Diabetes mellitus and psychotic disease

In 2006, investigators compiled data from the public mental health systems of eight states in the USA and compared life expectancy for patients with a major mental illness with general population values. Focusing on states with outpatient as well as inpatient data, this study indicated that individuals with a major mental illness have a mean age at death that is 25–30 years earlier than that observed in the general population over the same years in the same states (1). In this study, ‘major mental illness’ included affective disorders such as major depression and bipolar disorder, attention deficit/hyperactivity disorders, schizophrenia, and schizoaffective disorders. Importantly, these data indicated that the leading cause of death in the mentally ill is coronary heart disease (CHD) and when death due to stroke or cerebrovascular disease is included in a category of cardiovascular disease (CVD), they account for more than 35% of deaths in this population. Suicide, by contrast, was responsible for fewer than 5% of deaths overall. Such observations have led to growing clinical interest in the cardiovascular and metabolic risk factors that contribute to the major causes of morbidity and mortality in patients with psychotic disease, as exemplified by schizophrenia.