Stress and the genesis of diabetes mellitus in schizophrenia

BACKGROUND: The incidence of diabetes mellitus is higher in patients with schizophrenia than in the general population. Antipsychotic drugs have been implicated in the development of diabetes, but as non-medicated patients with schizophrenia have high rates of diabetes it is likely that factors other than medication are involved. AIM: To examine the role of stress in the emergence of diabetes mellitus in patients with schizophrenia. METHOD: Selective literature review. RESULTS: A model is developed suggesting that patients with schizophrenia show over activation of both the hypothalamic-pituitary-adrenal and sympathoadrenal medullary axes, manifested by increased production of cortisol and adrenaline. Both of these hormones are known to be diabetogenic and are proposed as playing a part in the onset of diabetes mellitus in schizophrenia. CONCLUSIONS: Stress has an important role in the onset of schizophrenia and may also play a part in relapse. Further research is needed to clarify the extent to which stress accounts for the genesis of diabetes in such patients.