ScholarPubMed
Bobes, J.Arango, C.Aranda, P.Carmena, R.Garcia-Garcia, M.Rejas, al.Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: results of the CLAMORS Study. Schizophr Res 2007;90(1-3):162173CrossRefGoogle ScholarPubMed
Brown, A.D.Barton, D.A.Lambert, G.W.Cardiovascular abnormalities in patients with major depressive disorder: autonomic mechanisms and implications for treatment. CNS Drugs 2009;23(7):583602CrossRefGoogle ScholarPubMed
Brown, L.C.Majumdar, S.R.Newman, S.C.Johnson, J.A.History of depression increases risk of type 2 diabetes in younger adults. Diabetes Care 2005;28:10631067CrossRefGoogle ScholarPubMed
Brown, S.Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 1997;171:502508CrossRefGoogle ScholarPubMed
Brown, S.Inskip, H.Barraclough, B.Causes of the excess mortality of schizophrenia. Br J Psychiatry 2000;177:212217CrossRefGoogle ScholarPubMed
Bruggeman, R.Schorr, S.Van der Elst, K.Postma, M.Taxis, K.Cost-effectiveness of screening for diabetes in a cohort of patients with schizophrenia. Schizophr Res 2008;102(1-3):161162CrossRefGoogle Scholar
Buckley, P.F.Miller, D.D.Singer, B.Clinicians’ recognition of the metabolic adverse effects of antipsychotic medications. Schizophr Res 2005;79:281288CrossRefGoogle ScholarPubMed
Bushe, C.J.Leonard, B.E.Blood glucose and schizophrenia: a systematic review of prospective randomized clinical trials. J Clin Psychiatry 2007;68(11):16821690CrossRefGoogle ScholarPubMed
Cahn, W.Ramlal, D.Bruggeman, Haan, L.Scheepers, F.E.van Soest, al.Prevention and treatment of somatic complications arising from the use of antipsychotics. Tijdschr Psychiatr 2008;50(9):579591Google ScholarPubMed
Canadian Diabetes Association Clinical Practice Guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2008;32(Suppl. 1):S1S20Google Scholar
Capasso, R.M.Lineberry, T.W.Bostwick, J.M.Decker, P.A.St Sauver, J.Mortality in schizophrenia and schizoaffective disorder: An Olmsted County, Minnesota cohort: 1950-2005. Schizophr Res 2008;98(1-3):287294CrossRefGoogle ScholarPubMed
Carnethon, M.R.Biggs, M.L.Barzilay, J.I.Smith, N.L.Vaccarino, V.Bertoni, al.Longitudinal Association Between Depressive Symptoms and Incident Type 2 Diabetes Mellitus in Older Adults. The Cardiovascular Health Study. Arch Intern Med 2007;167:801808CrossRefGoogle ScholarPubMed
Casey, D.E.Haupt, D.W.Newcomer, J.W.Henderson, D.C.Sernyak, M.J.Davidson, al.Antipsychotic-Induced Weight Gain and Metabolic Abnormalities: Implications for Increased Mortality in Patients With Schizophrenia. J Clin Psychiatry 2004;65(Suppl. 7):418Google ScholarPubMed
Cassidy, F.Ahearn, E.Carroll, B.J.Elevated frequency of diabetes mellitus in hospitalized manic-depressive patients. Am J Psychiatry 1999;156:14171420Google ScholarPubMed
Chrousos, G.P.The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuroendocrine and target tissue-related causes. Int J Obes 2000;24:S5055CrossRefGoogle ScholarPubMed
Citrome, L.Risk-Benefit Analysis of Available Treatments for Schizophrenia. Psychiatric Times 2007;1:2730Google Scholar
Citrome, L.Holt, R.I.G.Zachry, W.M.Clewell, J.D.Orth, P.A.Karagianis, al.Risk of treatment-emergent diabetes mellitus in patients receiving antipsychotics. Ann Pharmacother 2007;41:15931603CrossRefGoogle ScholarPubMed
Citrome, L.Yeomans, D.Do guidelines for severe mental illness promote physical health and well-being?. J Psychopharmacol 2005;19(6):102109CrossRefGoogle ScholarPubMed
Cohen, D.Huinink, S.Atypical antipsychotic-induced diabetes mellitus in child and adolescent psychiatry. CNS Drugs 2007;21(12):10351038CrossRefGoogle ScholarPubMed
Cohen, D.Stolk, R.P.Grobbee, D.E.Gispen-de Wied, C.C.Hyperglycemia and diabetes in patients with schizophrenia or schizoaffective disorders. Diabetes Care 2006;29(4):786791CrossRefGoogle ScholarPubMed
Cohn, T.A.Sernyak, M.J.Metabolic monitoring for patients treated with antipsychotic medications. Can J Psychiatry 2006;51:492501CrossRefGoogle ScholarPubMed
Colton, C.W.Manderscheid, R.W.Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006;3:A42Google ScholarPubMed
Correll, C.U.Assessing and maximizing the safety and tolerability of antipsychotics used in the treatment of children and adolescents. J Clin Psychiatry 2008;69(Suppl. 4):2636Google ScholarPubMed
Correll, C.U.Balancing efficacy and safety in the treatment with antipsychotics. CNS Spectr 2007;12(Suppl. 17):1220CrossRefGoogle ScholarPubMed
Correll, C.U.Frederickson, A.M.Kane, J.M.Manu, P.Equally increased risk for metabolic syndrome in patients with bipolar disorder and schizophrenia treated with second-generation antipsychotics. Bipolar Disord 2008;10:788797CrossRefGoogle ScholarPubMed
Correll, C.U.Frederickson, A.M.Kane, J.M.Manu, P.Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. J Clin Psychiatry 2006;67(4):575583CrossRefGoogle ScholarPubMed
Daniels, S.R.Greer, F.R.the Committee on Nutrition Lipid Screening and Cardiovascular Health in Childhood. Pediatrics 2008;122:198208CrossRefGoogle ScholarPubMed
Daumit, G.L.Goff, D.C.Meyer, J.M.Davis, V.G.Nasrallah, H.A.McEvoy, al.Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study. Schizophr Res 2008;105:175187CrossRefGoogle ScholarPubMed
De Hert, M.van Eyck, D.De Nayer, A.Metabolic abnormalities associated with second generation antipsychotics: fact or fiction? Development of guidelines for screening and monitoring. Int Clin Psychopharmacol 2006;21(Suppl. 2):1115CrossRefGoogle ScholarPubMed
De Hert, M.van Winkel, R.Van Eyck, D.Hanssens, L.Wampers, M.Scheen, al.Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study. Clin Pract Epidemiol Ment Health 2006;2:14 doi: 10.1186/ ScholarPubMed
De Hert, M.Kalnicka, D.van Winkel, R.M.Hanssens, L.Van Eyck, D.Wampers, al.Treatment with rosuvastatin for severe dyslipidemia in patients with schizophrenia and schizoaffective disorder. J Clin Psychiatry 2006;67(12):18891896CrossRefGoogle ScholarPubMed
De Hert, M.Falissard, B.Mauri, M.Shaw, K.Wetterling, T.Epidemiological study for the evaluation of metabolic disorders in patients with schizophrenia: The METEOR Study. Eur Neuropsychopharmacol 2008;18(Suppl. 4):S444CrossRefGoogle Scholar
De Hert, M.Schreurs, V.Sweers, K.Van Eyck, D.Hanssens, L.Šinko, al.Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: a retrospective chart review. Schizophr Res 2008;101(1-3):295303CrossRefGoogle ScholarPubMed
De Hert, M.Schreurs, V.Vancampfort, D.van Winkel, R.Metabolic syndrome in people with schizophrenia: a review. World Psychiatry 2009;8(1):1522CrossRefGoogle ScholarPubMed
De Nayer, A.De Hert, M.Scheen, A.Van Gaal, L.Peuskens, J.Belgian consensus on metabolic problems associated with atypical antipsychotics. Int J Clin Pract 2005;9:130137CrossRefGoogle ScholarPubMed
Druss, B.G.Improving medical care for persons with serious mental illness: challenges and solutions. J Clin Psych 2007;68(Suppl. 4):4044Google ScholarPubMed
Eaton, W.W.Armenian, H.Gallo, J.Pratt, L.Ford, D.E.Depression and risk for onset of type II diabetes. A prospective population-based study. Diabetes Care 1996;19(10):10971102CrossRefGoogle ScholarPubMed
Falkai, P.Wobrock, T.Lieberman, J.Glenthoj, B.Gattaz, W.F.Möller, al.Guidelines for Biological Treatment of Schizophrenia. Part 1: Acute treatment of Schizophrenia. World J Biol Psychiatry 2005;6(3):132191CrossRefGoogle ScholarPubMed
Farouhi, N.G.Balkau, B.Borch-Johnsen, K.Dekker, J.Glumer, C.Qiao, al.The threshold for diagnosing impaired fasting glucose: a position statement by the European Diabetes Epidemiology Group. Diabetologia 2006;49:822827Google Scholar
Faulkner, G.Soundy, A.A.Lloyd, K.Schizophrenia and weight management: a systematic review of interventions to control weight. Acta Psychiatrica Scandinavica 2003;108:324332CrossRefGoogle ScholarPubMed
Faulkner, G.Cohn, T.A.Pharmacologic and nonpharmacologic strategies for weight gain and metabolic disturbance in patients treated with antipsychotic medications. Can J Psychiatry 2006;51(8):502511CrossRefGoogle ScholarPubMed
Faulkner, G.Cohn, T.Remington, G.Interventions to reduce weight gain in schizophrenia. Schizophr Bull 2007;33(3):654656CrossRefGoogle Scholar
Faulkner, G.Taylor, A.Munro, S.Selby, P.Gee, C.The acceptability of physical activity programming within a smoking cessation service for individuals with severe mental illness. Patient Educ Couns 2007;66(1):123126CrossRefGoogle ScholarPubMed
Fenton, W.S.Stover, E.S.Mood disorders: cardiovascular and diabetes comorbidity. Curr Opin Psychiatry 2006;19:421427CrossRefGoogle ScholarPubMed
Fleischhacker, W.W.Cetkovich-Bakmas, M.De Hert, M.Hennekens, C.Lambert, M.Leucht, al.Cormorbid somatic illnesses in patients with severe mental disorders: clinical, policy and research challenges. J Clin Psychiatry 2008;69:514519CrossRefGoogle Scholar
Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur J Cardiovasc Prevent Rehabil 2007;14(Suppl. 2):E1E40Google Scholar
Goff, D.C.Sullivan, L.M.McEvoy, J.P.Meyer, J.Nasrallah, H.Daumit, al.A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophr Res 2005;80(1):4553CrossRefGoogle ScholarPubMed
Haddad, P.M.Sharma, S.G.Adverse effects of atypical antipsychotics; Differential Risk and Clinical Implications. CNS Drugs 2007;21:911936CrossRefGoogle ScholarPubMed
Hanssens, L.De Hert, M.Kalnicka, D.van Winkel, R.Wampers, M.Van Eyck, al.Pharmacological treatment of severe dyslipidaemia in patients with schizophrenia. Int Clin Psychopharmacol 2007;22:4349Google ScholarPubMed
Haupt, D.W.Rosenblatt, L.C.Kim, E.Baker, R.A.Whitehead, R.Newcomer, J.W.Prevalence and predictors of lipid and glucose monitoring in commercially insured patients treated with second-generation antipsychotic agents. Am J Psychiatry 2009;166(3):345353CrossRefGoogle ScholarPubMed
Henderson, D.C.Schizophrenia and comorbid metabolic disorders. J Clin Psychiatry 2005;66(Suppl. 6):1120Google ScholarPubMed
Hennekens, C.H.Schizophrenia and increased risks of cardiovascular disease. Am Heart J 2005;151(3):598603Google Scholar
Heuser, I.The hypothalamic-pituitary-adrenal system in depression. Pharmacopsychiatry 1998;31:1013CrossRefGoogle ScholarPubMed
Hill Golden, S.Lazo, M.Carnethon, M.Bertoni, A.G.Schreiner, P.J.Dieze Roux, al.Examining a Bidirectional Association Between Depressive Symptoms and Diabetes. JAMA 2008;299(23):27512759CrossRefGoogle Scholar
Holt, R.I.G.Bushe, C.Citrome, L.Diabetes and schizophrenia 2005: are we any closer to understanding the link?. J Psychopharmacol 2005;19(6):5665CrossRefGoogle ScholarPubMed
Holt, R.I.G.Severe mental illness, antipsychotic drugs and the metabolic syndrome. Br J Diab Vasc Disease 2006;6(5):199204CrossRefGoogle Scholar
Holt, R.I.G.Peveler, R.C.Antipsychotic drugs and diabetes - an application of the Austin Bradford Hill criteria. Diabetologia 2006;49(7):14671476CrossRefGoogle ScholarPubMed
Holt, R.Peveler, R.Obesity, serious mental illness and antipsychotic drugs. Diabetes Obes Metab 2009;11(7):665679CrossRefGoogle ScholarPubMed
Kahl, K.G.Bester, M.Greggersen, W.Rudolf, S.Dibbelt, L.Stoeckelhuber, al.Visceral fat disposition and insulin sensitivity in depressed women with and without borderline personality disorder. Psychosom Med 2005;67:407412CrossRefGoogle Scholar
Kahn, R.S.Fleischhacker, W.W.Boter, H.Davidson, M.Vergouwe, Y.Keet, al.Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008;371:10851097CrossRefGoogle ScholarPubMed
Katon, W.J.The comorbidity of diabetes and depression. Am J Med 2008;121(11 Suppl. 2):S8S15CrossRefGoogle ScholarPubMed
Kinder, L.S.Carnethon, M.R.Palaniappan, L.P.King, A.C.Fortmann, S.P.Depression and the metabolic syndrome in young adults: Findings from the Third National Health and nutrition Examination Survey. Psychosom Med 2004;66:316322CrossRefGoogle ScholarPubMed
Kinon, B.J.Kaiser, C.J.Ahmed, S.Roteli, M.Kolloack-Walker, S.Association between early and rapid weight gain and change in weight over one year of olanzapine therapy in patients with schizophrenia and related disorders. J Clin Psychopharmacol 2005;25(3):255258CrossRefGoogle ScholarPubMed
Kissebah, A.H.Intra-abdominal fat: is it a major factor in developing diabetes and coronary artery disease?. Diab Res Clin Pract 1996;30:2530CrossRefGoogle Scholar
Knowler, W.C.Barrett-Connor, E.Fowler, S.E.Hamman, R.F.Lachin, al.Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393403Google ScholarPubMed
Kryzhanovskaya, L.A.Robertson-Plouch, C.K.Xu, W.Carlson, J.L.Merida, K.M.Dittmann, R.W.The safety of olanzapine in adolescents with schizophrenia or bipolar I disorder: a pooled analysis of 4 clinical trials. J Clin Psychiatry 2009;70(2):247258CrossRefGoogle ScholarPubMed
Kumra, S.Oberstar, J.V.Sikich, L.Findling, R.McClellan, J.Vinogradoc, al.Efficacy and Tolerability of Second-Generation Antipsychotics in Children and Adolescents With Schizophrenia. Schizophr Bull 2008;34:6071CrossRefGoogle ScholarPubMed
Lamberti, J.S.Crilly, J.F.Maharaj, K.Olson, D.Wiener, K.Dvorin, al.Prevalence of diabetes mellitus among outpatients with severe mental disorders receiving atypical antipsychotic drugs. J Clin Psychiatry 2004;65:702706CrossRefGoogle ScholarPubMed
Laursen, T.M.Munk-Olsen, T.Agerbo, E.Gasse, C.Mortensen, P.B.Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry 2009;66(7):713720CrossRefGoogle ScholarPubMed
Lawrence, D.M.Holman, C.D.Jablensky, A.V.Hobbs, M.S.Death rate from ischemic heart disease in Western Australian psychiatric patients 1980-1998. Br J Psychiatry 2003;182:3136CrossRefGoogle ScholarPubMed
Leucht, S.Burkard, T.Henderson, J.Maj, M.Sartorius, N.Physical illness and schizophrenia. Acta Psychiatr Scand 2007;116(5):317333CrossRefGoogle Scholar
Leucht, S.Corves, C.Arbter, D.Engel, R.R.Li, C.Davis, J.M.Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 2009;373(9657):3141CrossRefGoogle ScholarPubMed
Lieberman, J.A.Stroup, T.S.McEvoy, J.P.Swartz, M.S.Rosenheck, R.A.Perkins, al.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353(12):12091223CrossRefGoogle ScholarPubMed
Mackin, P.Bishop, D.Watkinson, H.A prospective study of monitoring practices for metabolic disease in antipsychotic-treated community psychiatric patients. BMC Psychiatry 2007;25:728Google Scholar
Maina, G.Salvi, V.Vitalucci, A.D’Ambrosio, V.Bogetto, F.Prevalence and correlates of overweight in drug-naive patients with bipolar disorders. J Affect Disord 2008;110:149155CrossRefGoogle Scholar
Mancia, G.De Backer, G.Dominiczak, A.Cifkova, R.Fagard, R.Germono, al.Guidelines for the management of arterial hypertension. Eur Heart J 2007;28:14621536Google ScholarPubMed
Marder, S.R.Essock, S.M.Miller, A.L.Buchanan, R.W.Casey, D.E.Davis, al.Physical health monitoring of patients with schizophrenia. Am J Psychiatry 2004;161:13341349CrossRefGoogle ScholarPubMed
McIntyre, R.S.Konarski, J.Z.Misener, V.L.Kennedy, S.H.Bipolar disorder and diabetes mellitus: epidemiology, etiology, and treatment implications. Ann Clin Psychiatry 2005;17(2):8393CrossRefGoogle ScholarPubMed
McIntyre, R.S.Sozcynska, J.K.Konarski, J.Z.Kennedy, S.H.The effect of antidepressants on glucose homeostasis and insulin sensitivity: synthesis and mechanisms. Expert Opin Drug Saf 2006;5:157168CrossRefGoogle ScholarPubMed
Meyer, J.M.Davis, V.G.Goff, D.C.McEvoy, J.Nasrallah, H.Davis, al.Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: Prospective data from phase 1. Schizophr Res 2008;101(1-3):273286CrossRefGoogle ScholarPubMed
Meyer, J.M.Stahl, S.M.The metabolic syndrome and schizophrenia. Acta Psychiatr Scand 2009;119(1):414CrossRefGoogle Scholar
Miller, L.J.Management of Atypical Antipsychotic Drug–Induced Weight Gain: Focus on Metformin Pharmacotherapy 2009;29(6):725735Google Scholar
Nasrallah, H.A.Meyer, J.M.Goff, D.C.McEvoy, J.P.Davis, S.M.Stroup, al.Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res 2006;86(1-3):1522CrossRefGoogle ScholarPubMed
Nasrallah, H.A.Atypical antipsychotic-induced metabolic side effects: insights from receptor-binding profiles. Mol Psychiatry 2008;13:2735CrossRefGoogle ScholarPubMed
Nathan, D.M.Davidson, M.B.DeFronzo, R.A.Heine, R.J.Henry, al.Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 2007;30:753759CrossRefGoogle Scholar
Newcomer, J.W.Nasrallah, H.A.Loebel, A.D.The atypical antipsychotic therapy and metabolic issues national survey. J Clin Psychopharmacol 2004;24:16CrossRefGoogle ScholarPubMed
Newcomer, J.W.Second-Generation (Atypical) Antipsychotics and Metabolic Effects. A Comprehensive Literature Review. CNS Drugs 2005;19(Suppl. 1):193CrossRefGoogle ScholarPubMed
Newcomer, J.W.Antipsychotic medications: metabolic and cardiovascular risk. J Clin Psychiatry 2007;68(Suppl. 4):813Google ScholarPubMed
NICE. Schizophrenia Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. 2008; online: (site consulted on 1st July 2009).Google Scholar
Nicol, G.Haupt, D.Flavin, K.Schweiger, J.Hessler, M.Hessler, al.Preliminary results of the MEAC study: metabolic effects of antipsychotics in children. Schizophr Bull 2009;35(Suppl. 1):32Google Scholar
Osborn, D.P.Levy, G.Nazareth, I.Petersen, I.Islam, A.King, M.B.Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom's General Practice Rsearch Database. Arch Gen Psychiatry 2007;64(2):242249CrossRefGoogle ScholarPubMed
Osborn, D.P.Wright, C.A.Levy, G.King, M.B.Deo, R.Nazareth, I.Relative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: systematic review and meta-analysis. BMC Psychiatry 2008;8:84 25CrossRefGoogle Scholar
Ösby, U.Correia, N.Brandt, L.Ekbom, A.Sparen, P.Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000;45(1-2):2128CrossRefGoogle ScholarPubMed
Ösby, U.Correia, N.Brandt, L.Ekbom, A.Sparen, P.Time trends in schizophrenia mortality in Stockholm County, Sweden: cohort study. BMJ 2000;321(7259):483484CrossRefGoogle ScholarPubMed
Peiris, A.N.Sothmann, M.S.Hoffmana, R.G.Hennes, M.I.Wilson, C.R.Adiposity, fat distribution, and cardiovascular risk. Ann Int Med 1989;110:867872CrossRefGoogle ScholarPubMed
Pratt, L.Ford, D.Crum, R.Armenian, H.Gallo, J.Eaton, W.Depression, Psychotropic Medication, and Risk of Myocardial Infarction. Circulation 1996;94:31233129CrossRefGoogle ScholarPubMed
Ray, W.A.Chung, C.P.Murray, K.T.Hall, K.Stein, C.M.Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009;360(3):225235CrossRefGoogle ScholarPubMed
Rozanski, A.Blumenthal, J.A.Kaplan, J.Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:21922217CrossRefGoogle ScholarPubMed
Rubin, R.R.Ma, Y.Marrero, D.G.Peyrot, M.Barret-Conner, E.L.Kahn, al.Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the diabetes prevention program. Diabetes Care 2008;31:420426CrossRefGoogle ScholarPubMed
Saha, S.Chant, D.McGrath, J.A Systematic Review of Mortality in Schizophrenia. Arch Gen Psychiatry 2007;64:11231131CrossRefGoogle Scholar
Sahota, D.P.Knowler, W.Looker, H.Depression, diabetes and glycemic control in an American Indian Community. J Clin Psychiatry 2008;69(5):800809CrossRefGoogle Scholar
Sáiz Ruiz, J.Bobes García, J.Vallejo Ruiloba, J.Giner Ubago, J.García-Portilla González, M.P.Consensus on physical health of patients with schizophrenia from the Spanish Societies of Psychiatry and Biological Psychiatry. Actas Esp Psiquiatr 2008;36(5):251264Google ScholarPubMed
Scheen, A.J.De Hert, M.A.Abnormal glucose metabolism in patients treated with antipsychotics. Diabetes Metab 2007;33:169175CrossRefGoogle ScholarPubMed
Scheen, A.van Winkel, R.De Hert, M.Traitement neuroleptique et troubles metabolic. Med Mal Metabol 2008;2(6):593599Google Scholar
Simon, V.van Winkel, R.De Hert, M.Are weight gain and metabolic side-effects of atypical antipsychotics dose-dependent? A Literature review. J Clin Psychiatry 2009;70(7):10411050CrossRefGoogle ScholarPubMed
Smith, M.Hokins, D.Peveler, R.Holt, R.Woodward, M.Ismail, K.First- versus second generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 2008;192(6):406411CrossRefGoogle Scholar
Smith, R.C.Lindenmayer, J.P.Davis, J.M.Cornwell, J.Noth, K.Gupta, al.Cognitive and antismoking effects of varenicline in patients with schizophrenia or schizoaffective disorder. Schizophr Res 2009;110(1-3):149155CrossRefGoogle ScholarPubMed
Stahl, S.M.Mignon, L.Meyer, J.M.Which comes first: atypical antipsychotic treatment or cardiometabolic risk?. Acta Psychiatr Scand 2009;119(3):171179CrossRefGoogle ScholarPubMed
Stroup, T.S.Lieberman, J.A.McEvoy, J.P.Swartz, M.S.Davis, S.M.Rosenheck, al.Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic. Am J Psychiatry 2006;163(4):611622CrossRefGoogle ScholarPubMed
Stunkard, A.J.Myles, M.S.Allison, K.C.Depression and obesity. Biol Psychiatry 2003;54:330337Google ScholarPubMed
Surtees, P.G.Wainwright, N.W.J.Luben, R.N.Wareham, N.J.Bingham, S.A.Khaw, S.Depression and ischemic Heart Disease Mortality: Evidence From the EPIC-Norfolk United Kingdom Prospective Cohort Study. Am J Psychiatry 2008;165:515523CrossRefGoogle ScholarPubMed
Taxis, K.Schorr, S.Fouchier, M.Slooff, C.Bruggeman, R.Is it appropriate to use cardiovascular risk scores in patients with psychotic disorders?. Schizophr Res 2008;102(1-3):169CrossRefGoogle Scholar
Thakore, J.H.Richards, P.J.Reznek, R.H.Martin, A.Dinan, T.G.Increased intra-abdominal fat deposition in patients with major depressive illness as measured by computer tomography. Biol Psychiatry 1997;41:11401142CrossRefGoogle Scholar
Thakore, J.H.Mann, J.N.Vlahos, I.Martin, A.Reznek, R.H.Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia. Int J Obes 2002;26:137141CrossRefGoogle ScholarPubMed
Tiihonen, J.Wahlbeck, K.Lönnqvist, J.Klaukka, T.Ioannidis, J.P.Volavka, al.Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ 2006;333(7561):224 [Epub 2006 Jul 6]CrossRefGoogle Scholar
The international expert committee International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care 2009;32:1327L1334 doi: 10.2337/dc09-9033.CrossRefGoogle Scholar
Tschoner, A.Engl, J.Laimer, M.S.Rettenbacher, M.Fleischhacker, al.Metabolic side effects of antipsychotic medication. Int J Clin Pract 2007;61(8):13561370CrossRefGoogle ScholarPubMed
Tuomilehto, J.Lindström, J.Eriksson, J.G.Valle, T.T.Hämäläinen, al.Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344(18):13431350CrossRefGoogle ScholarPubMed
Ussher, M.H.Taylor, A.Faulkner, G.Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2008;4:CD002295Google Scholar
van Winkel, R.De Hert, M.Van Eyck, D.Hanssens, L.Wampers, M.Scheen, al.Screening for diabetes and other metabolic abnormalities in patients with schizophrenia and schizoaffective disorder: evaluation of incidence and screening methods. J Clin Psychiatry 2006;67(10):14931500CrossRefGoogle ScholarPubMed
van Winkel, R.De Hert, M.Wampers, M.Van Eyck, D.Hanssens, L.Scheen, al.Major changes in glucose metabolism including new-onset diabetes within 3 months after initiation or switch of atypical antipsychotic medication in patients with schizophrenia and schizoaffective disorder. J Clin Psychiatry 2008;69:472479CrossRefGoogle ScholarPubMed
van Winkel, R.De Hert, M.Van Eyck, D.Prevalence of diabetes and the metabolic syndrome in a sample of patients with bipolar disorder. Bipolar Disord 2008;10:342348CrossRefGoogle Scholar
van Winkel, R.van Os, J.Celic, I.Van Eyck, D.Wampers, M.Scheen, al.Psychiatric diagnosis as an independent risk factor for metabolic disturbance. Results from a comprehensive, naturalistic screening program. J Clin Psychiatry 2008;69(8):13191327CrossRefGoogle ScholarPubMed
Waterreus, A.J.Laugharne, J.D.Screening for the metabolic syndrome in patients receiving antipsychotic treatment: a proposed algorithm. Med J Aust 2009;190(4):185189CrossRefGoogle ScholarPubMed
World Health Organisation: Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia– Report of a WHO/IDF Consultation, 2006.Google Scholar
Wu, R.R.Zhao, J.P.Liu, Z.N.Zhai, J.G.Guo, X.F.Guo, al.Effects of typical and atypical antipsychotics on glucose-insulin homeostasis and lipid metabolism in first-episode schizophrenia. Psychopharmacology 2006;186(4):572578CrossRefGoogle ScholarPubMed
Wu, R.R.Zhao, J.P.Jin, H.Shao, P.Fang, M.S.Guo, al.Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain: a randomized controlled trial. JAMA 2008;299(2):185193CrossRefGoogle ScholarPubMed
Zimmermann, U.Kraus, T.Himmerich, H.Schuld, A.Pollmächer, T.Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res 2003;37:193220CrossRefGoogle ScholarPubMed
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