The British Journal of Psychiatry
Psychiatric Disorders and Diabetes Mellitus
David P. Osborn

The chapter order in this diabetes book is a sign of the times. After a brief overview of diabetes for psychiatrists, the editors dive straight into schizophrenia. Ten years ago psychotic illnesses would have barely attracted a mention. In 2007, the adverse effects of the second generation antipsychotics have propelled schizophrenia to headline status. It’s aimed at mental health professionals and is a practical, clinical text. The role of antipsychotics and non-pharmacological factors in generating diabetes in severe mental illness are covered proportionately (although the relative public health burdens of these different factors are not teased out).

The more familiar ground linking diabetes with depression, cognitive impairment and sexual dysfunction are explored chapter by chapter with a judicious combination of research evidence and clinical recommendations. We have known that these conditions overlap for years, yet their combination continues to lead to worse physical and psychiatric outcomes, and management is frequently inadequate. The commonality between diabetic and psychiatric management principles is striking, with both relying heavily on multi-disciplinary biopsychosocial approaches. These are well reflected throughout this book with separate chapters devoted to diet and exercise interventions as well as psychosocial therapies. The final chapter says it all; we still need to develop and evaluate coherent services which address both mental health and physical needs. Despite the maturity of liaison psychiatry as a discipline, holistic approaches to the mental health needs of people with diabetes, and vice versa, have a long way to go. A variety of approaches are outlined with an emphasis on working with primary care. The book is a helpful ally in the struggle to overcome this age-old and artificial dichotomy between physical and mental health. It is an easy informative read, without being superficial. Sure, its Americocentric (for instance in its frequent use of serum levels in mg/dl rather than mmol/l) but that should not put anyone off. It is a good refresher text on basic diabetes and psychopharmacology as well as incorporating the latest evidence on effective interventions. The main emphasis of the book is a consistent approach to both diabetes and mental health, and that emphasis has international resonance.