The relationship between schizophrenia and diabetes mellitus has been recognized in case reports since the end of the nineteenth century (Holt, Bushe, & Citrome, 2005). More recent data suggest that diabetes, obesity, and the metabolic syndrome are 1.5–2 times more common in patients with schizophrenia than in the general population (American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, & North American Association for the Study of Obesity, 2004; Henderson, 2005). Although the mechanisms of this relationship are not clearly understood, a combination of genetic and environmental factors (e.g., sedentary lifestyle, poor diet, and side effects of antipsychotic medications) may play a role in the high prevalence of metabolic dysregulation in this population (Citrome, 2004; Cohn, Prud’homme, Streiner, Kameh, & Remington, 2004; Henderson, Cagliero et al., 2006; De Hert et al., 2006; Lamberti et al., 2004; McEvoy et al., 2005). While some increased risk may be attributed to standard risk patterns (i.e., 17–50% of people with schizophrenia have a family history of diabetes; Mukherjee, Schnur, & Reddy, 1989), the high rates of obesity in patients with schizophrenia (Marder et al., 2004) may also contribute to increased risk, due, in part, to the relative weight gain liabilities of second-generation antipsychotics (Newcomer, 2005).
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, & North American Association for the Study of Obesity. (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care, 27, 596–601.
Anderson, R. M., Funnell, M. M., Fitgerald, J. T., & Marrero, D. G. (2000). The diabetes empowerment scale: A measure of psychosocial self-efficacy. Diabetes Care, 23, 739–743.
Archie, S., Wilson, J. H., Osbourne, S., Hobbs, H., & McNiven, J. (2003). Pilot study: Access to fitness facility and exercise levels in olanzapine-treated patients. Canadian Journal of Psychiatry, 48, 628–632.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.
Bandura, A. (1989). Perceived self-efficacy. In V. Mays, G. Albee, & S. Schneider (Eds.), Primary prevention of AIDS: Psychological approaches. Newbury Park, CA: Sage.
Bartels, S. J., Forester, B., Mueser, K. T., Miles, K. M., Dums, A. R., Pratt, S. I., et al. (2004). Enhanced skills training and health care management for older persons with severe mental illness. Community Mental Health Journal, 40, 75–90.
Brar, J. S., Ganguli, R., Pandina, G., Turkoz, I., Berry, S., & Mahmoud, R. (2005). Effects of behavior therapy on weight loss in overweight and obese patients with schizophrenia or schizoaffective disorder. Journal of Clinical Psychiatry, 66, 205–212.
Brown, S., Birtwistle, J., Roe, L., & Thompson, C. (1999). The unhealthy lifestyle of people with schizophrenia. Psychological Medicine, 29, 697–701.
Citrome, L. (2004). The increase in risk of diabetes mellitus from exposure to second-generation antipsychotic agents. Drugs Today (Barc), 40, 445–464.
Cohn, T., Prud’homme, D., Streiner, D., Kameh, H., & Remington, G. (2004). Characterizing coronary heart disease risk in chronic schizophrenia: High prevalence of the metabolic syndrome. Canadian Journal of Psychiatry, 49, 753–760.
Council on Scientific Affairs. (1991). Hispanic health in the United States. Journal of the American Medical Association, 265, 248–252.
Daumit, G. L., Goldberg, R. W., Anthony, C., Dickerson, F., Brown, C. H., Kreyenbuhl, J., et al. (2005). Physical activity patterns in adults with severe mental illness. Journal of Nervous and Mental Disease, 193, 641–646.
Davidson, S., Judd, F., Jolley, D., Hocking, B., Thompson, S., & Hyland, B. (2001). Cardiovascular risk factors for people with mental illness. Australian and New Zealand Journal of Psychiatry, 35, 196–202.
De Hert, M. A., van Winkel, R., van Eyck, D., Hanssens, L., Wampers, M., Scheen, A., et al. (2006). Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophrenia Research, 83, 87–93.
Dickerson, F. B., Brown, C. H., Daumit, G. L., Lijuan, F., Goldberg, R. W., Wohlheiter, K., et al. (2006). Health status of individuals with serious mental illness. Schizophrenia Bulletin, 32, 584–589.
Elyer-Zorrilla, L. T., Heaton, R. K., McAdams, L. A., Zisook, S., & Jeste, D. V. (2000). Cross-sectional study of older outpatients with schizophrenia and healthy comparison subjects: No difference in age-related cognitive decline. American Journal of Psychiatry, 157, 1324–1326.
Evans, S., Newton, R., & Higgins, S. (2005). Nutritional intervention to prevent weight gain in patients commenced on olanzapine: A randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 39, 479–486.
Faulkner, G., Soundy, A. A., & Lloyd, K. (2003). Schizophrenia and weight management: A systematic review of interventions to control weight. Acta Psychiatrica Scandinavica, 108, 324–332.
Fitzgerald, J. T., Davis, W. K., Connell, C. M., Hess, G. E., Funnell, M. M., & Hiss, R. G. (1996). Development and validation of the diabetes care profile. Evaluation and the Health Professions, 19, 208–230.
Fitzgerald, J. T., Anderson, R. M., Funnell, M. M., et al. (1998). The reliability and validity of a brief diabetes knowledge test. Diabetes Care, 21, 706–710.
Fuller, R., Nopoulos, P., Arndt, S., O’Leary, D., Ho, B. C., & Andreasen, N. C. (2002). Longitudinal assessment of premorbid cognitive functioning in patients with schizophrenia through examination of standardized scholastic test performance. American Journal of Psychiatry, 159, 1183–1189.
Harmatz, M. G., & Lapuc, P. (1968). Behavior modification of overeating in a psychiatric population. Journal of Consulting and Clinical Psychology, 32, 583–587.
Harvey, P. D., Moriarty, P. J., Friedman, J. I., White, L., Parrella, M., Mohs, R. C., et al. (2000). Differential preservation of cognitive functions in geriatric patients with lifelong chronic schizophrenia: Less impairment in reading compared with other skill areas. Society of Biological Psychiatry, 47, 962–968.
Hayes, R. L., & O’Grady, B. M. (2003). Do people with schizophrenia comprehend what they read? Schizophrenia Bulletin, 29, 499–507.
Henderson, D. C. (2005). Schizophrenia and comorbid medical disorders. Journal of Clinical Psychiatry, 66, 11–20.
Henderson, D. C., Cagliero, E., Copeland, P. M., Borba, C. P., Ervins, E., Hayden, D., et al. (2005). Glucose metabolism in patients with schizophrenia treated with atypical antipsychotic agents: A frequently sampled intravenous glucose tolerance test and minimal model analysis. Archives of General Psychiatry, 62, 19–28.
Henderson, D. C., Nguyen, D. D., Copeland, P. M., Hayden, D. L., Borba, C. P., Louie, et al. (2005). Clozapine, diabetes mellitus, hyperlipidemia, and cardiovascular risks and mortality: Results of a 10-year naturalistic study. Journal of Clinical Psychiatry, 66, 1116–1121.
Holt, R. I., Bushe, C., & Citrome, L. (2005). Diabetes and schizophrenia 2005: Are we any closer to understanding the link? Journal of Psychopharmacology, 19, 56–65.
Jablensky, A., McGrath, J., Herrman, H., Castle, D., Gureje, O., Morgan, V., et al. (1999). People living with psychotic illness: An Australian study 1997–98. Commonwealth of Australia.
Kopelowicz, A., Zarate, R., Gonzalez Smith, V., Mintz, J., & Liberman, R. P. (2003). Disease management in Latinos with schizophrenia: A family-assisted, skills training approach. Schizophrenia Bulletin, 29, 211–217.
Lamberti, J. S., Crilly, J. F., Maharaj, K., Olson, D., Wiener, K., Dvorin, S., et al. (2004). Prevalence of diabetes mellitus among outpatients with severe mental disorders receiving atypical antipsychotic drugs. Journal of Clinical Psychiatry, 65, 702–706.
Leslie, D. L., & Rosenheck, R. A. (2004). Incidence of newly diagnosed diabetes attributable to atypical antipsychotic medications. American Journal of Psychiatry, 161, 1709–1711.
Lindamer, L., McKibbin, C. L., Jin, H., Ueki, K., & Jeste, D. V. (2006). Physical activity in middle-age and older patients with schizophrenia. Paper Presented at the meeting of the American Association for Geriatric Psychiatry, San Juan, Puerto Rico.
Littrell, K. H., Hilligoss, N. M., Kirshner, C. D., Petty, R. G., & Johnson, C. G. (2003). The effects of an educational intervention on antipsychotic-induced weight gain. Journal of Nursing Scholarship, 35, 237–241.
Loh, C., Meyer, J. M., & Leckband, S. G. (2006). A comprehensive review of behavioral interventions for weight management in schizophrenia. Annals of Clinical Psychiatry, 18, 18–31.
Marder, S. R., Essock, S. M., Miller, A. L., Buchanan, R. W., Casey, D. E., Davis, J. M., et al. (2004). Physical health monitoring of patients with schizophrenia. American Journal of Psychiatry, 161, 1334–1349.
Mausbach, B. T., Bucardo, J., Cardenas, V., McKibbin, C., Barrio, C., Goldman, S. R., et al. (in press). Evaluation of a culturally tailored skills intervention for Latinos with persistent psychotic disorders. American Journal of Psychiatric Rehabilitation.
McCreadie, R. G., Kelly, C., Connolly, M., Williams, S., Baxter, G., Lean, M., et al. (2005). Dietary improvement in people with schizophrenia: Randomised controlled trial. British Journal of Psychiatry, 187, 346–351.
McCreadie, R., Macdonald, E., Blacklock, C., Tilak-Singh, D., Wiles, D., Halliday, J., et al. (1998). Dietary intake of schizophrenic patients in Nithsdale, Scotland: Case–control study. British Medical Journal, 317, 784–785.
McEvoy, J. P., Meyer, J. M., Goff, D. C., Nasrallah, H. A., Davis, S. M., Sullivan, L., et al. (2005). Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research, 80, 19–32.
McKibbin, C. L., Lindamer, L., Sirkin, A., Jin, H., Ueki, K., Patterson, T., et al. (2006). Dietary habits in middle-aged and elderly patients with schizophrenia. Paper Presented at the meeting of the American Association for Geriatric Psychiatry, San Juan, Puerto Rico.
McKibbin, C. L., Patterson, T. L., Norman, G., Patrick, K., Jin, H., Roesch, S., et al. (2006). A lifestyle intervention for older schizophrenia patients with Diabetes Mellitus: A randomized controlled trial. Schizophrenia Research, 86, 36–44.
Miller, C. K., Edwards, L., Kissling, G., & Sanville, L. (2002). Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus. Journal of American Dietary Association, 102, 1069–1081.
Mukherjee, S., Schnur, D. B., & Reddy, R. (1989). Family history of type 2 diabetes in schizophrenic patients. Lancet, 1, 495.
Newcomer, J. W. (2005). Second-generation (atypical) antipsychotics and metabolic effects: A comprehensive literature review. CNS Drugs, 19, 1–93.
Patterson, T. L., Bucardo, J., McKibbin, C. L., Mausbach, B. T., Moore, D., Barrio, C., et al. (2005). Development and pilot testing of a new psychosocial intervention for older Latinos with chronic psychosis. Schizophrenia Bulletin, 31, 922–930.
Patterson, T. L., McKibbin, C. L., Taylor, M. J., Goldman, S., Davila-Fraga, W., Bucardo, J., et al. (2003). Functional Adaptation Skills Training (FAST): A pilot psychosocial intervention study in middle-aged and older patients with chronic psychotic disorders. American Journal of Geriatric Psychiatry, 11, 17–23.
Radomile, R. R. (2000). Obesity. In J. R. White & A. S. Freeman (Eds.), Cognitive-behavioral group therapy for specific problems and populations (pp. 99–126). Washington, DC: American Psychological Association.
Rotatori, A. F., Fox, R., & Wicks, A. (1980). Weight loss with psychiatric residents in a behavioral self control program. Psychological Reports, 46, 483–486.
Strassnig, M., Brar, J. S., & Ganguli, R. (2003). Nutritional assessment of patients with schizophrenia: A preliminary study. Schizophrenia Bulletin, 29, 393–397.
Telles, C., Karno, M., & Mintz, J. (1995). Immigrant families coping with schizophrenia: Behavioral family intervention v. case management with a low-income Spanish speaking population. British Journal of Psychiatry, 167, 473–479.
US Census Bureau. (2000). www.factfinder.census.gov .
Velligan, D. I., Kern, R. S., & Gold, J. M. (2006). Cognitive rehabilitation for schizophrenia and the putative role of motivation and expectancies. Schizophrenia Bulletin, 32, 474–485.
Weber, M., & Wyne, K. (2006). A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics. Schizophrenia Research, 83, 95–101.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
McKibbin, C.L., Folsom, D., Meyer, J., Sirkin, A., Loh, C., Lindamer, L. (2008). Behavioral Interventions to Improve Management of Overweight, Obesity, and Diabetes in Patients with Schizophrenia. In: Gallagher-Thompson, D., Steffen, A.M., Thompson, L.W. (eds) Handbook of Behavioral and Cognitive Therapies with Older Adults. Springer, New York, NY. https://doi.org/10.1007/978-0-387-72007-4_11
Download citation
DOI: https://doi.org/10.1007/978-0-387-72007-4_11
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-72006-7
Online ISBN: 978-0-387-72007-4
eBook Packages: Behavioral ScienceBehavioral Science and Psychology (R0)