Diabetes and the Metabolic Syndrome in Mental Health PDF
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Rosen_FM_i-xiv.qxd 1/30/08 2:30 PM Page i Diabetes and the Metabolic Syndrome in Mental Health Rosen_FM_i-xiv.qxd 1/30/08 2:30 PM Page ii Rosen_FM_i-xiv.qxd 1/30/08 2:30 PM Page iii Diabetes and the Metabolic Syndrome in Mental Health E D I T O R S Jennifer A. Rosen, Pharm.D., BCPP Clinical Pharmacist in Psychiatry VA Long Beach Healthcare System Long Beach, California Donna A. Wirshing, M.D. Attending Psychiatrist VA Greater Los Angeles Healthcare System Los Angeles, California Rosen_FM_i-xiv.qxd 2/1/08 12:00 PM Page iv Acquisitions Editor: Charles W. Mitchell Managing Editor: Sirkka E. Howes Project Manager: Jennifer Harper Manufacturing Coordinator: Kathleen Brown Marketing Manager: Kimberly Schonberger Design Coordinator: Steve Druding Production Services: International Typesetting and Composition © 2008 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business 530 Walnut Street Philadelphia, PA 19106 USA LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in the USA Library of Congress Cataloging-in-Publication Data Diabetes and the metabolic syndrome in mental health / editors, Jennifer A. Rosen, Donna A. Wirshing. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-7817-8270-8 (alk. paper) ISBN-10: 0-7817-8270-8 (alk. paper) 1. Diabetes. 2. Metabolism—Disorders. 3. Mentally ill—Diseases. I. Rosen, Jennifer A. II. Wirshing, Donna. [DNLM: 1. Diabetes Mellitus. 2. Mentally Ill Persons. WK 810 D53752537 2008] RC660.D4493 2008 616.4'62—dc22 2007050598 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regula- tions, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638- 3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10 9 8 7 6 5 4 3 2 1 Rosen_FM_i-xiv.qxd 1/30/08 2:30 PM Page v We would like to dedicate this book to our patients, who serve as our daily inspiration. Rosen_FM_i-xiv.qxd 1/30/08 2:30 PM Page vi Rosen_FM_i-xiv.qxd 2/1/08 12:00 PM Page vii C O N T E N T S Preface ix Contributors xi 1 Diabetes and Mental Health 1 Jacob S. Ballon and Jamie W. Fernandez 2 The Cost of Diabetes 15 Gale Z. Feldman 3 The Risk of Litigation 43 Jeremy M. Wilkinson 4 Psychotropic Medications and Metabolic Disorders 49 Cara F. Adamson Greene and Jennifer A. Rosen 5 Interventions 85 Jennifer A. Rosen, Arlene E. Johns, Shahla S. Cano, and Eda Vesterman 6 The Management of Diabetes in Patients with Mental Illness 111 Vasanthi L. Narayan and Jane E. Weinreb Appendix: Patient Education Handouts 131 Index 135 vii Rosen_FM_i-xiv.qxd 1/30/08 2:30 PM Page viii Rosen_FM_i-xiv.qxd 1/30/08 2:30 PM Page ix P R E F A C E Over the years, my patients have been my greatest teachers. This book is ded- icated to these great teachers. When I think of the challenges of living with mental illness and diabetes, I think of Michael, my first teacher. Michael was one of my very first patients on an inpatient psychiatric ward. He was a man with schizophrenia and very advanced diabetes. I first met him in the kidney dialysis unit of our hospital, where I was called to see him because he was ter- ribly depressed, suicidal, and refusing treatment. The diabetes had also caused him to become blind and to lose one of his legs. He was wheelchair-bound in a dark, confusing world. After I spoke with him, he resolved to allow himself to undergo dialysis. Michael taught me about the extraordinary challenge of facing both life-threatening psychiatric and medical conditions. Here, I became immersed in the challenge the medical and psychiatric teams to pro- vide uncomfortable, yet necessary treatment—dialysis to a blind man whose mind was ravaged by paranoia and auditory hallucinations. I thought Michael’s resolve to remain in treatment was quite extraordi- nary. I was equally impressed by the care of the nurses and physicians in the dialysis unit who humored him through these difficult sessions. With the excellent collaborative care he received, Michael lived for 10 years following my first meeting with him, but I often wondered, at what cost, and with what quality of life? What could have been done differently to prevent this series of events that resulted in such discomfort and cost to Michael, to his family, and to society? The epidemic of diabetes has affected the entire United States and it has not excluded the many patients with severe mental illness. This epidemic is costing the nation billions of dollars in direct and indirect costs, resulting in a huge public health crisis. It is estimated that 7% of the people in the United States have diabetes, and that another 7% are undiagnosed. In 2005, 1.5 million new cases of dia- betes were diagnosed in people over 20 years of age. The epidemic in children is even more of a concern. It is estimated that 1 in 3 children born in the year 2000 will develop diabetes, and that one in two Hispanic children born that year will develop diabetes.1 In this book, we will explore the prevalence of diabetes in patients with mental illnesses and the role of cortisol in relation to diabetes. We will discuss the costs related to the treatment of diabetes and its comorbidities, and the legal ramifications doctors must consider when prescribing medications that may potentially worsen or precipitate new-onset diabetes. We will also review the relationship between various pharmacotherapies used to treat psychiatric disorders that may impact and actually cause new-onset diabetes and other metabolic disorders, either directly or indirectly, by contributing to obesity. ix Rosen_FM_i-xiv.qxd 3/17/08 3:16 PM Page x x Preface Our research group was among the first in the field to identify a possible link between the development of obesity, diabetes, and other metabolic derangements (e.g., lipid abnormalities) and the use of newer, second- generation antipsychotic medications. We will review the scientific literature on this particular subject, as well as discuss the association between antide- pressants and mood stabilizers, and diabetes. Finally, we will elaborate on the latest research in regards to the preven- tion and management of obesity and diabetes in patients with severe mental illness. We provide the reader with resources to help patients who suffer from these comorbidities. We hope that this will be a useful resource for clinicians treating mentally ill patients with diabetes, so that clinicians can learn more about diabetes, as well as about the link between mental illness, its pharmacotherapies, and dia- betes. Ultimately, we hope that this book will serve as a tool for prevention of diabetes and the devastating incapacitation of blindness, kidney failure, and limb loss that my very first patient with schizophrenia endured. We do not expect a psychiatrist to become an endocrinologist, or an endocrinologist to become a psychiatrist, but we do hope that this book can help with the col- laborative process needed to provide comprehensive medical care to patients like Michael, challenged by both diseases. 1. Facing the diabetes epidemic-mandatory reporting of glycosylated hemo- globin values in New York City. New Engl Journal Med. 2006;354(6): 545–548. Donna A. Wirshing M.D.
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