With widespread use of `atypical' antipsychotics for the treatment of psychiatric disorders, attention has focused on their association with obesity, diabetes and risk factors for cardiovascular disease. People with schizophrenia are more likely to develop diabetes than the general population, with antipsychotics appearing to add to this risk. The exact mechanism(s) by which antipsychotics cause hyperglycaemia, diabetic ketoacidosis and aggravation of pre-existing diabetes remain uncertain. Plausible mechanisms have been postulated for the promotion of obesity by these agents, with resultant insulin resistance and type 2 diabetes in some patients. Whatever the mechanism, careful consideration of potential risks and benefits is required in prescribing: people with schizophrenia are often exposed to antipsychotic agents in the long term and frequently have co-existing cardiovascular risk factors (smoking, poor diet, physical inactivity, social deprivation). Regular monitoring of body weight, blood glucose and serum lipids may help clinical management.
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