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PAPERS:
Emilio Fernandez-Egea, Miguel Bernardo, Thomas Donner, Ignacio Conget, Eduard Parellada, Azucena Justicia, Enric Esmatjes, Clemente Garcia-Rizo, and Brian Kirkpatrick
Metabolic profile of antipsychotic-naive individuals with non-affective psychosis
The British Journal of Psychiatry 2009; 194: 434-438 [Abstract] [Full text] [PDF]
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[Read eLetter] Metabolic profile of antipsychotic-naive individuals with non-affective psychosis
Jeshoor Kumar Jebadurai, Karim Dar, Consultant psychiatrist, Max Glatt Unit, CNWL NHS Foundation Trust, London.   (3 June 2009)

Metabolic profile of antipsychotic-naive individuals with non-affective psychosis 3 June 2009
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Jeshoor Kumar Jebadurai,
Speciality doctor, Max Glatt Unit, CNWL NHS Foundation Trust, London. ,
Karim Dar, Consultant psychiatrist, Max Glatt Unit, CNWL NHS Foundation Trust, London.

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Re: Metabolic profile of antipsychotic-naive individuals with non-affective psychosis

drjeshur{at}gmail.com Jeshoor Kumar Jebadurai, et al.

The study by Emilio FE et.al. is an intriguing paper attempting to explore the possible links between various risk factors ranging from prenatal stresses to poor physical health and the onset of diabetes in a drug naïve patients with non affective psychosis. This hypothesis is in its developmental stage and as the author emphasised, further research would be necessary to confirm it. I would like to highlight some of the limitations in this study.

According to the American Diabetic Association guidelines, impaired glucose tolerance was defined as 2 h glucose levels of 7.8 – 11.1 mmol/L on 75g oral glucose tolerance test, but in the psychosis group, the mean 2 h glucose was 6.10 mmol/L which was well within the normal range. Also, it could be an interesting finding, if the baseline measurement would be compared with a follow up measurement after 6- 12 months.

Secondly, the sample size of the psychosis group was small (n=50) and about a third of the population (n=15) consisted of other related disorders such as delusional disorder, schizophreniform disorder and brief psychotic disorder. Hence, this study supports the finding that related disorders also have a high risk of abnormal glucose tolerance. But other studies, which the author quoted, (Arranz B et al and Mukherjee et al) have confirmed impaired glucose tolerance in drug naive schizophrenic patients only and not in patients with other related disorders such as delusional disorders.

Thirdly, although the author has mentioned diet as a possible confounding factor, other variables such as exercise, life style and family history of diabetes are equally important.