Although recent research has focused on the possible role of antipsychotic medications in the development of diabetes mellitus, studies conducted in the pre-neurolepticera suggest that schizophrenia itself might predispose individuals to diabetes.

To test the hypothesis that diabetes mellitus is an integral part of schizophrenia.

Historical literature review.

Many people with severe mental illnesses, including dementia praecox, showed abnormal responses to insulin and diabetes-like glucose tolerance curves long before the advent of phenothiazines. Early studies with chlorpromazine suggested that a latent tendency towards diabetes in patients with schizophrenia could be unmasked by this treatment.

Diabetes and disturbed carbohydrate metabolism maybe an integral part of schizophrenia. Further research is required to explain how metabolic factors, medications and lifestyle factors might precipitate diabetes in patients with this mental disorder.

A number of studies have examined the prevalence of diabetes mellitus and impaired glucose tolerance in general populations and in those with schizophrenia and other forms of serious mental illness.

To establish whether it is possible to describe accurately comparative rates of diabetes mellitus and impaired glucose tolerance in populations of people with schizophrenia and those without mental illness.

Review of current literature.

Research published in the pre-neuroleptic era suggested that people with severe mental illness were at increased risk of developing glycaemic abnormalities. Recent studies appear to confirm that the prevalence of diabetes and impaired glucose tolerance may be higher in people with schizophrenia than in the general population, and suggest that patients with schizophrenia have impaired glucose tolerance even before they begin treatment.

Schizophrenia may be a significant and independent risk factor for both diabetes and impaired glucose tolerance. Current data preclude precise estimates of the prevalence of these conditions among people with schizophrenia.

To date, no study has used standardised diagnostic assessment procedures to determine whether rates of perinatal depression vary across cultures.

To adapt the Structured Clinical Interview for DSM–IV Disorders (SCID) for assessing depression and other non-psychotic psychiatric illness perinatally and to pilot the instrument in different centres and cultures.

Assessments using the adapted SCID and the Edinburgh Postnatal Depression Scale were conducted during the third trimester of pregnancy and at 6 months postpartum with 296 women from ten sites in eight countries. Point prevalence rates during pregnancy and the postnatal period and adjusted 6-month period prevalence rates were computed for caseness, depression and major depression.

The third trimester and 6-month point prevalence rates for perinatal depression were 6.9% and 8.0%, respectively. Postnatal 6-month period prevalence rates for perinatal depression ranged from 2.1% to 31.6% across centres and there were significant differences in these rates between centres.

Study findings suggest that the SCID was successfully adapted for this context. Further research on determinants of differences inprevalence of depression across cultures isneeded.

There is evidence that stressors may trigger the onset of a depressive episode in vulnerable women. A new UK interview measure, the Contextual Assessment of the Maternity Experience (CAME), was designed to assess major risk factors for emotional disturbances, especially depression, during pregnancy and post-partum.

Within the context of a cros-scultural study, to establish the use fulness of the CAME, and to test expected associations of the measure with characteristics of the social context and with major or minor depression.

The CAME was administered antenatally and postnatally in ten study sites, respectively to 296 and 249 women. Affective disorder throughout pregnancy and upto 6 month spostnatally was assessed by means of the Structured Clinical Interview for DSM–IV Axis I Disorders.

Adversity, poor relationship with either a partner or a confidant, and negative feelings about the pregnancy all predicted onset of depression during the perinatal period.

The CAME was able to assess major domains relevant to the psychosocial context of the maternity experience in different cultures. Overall, the instrument showed acceptable psychometric properties in its first use in different cultural settings.

The incidence of diabetes mellitus is higher in patients with schizophrenia than in the general population. Antipsychotic drugs have been implicated in the development of diabetes, but as non-medicated patients with schizophrenia have high rates of diabetes it is likely that factors other than medication are involved.

To examine the role of stress in the emergence of diabetes mellitus in patients with schizophrenia.

Selective literature review.

A model is developed suggesting that patients with schizophrenia show overactivation of both the hypothalamic–pituitary–adrenal and sympathoadrenal medullary axes, manifested by increased production of cortisol and adrenaline. Both of these hormones are known to be diabetogenic and are proposed as playing a part in the onset of diabetes mellitus in schizophrenia.

Stress has an important role in the onset of schizophrenia and may also play a part in relapse. Further research is needed to clarify the extent to which stress accounts for the genesis of diabetes in such patients.