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The British Journal of Psychiatry (2004) 184: s72-S75
© 2004 The Royal College of Psychiatrists

Stress and the genesis of diabetes mellitus in schizophrenia

Timothy G. Dinan, MD PhD DSc FRCPsych

Department of Psychiatry, University College Cork

Correspondence: GF Unit, Cork University Hospital, Wilton, Cork, Ireland. E-mail: t.dinan{at}ucc.ie

Declaration of interest T.G.D. has lectured at meetings and served on advisory boards organised by companies promoting antipsychotic medications, including Eli Lilly, Janssen-Cilag, Pfizer and AstraZeneca.

Background 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.

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

Method Selective literature review.

Results 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.

Conclusions 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.




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Introduction
The British Journal of Psychiatry, April 1, 2004; 184(47): s53 - s54.
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