Información del artículo
Abstract
People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed to an increased risk of the modifiable coronary heart disease risk factors, obesity, smoking, diabetes, hypertension, and dyslipidaemia. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain and further increase the risk of adverse metabolic effects which may result in further increased incidence of cardiovascular disease. Patients have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population.
The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) published this statement aiming to improve the care of patients suffering from severe mental illness. The intention is to initiate co-operation and shared care between the different health care professionals and to increase the awareness of psychiatrists caring for patients suffering from severe mental illness to screen and treat increased cardiovascular risk factors and diabetes.
Keywords:
Severe mental illness
Schizophrenia
Depression
Bipolar disorder
Physical health
Weight gain
Cardiovascular disease
Diabetes
Resumen
Comparativamente con la población general, la salud física de las personas con enfermedades mentales graves, como la esquizofrenia, la depresión o el trastorno bipolar, es peor y su esperanza de vida, menor. La mayor mortalidad cardiovascular en relación con la esquizofrenia y el trastorno bipolar se atribuye a un riesgo mayor de presentar factores de riesgo coronario modificables, obesidad, tabaquismo, diabetes, hipertensión y dislipemia. La medicación antipsicótica y, posiblemente, otros tipos de psicofármacos, como los antidepresivos, pueden inducir un aumento de peso y un riesgo mayor de efectos metabólicos adversos que incrementan la incidencia de enfermedades cardiovasculares. El acceso de estos pacientes a la atención sanitaria general es limitado y sus oportunidades de cribado y prevención del riesgo cardiovascular son menores que las esperables para la población no psiquiátrica.
La Asociación Psiquiátrica Europea (EPA), respaldada por la Asociación Europea para el Estudio de la Diabetes (EASD) y la Sociedad Europea de Cardiología (ESC), ha publicado esta declaración con el ánimo de mejorar la atención de los pacientes que sufren enfermedades mentales graves. Se pretende iniciar una cooperación y una atención conjunta entre los distintos profesionales sanitarios, así como mejorar la conciencia de los psiquiatras que atienden a enfermos mentales graves respecto a la detección sistemática y el tratamiento de esta mayor incidencia de factores de riesgo cardiovascular y de diabetes.
Palabras clave:
Enfermedad mental grave
Esquizofrenia
Depresión
Trastorno bipolar
Salud física
Aumento de peso
Enfermedad cardiovascular
Diabetes
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References
[1.]
American Association of Clinical Endocrinologists 2007. Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus. AACE Diabetes Mellitus Guidelines, Endocr Pract. 2007;13 Suppl 1:3–68.
[2.]
D.B. Allison, J.L. Mentore, M. Heo, L.P. Chandler, J.C. Cappelleri, M.C. Infante, et al.
Antipsychotic-induced weight gain: a comprehensive research synthesis.
Am J Psychiatry, 156 (1999), pp. 1686-1696
[3.]
American Diabetes Association. Standards of medical care in diabetes – 2008. Diabetes Care. 2008;31 Suppl 1:S12–S54.
[4.]
American Diabetes Association. Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Diabetes Care. 2004;27:596–601.
[5.]
American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2008;31 Suppl 1:S55–S60.
[6.]
F. Angst, H.H. Stassen, P.J. Clayton, J. Angst.
Mortality of patients with mood disorders: follow-up over 34–38 years.
J Affect Disord, 68 (2002), pp. 167-181
[7.]
C. Arango, J. Bobes, P. Aranda, R. Carmena, M. Garcia-Garcia, J. Rejas, on behalf of the CLAMORS Study Collaboratove Group.
A comparison of schizophrenia outpatients treated with antipsychotics with and without metabolic syndrome: Findings from the CLAMORS study.
Schizophr Res, 104 (2008), pp. 1-12
[8.]
A.H. Barnett, P. Mackin, I. Chaudhry, A. Farooqi, R. Gadsby, A. Heald, et al.
Minimising metabolic and cardiovascular risk in schizophrenia.
J Psychopharmacol, 21 (2007), pp. 357-373
[9.]
P. Bech, P.J. Vendsborg, O.J. Rafaelson.
Lithium maintenance treatment of manic-melancholic patients: its role in the daily routine.
Acta Psychiatr Scand, 53 (1976), pp. 70-81
[10.]
G.H. Berken, D.O. Weinstein, W.C. Stern.
Weight gain: a side effect of tricyclic antidepressants.
J Affect Disord, 7 (1984), pp. 133-138
[11.]
P. Bjorntorp.
Stress and cardiovascular disease.
Acta Physiol Scand Suppl, 640 (1997), pp. 144-148
[12.]
J. Bobes, C. Arango, P. Aranda, R. Carmena, M. Garcia-Garcia, J. Rejas, CLAMORS Study Collaboratove Group.
Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: results of the CLAMORS Study.
Schizophr Res, 90 (2007), pp. 162-173
[13.]
L.C. Brown, S.R. Majumdar, S.C. Newman, J.A. Johnson.
History of depression increases risk of type 2 diabetes in younger adults.
Diabetes Care, 28 (2005), pp. 1063-1067
[14.]
S. Brown.
Excess mortality of schizophrenia. A meta-analysis.
Br J Psychiatry, 171 (1997), pp. 502-508
[15.]
S. Brown, H. Inskip, B. Barraclough.
Causes of the excess mortality of schizophrenia.
Br J Psychiatry, 177 (2000), pp. 212-217
[16.]
P.F. Buckley, D.D. Miller, B. Singer.
Clinicians’ recognition of the metabolic adverse effects of antipsychotic medications.
Schizophr Res, 79 (2005), pp. 281-288
[17.]
R. Bruggeman, S. Schorr, K. van der Elst, M. Postma, K. Taxis.
Costeffectiveness of screening for diabetes in a cohort of patients with schizophrenia.
Schizophr Res, 102 (2008), pp. 161-162
[18.]
Canadian Diabetes Association. Clinical Practice Guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2008;32 Suppl 1:S1–S20.
[19.]
R.M. Capasso, T.W. Lineberry, J.M. Bostwick, P.A. Decker, J. St Sauver.
Mortality in schizophrenia and schizoaffective disorder: An Olmsted County, Minnesota cohort: 1950–2005.
Schizophr Res, 98 (2008), pp. 287-294
[20.]
M.R. Carnethon, M.L. Biggs, J.I. Barzilay, N.L. Smith, V. Vaccarino, A.G. Bertoni, et al.
Longitudinal Association Between Depressive Symptoms and Incident Type 2 Diabetes Mellitus in Older Adults. The Cardiovascular Health Study.
Arch Intern Med, 167 (2007), pp. 801-808
[21.]
D.E. Casey, D.W. Haupt, J.W. Newcomer, D.C. Henderson, M.J. Sernyak, M. Davidson, et al.
Antipsychotic-Induced Weight Gain and Metabolic Abnormalities: Implications for Increased Mortality in Patients With Schizophrenia.
J Clin Psychiatry, 65 (2004), pp. 4-18
[22.]
F. Cassidy, E. Ahearn, B.J. Carroll.
Elevated frequency of diabetes mellitus in hospitalized manic-depressive patients.
Am J Psychiatry, 156 (1999), pp. 1417-1420
[23.]
L. Citrome, D. Yeomans.
Do guidelines for severe mental illness promote physical health and well-being?.
J Psychopharmacol, 19 (2005), pp. 102-109
[24.]
L. Citrome.
Risk-Benefit Analysis of Available Treatments for Schizophrenia.
Psychiatric Times, 1 (2007), pp. 27-30
[25.]
T.A. Cohn, M.J. Sernyak.
Metabolic monitoring for patients treated with antipsychotic medications.
Can J Psychiatry, 51 (2006), pp. 492-501
[26.]
C.W. Colton, R.W. Manderscheid.
Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states.
Prev Chronic Dis, 3 (2006), pp. A42
[27.]
C.U. Correll, A.M. Frederickson, J.M. Kane, P. Manu.
Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs.
J Clin Psychiatry, 67 (2006), pp. 575-583
[28.]
C.U. Correll.
Balancing efficacy and safety in the treatment with antipsychotics.
CNS Spectr, 12 (2007), pp. 12-20
[29.]
C.U. Correll.
Assessing and maximizing the safety and tolerability of antipsychotics used in the treatment of children and adolescents.
J Clin Psychiatry, 69 (2008), pp. 26-36
[30.]
C.U. Correll, A.M. Frederickson, J.M. Kane, P. Manu.
Equally increased risk for metabolic syndrome in patients with bipolar disorder and schizophrenia treated with second-generation antipsychotics.
Bipolar Disord, 10 (2008), pp. 788-797
[31.]
G.P. Chrousos.
The role of stress and the hypothalamic-pituitaryadrenal axis in the pathogenesis of the metabolic syndrome: neuroendocrine and target tissue-related causes.
Int J Obes, 24 (2000), pp. S50-S55
[32.]
S.R. Daniels, F.R. Greer.
Lipid Screening and Cardiovascular Health in Childhood.
Pediatrics, 122 (2008), pp. 198-208
[33.]
G.L. Daumit, D.C. Goff, J.M. Meyer, V.G. Davis, H.A. Nasrallah, J.P. McEvoy, et al.
Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study.
Schizophr Res, 105 (2008), pp. 175-187
[34.]
M. De Hert, D. van Eyck, A. de Nayer.
Metabolic abnormalities associated with second generation antipsychotics: fact or fiction? Development of guidelines for screening and monitoring.
Int Clin Psychopharmacol, 21 (2006), pp. 11-15
[35.]
M. De Hert, R. van Winkel, D. van Eyck, L. Hanssens, M. Wampers, A. Scheen, et al.
Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study.
Clin Pract Epidemiol Ment Health, 2 (2006), pp. 14
[36.]
M. De Hert, D. Kalnicka, R.M. van Winkel, L. Hanssens, D. van Eyck, M. Wampers, et al.
Treatment with rosuvastatin for severe dyslipidemia in patients with schizophrenia and schizoaffective disorder.
J Clin Psychiatry, 67 (2006), pp. 1889-1896
[37.]
M. de Hert, B. Falissard, M. Mauri, K. Shaw, T. Wetterling.
Epidemiological study for the evaluation of metabolic disorders in patients with schizophrenia: The METEOR Study.
Eur Neuropsychopharmacol, 18 (2008), pp. S444
[38.]
M. de Hert, V. Schreurs, K. Sweers, D. van Eyck, L. Hanssens, S. Šinko, et al.
Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in firstepisode patients with schizophrenia: a retrospective chart review.
Schizophr Res, 101 (2008), pp. 295-303
[39.]
A. de Nayer, M. de Hert, A. Scheen, L. van Gaal, J. Peuskens.
Belgian consensus on metabolic problems associated with atypical antipsychotics.
Int J Clin Pract, 9 (2005), pp. 130-137
[40.]
B.G. Druss.
Improving medical care for persons with serious mental illness: challenges and solutions.
J Clin Psych, 68 (2007), pp. 40-44
[41.]
P. Falkai, T. Wobrock, J. Lieberman, B. Glenthoj, W.F. Gattaz, H.J. Möller.
WFSBP World Federation of Societies of Biological Psychiatry (WFSBP) Task Force on Treatment Guidelines for Schizophrenia. Guidelines for Biological Treatment of Schizophrenia, Part 1: Acute treatment of Schizophrenia.
World J Biol Psychiatry, 6 (2005), pp. 132-191
[42.]
N.G. Farouhi, B. Balkau, K. Borch-Johnsen, J. Dekker, C. Glumer, Q. Qiao, on behalf of EDEG, et al.
The threshold for diagnosing impaired fasting glucose: a position statement by the European Diabetes Epidemiology Group.
Diabetologia, 49 (2006), pp. 822-827
[43.]
G. Faulkner, A.A. Soundy, K. Lloyd.
Schizophrenia and weight management: a systematic review of interventions to control weight.
Acta Psychiatrica Scandinavica, 108 (2003), pp. 324-332
[44.]
G. Faulkner, T.A. Cohn.
Pharmacologic and nonpharmacologic strategies for weight gain and metabolic disturbance in patients treated with antipsychotic medications.
Can J Psychiatry, 51 (2006), pp. 502-511
[45.]
W.S. Fenton, E.S. Stover.
Mood disorders: cardiovascular and diabetes comorbidity.
Curr Opin Psychiatry, 19 (2006), pp. 421-427
[46.]
W.W. Fleischhacker, M. Cetkovich-Bakmas, M. de Hert, C. Hennekens, M. Lambert, S. Leucht, et al.
Cormorbid somatic illnesses in patients with severe mental disorders: clinical, policy and research challenges.
J Clin Psychiatry, 69 (2008), pp. 514-519
[47.]
Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur J Cardiovasc Prevent Rehabil. 2007;14 Suppl 2:E1-E40.
[48.]
D.C. Goff, L.M. Sullivan, J.P. McEvoy, J. Meyer, H. Nasrallah, G. Daumit, et al.
A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls.
Schizophr Res, 80 (2005), pp. 45-53
[49.]
P.M. Haddad, S.G. Sharma.
Adverse effects of atypical antipsychotics; Differential Risk and Clinical Implications.
CNS Drugs, 21 (2007), pp. 911-936
[50.]
L. Hanssens, M. de Hert, D. Kalnicka, R. van Winkel, M. Wampers, D. Van Eyck, et al.
Pharmacological treatment of severe dyslipidaemia in patients with schizophrenia.
Int Clin Psychopharmacol, 22 (2007), pp. 43-49
[51.]
D.C. Henderson.
Schizophrenia and comorbid metabolic disorders.
J Clin Psychiatry, 66 (2005), pp. 11-20
[52.]
C.H. Hennekens.
Schizophrenia and increased risks of cardiovascular disease.
Am Heart J, 151 (2005), pp. 598-603
[53.]
I. Heuser.
The hypothalamic-pituitary-adrenal system in depression.
Pharmacopsychiatry, 31 (1998), pp. 10-13
[54.]
S. Hill Golden, M. Lazo, M. Carnethon, A.G. Bertoni, P.J. Schreiner, A. Dieze Roux, et al.
Examining a Bidirectional Association Between Depressive Symptoms and Diabetes.
JAMA, 299 (2008), pp. 2751-2759
[55.]
K.G. Kahl, M. Bester, W. Greggersen, S. Rudolf, L. Dibbelt, et al.
Visceral fat disposition and insulin sensitivity in depressed women with and without borderline personality disorder.
Psychosom Med, 67 (2005), pp. 407-412
[56.]
R.S. Kahn, W.W. Fleischhacker, H. Boter, M. Davidson, Y. Vergouwe, I. Keet, et al.
Effectiveness of antipsychotic drugs in firstepisode schizophrenia and schizophreniform disorder: an open randomised clinical trial.
Lancet, 371 (2008), pp. 1085-1097
[57.]
W.J. Katon.
The comorbidity of diabetes and depression.
Am J Med, 121 (2008), pp. S8-S15
[58.]
L.S. Kinder, M.R. Carnethon, L.P. Palaniappan, A.C. King, S.P. Fortmann.
Depression and the metabolic syndrome in young adults: Findings from the Third National Health and nutrition Examination Survey.
Psychosom Med, 66 (2004), pp. 316-322
[59.]
B.J. Kinon, C.J. Kaiser, S. Ahmed, M. Roteli, S. Kolloack-Walker.
Association between early and rapid weight gain and change in weight over one year of olanzapine therapy in patients with schizophrenia and related disorders.
J Clin Psychopharmacol, 25 (2005), pp. 255-258
[60.]
A.H. Kissebah.
Intra-abdominal fat: is it a major factor in developing diabetes and coronary artery disease?.
Diab Res Clin Pract, (1996), pp. S25-S30
[61.]
S. Kumra, J.V. Oberstar, L. Sikich, R. Findling, J. McClellan, S. Vinogradoc, et al.
Efficacy and Tolerability of Second-Generation Antipsychotics in Children and Adolescents With Schizophrenia.
Schizophr Bull, 34 (2008), pp. 60-71
[62.]
D.M. Lawrence, C.D. Holman, A.V. Jablensky, M.S. Hobbs.
Death rate from ischemic heart disease in Western Australian psychiatric patients 1980–1998.
Br J Psychiatry, 182 (2003), pp. 31-36
[63.]
S. Leucht, T. Burkard, J. Henderson, M. Maj, N. Sartorius.
Physical illness and schizophrenia.
Acta Psychiatr Scand, 116 (2007), pp. 317-333
[64.]
P. Mackin, D. Bishop, H. Watkinson.
A prospective study of monitoring practices for metabolic disease in antipsychotictreated community psychiatric patients.
BMC Psychiatry, 25 (2007), pp. 7-28
[65.]
G. Maina, V. Salvi, A. Vitalucci, V. D’Ambrosio, F. Bogetto.
Prevalence and correlates of overweight in drug-naive patients with bipolar disorders.
J Affect. Disord, 110 (2008), pp. 149-155
[66.]
G. Mancia, G. de Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germono, et al.
guidelines for the management of arterial hypertension.
Eur Heart J, 28 (2007), pp. 1462-1536
[67.]
S.R. Marder, S.M. Essock, A.L. Miller, R.W. Buchanan, D.E. Casey, J.M. Davis, J.M. Kane, et al.
Physical health monitoring of patients with schizophrenia.
Am J Psychiatry, 161 (2004), pp. 1334-1349
[68.]
R.S. McIntyre, J.K. Sozcynska, J.Z. Konarski, S.H. Kennedy.
The effect of antidepressants on glucose homeostasis and insulin sensitivity: synthesis and mechanisms.
Expert Opin Drug Saf, 5 (2006), pp. 157-168
[69.]
J.M. Meyer, V.G. Davis, D.C. Goff, J. McEvoy, H. Nasrallah, S. Davis, et al.
Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: Prospective data from phase 1.
Schizophr Res, 101 (2008), pp. 273-286
[70.]
H.A. Nasrallah, J.M. Meyer, D.C. Goff, J.P. McEvoy, S.M. Davis, T.S. Stroup, et al.
Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline.
Schizophr Res, 86 (2006), pp. 15-22
[71.]
H.A. Nasrallah.
Atypical antipsychotic-induced metabolic side effects: insights from receptor-binding profiles.
Mol Psychiatry, 13 (2008), pp. 27-35
[72.]
D.M. Nathan, J.B. Buse, M.B. Davidson, E. Ferrannini, R.R. Holman, R. Sherwin, et al.
Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes.
Diabetologia, 52 (2009), pp. 17-30
[73.]
J.W. Newcomer, H.A. Nasrallah, A.D. Loebel.
The atypical antipsychotic therapy and metabolic issues national survey.
Journal of Clinical Psychopharmacology, 24 (2004), pp. 1-6
[74.]
J.W. Newcomer.
Second-Generation (Atypical) Antipsychotics and Metabolic Effects. A Comprehensive Literature Review.
CNS Drugs, 19 (2005), pp. 1-93
[75.]
J.W. Newcomer.
Antipsychotic medications: metabolic and cardiovascular risk.
J Clin Psychiatry, 68 (2007), pp. 8-13
[76.]
NICE. Schizophrenia Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. 2008; online.http://www.nice.org.uk/guidance/index.jsp?action=download&o=42139
[77.]
U. Ösby, N. Correia, L. Brandt, A. Ekbom, P. Sparen, et al.
Mortality and causes of death in schizophrenia in Stockholm county, Sweden.
Schizophr Res, 45 (2000), pp. 21-28
[78.]
U. Ösby, N. Correia, L. Brandt, A. Ekbom, P. Sparen.
Time trends in schizophrenia mortality in Stockholm County, Sweden: cohort study.
BMJ, 321 (2000), pp. 483-484
[79.]
A.N. Peiris, M.S. Sothmann, R.G. Hoffmana, M.I. Hennes, C.R. Wilson.
Adiposity, fat distribution, and cardiovascular risk.
Ann. Int. Med, 110 (1989), pp. 867-872
[80.]
A. Rozanski, J.A. Blumenthal, J. Kaplan.
Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy.
Circulation, 99 (1999), pp. 2192-2217
[81.]
R.R. Rubin, D.G. Marrero, M. Peyrot, et al.
Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the diabetes prevention program.
Diabetes Care, 31 (2008), pp. 420-426
[82.]
S. Saha, D. Chant, J. McGrath.
A Systematic Review of Mortality in Schizophrenia.
Arch Gen Psychiatry, 64 (2007), pp. 1123-1131
[83.]
D.P. Sahota, W. Knowler, H. Looker.
Depression, diabetes and glycemic control in an American Indian Community.
J Clin Psychiatry, (2008), pp. e1-e10
[84.]
A.J. Scheen, M.A. De Hert.
Abnormal glucose metabolism in patients treated with antipsychotics.
Diabetes & Metab, 33 (2007), pp. 169-175
[85.]
A. Scheen, R. van Winkel, M. de Hert.
Traitement neuroleptique et troubles metabolic.
Méd Mal Métabol, 2 (2008), pp. 1-7
[86.]
Simon V, van Winkel R, De Hert M. Are weight gain and metabolic side-effects of atypical antipsychotics dose-dependent? A Literature review. J Clin Psychiatry 2009;in press.
[87.]
M. Smith, D. Hokins, R. Peveler, R. Holt, M. Woodward, K. Ismail.
First- versus second generation antipsychotics and risk for diabetes in schizophrenia: systematic review and metaanalysis.
Br J Psychiatry, 192 (2008), pp. 406-411
[88.]
A.J. Stunkard, M.S. Myles, K.C. Allison.
Depression and obesity.
Biol Psychiatry, 54 (2003), pp. 330-337
[89.]
P.G. Surtees, N.W.J. Wainwright, R.N. Luben, N.J. Wareham, S.A. Bingham, et al.
Depression and ischemic Heart Disease Mortality: Evidence From the EPIC-Norfolk United Kingdom Prospective Cohort Study.
Am J Psychiatry, 165 (2008), pp. 515-523
[90.]
J.H. Thakore, P.J. Richards, R.H. Reznek, A. Martin, T.G. Dinan.
Increased intra-abdominal fat deposition in patients with major depressive illness as measured by computer tomography.
Biol Psychiatry, 41 (1997), pp. 1140-1142
[91.]
J.H. Thakore, J.N. Mann, I. Vlahos, A. Martin, R.H. Reznek.
Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia.
Int J Obes, 26 (2002), pp. 137-141
[92.]
K. Taxis, S. Schorr, M. Fouchier, C. Slooff, R. Bruggeman.
Is it appropriate to use cardiovascular risk scores in patients with psychotic disorders?.
Schizophr Res, 102 (2008), pp. 169
[93.]
A. Tschoner, J. Engl, M.S. Laimer, M. Rettenbacher, W. Fleischhacker, et al.
Metabolic side effects of antipsychotic medication.
Int J Clin Pract, 61 (2007), pp. 1356-1370
[94.]
R. van Winkel, M. de Hert, D. van Eyck, L. Hanssens, M. Wampers, A. Scheen, et al.
Screening for diabetes and other metabolic abnormalities in patients with schizophrenia and schizoaffective disorder: evaluation of incidence and screening methods.
J Clin Psychiatry, 67 (2006), pp. 1493-1500
[95.]
R. van Winkel, M. de Hert, M. Wampers, D. van Eyck, L. Hanssens, A. Scheen, et al.
Major changes in glucose metabolism including new-onset diabetes within 3 months after initiation or switch of atypical antipsychotic medication in patients with schizophrenia and schizoaffective disorder.
J Clin Psychiatry, 69 (2008), pp. 472-479
[96.]
R. van Winkel, M. de Hert, D. van Eyck.
Prevalence of diabetes and the metabolic syndrome in a sample of patients with bipolar disorder.
Bipolar Disord, 10 (2008), pp. 342-348
[97.]
R. van Winkel, J. van Os, I. Celic, D. van Eyck, M. Wampers, A. Scheen, et al.
Psychiatric diagnosis as an independent risk factor for metabolic disturbance. Results from a comprehensive, naturalistic screening program.
J Clin Psychiatry, 69 (2008), pp. 1319-1327
[98.]
World Health Organisation: Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia – Report of a WHO/ IDF Consultation, 2006.
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