Interplay between Schizophrenia, Diabetes, and Cardiovascular Disease
DOI:
https://doi.org/10.58445/rars.3589Keywords:
Schizophrenia, Antipsychotic medications, Diabetes, Cardiovascular DiseaseAbstract
Schizophrenia is a severe, chronic mental illness that affects about 1% of people globally. Due
to schizophrenia’s psychotic symptoms, patients have a difficult time adhering to medications
such as antipsychotics, which can negatively impact both their mental and physical health due
to side effects and disorganized thoughts that arise after medication non-adherence.
Furthermore, antipsychotics are known to cause weight gain and decrease insulin sensitivity,
which can make patients resistant to taking antipsychotics. Nonetheless, along with taking
antipsychotics, staying active is important, because antipsychotics can cause weight gain and
some antipsychotics, especially second-generation antipsychotics, can reduce insulin sensitivity.
Recent studies have shown that schizophrenic patients are more likely to have co-morbid
conditions, like type II diabetes and cardiovascular disease.
In this paper, the impact schizophrenia has on both diabetes and cardiovascular disease on
diagnosis and symptom management will be explored. Due to the epidemiology, burden of
symptoms, and limited methods for effective management of schizophrenia, patients with
schizophrenia are more likely to experience more extensive complications from diabetes and
cardiovascular disease compared to an otherwise healthy person.
References
Luvsannyam, E., Jain, M. S., Pormento, M. K. L., Siddiqui, H., Balagtas, A. R. A., Emuze,
B. O., & Poprawski, T. (2022). Neurobiology of Schizophrenia: A Comprehensive Review.
Cureus, 14(4), e23959. https://doi.org/10.7759/cureus.23959
Rahman, T., & Lauriello, J. (2016). Schizophrenia: An Overview. Focus (American
Psychiatric Publishing), 14(3), 300–307. https://doi.org/10.1176/appi.focus.20160006
Fatemi, S. H., & Folsom, T. D. (2009). The neurodevelopmental hypothesis of
schizophrenia, revisited. Schizophrenia bulletin, 35(3), 528–548.
https://doi.org/10.1093/schbul/sbn187
Campbell, R. K. (2009). Type 2 diabetes: where we are today: an overview of disease
burden, current treatments, and treatment strategies. Journal of the American
Pharmacists Association, 49(5), S3-S9.
Zimmet, P. Z., Magliano, D. J., Herman, W. H., & Shaw, J. E. (2014). Diabetes: a 21st
century challenge. The lancet. Diabetes & endocrinology, 2(1), 56–64.
https://doi.org/10.1016/S2213-8587(13)70112-8
Roglic, Gojka. WHO Global report on diabetes: A summary. International Journal of
Noncommunicable Diseases 1(1):p 3-8, Apr–Jun 2016. | DOI:
4103/2468-8827.184853
Lusis A. J. (2000). Atherosclerosis. Nature, 407(6801), 233–241.
https://doi.org/10.1038/35025203
Adhikary, D., Barman, S., Ranjan, R., & Stone, H. (2022). A Systematic Review of Major
Cardiovascular Risk Factors: A Growing Global Health Concern. Cureus, 14(10), e30119.
https://doi.org/10.7759/cureus.30119
Betensky, J. D., Robinson, D. G., Gunduz-Bruce, H., Sevy, S., Lencz, T., Kane, J. M.,
Malhotra, A. K., Miller, R., McCormack, J., Bilder, R. M., & Szeszko, P. R. (2008).
Patterns of stress in schizophrenia. Psychiatry research, 160(1), 38–46.
https://doi.org/10.1016/j.psychres.2007.06.001
Kesby, J. P., Eyles, D. W., McGrath, J. J., & Scott, J. G. (2018). Dopamine, psychosis and
schizophrenia: the widening gap between basic and clinical neuroscience. Translational
psychiatry, 8(1), 30. https://doi.org/10.1038/s41398-017-0071-9
Degenhardt, L., Hall, W., & Lynskey, M. (2003). Testing hypotheses about the relationship
between cannabis use and psychosis. Drug and alcohol dependence, 71(1), 37–48.
https://doi.org/10.1016/s0376-8716(03)00064-4
Casadio, P., Fernandes, C., Murray, R. M., & Di Forti, M. (2011). Cannabis use in young
people: the risk for schizophrenia. Neuroscience and biobehavioral reviews, 35(8),
–1787. https://doi.org/10.1016/j.neubiorev.2011.04.007
Hickman, M., Vickerman, P., Macleod, J., Kirkbride, J., & Jones, P. B. (2007). Cannabis
and schizophrenia:Hickman, M., Vickerman, P., Macleod, J., Kirkbride, J., & Jones, P. B.
(2007). Cannabis and schizophrenia: model projections of the impact of the rise in
cannabis use on historical and future trends in schizophrenia in England and Wales.
Addiction (Abingdon, England), 102(4), 597–606.
https://doi.org/10.1111/j.1360-0443.2006.01710.x
Buckley, P. F., Miller, B. J., Lehrer, D. S., & Castle, D. J. (2009). Psychiatric comorbidities
and schizophrenia. Schizophrenia bulletin, 35(2), 383–402.
https://doi.org/10.1093/schbul/sbn135
Bystritsky, A., Kerwin, L., Niv, N., Natoli, J. L., Abrahami, N., Klap, R., Wells, K., & Young,
A. S. (2010). Clinical and subthreshold panic disorder. Depression and anxiety, 27(4),
–389. https://doi.org/10.1002/da.20622
Morgan, C., & Fisher, H. (2007). Environment and schizophrenia: environmental factors
in schizophrenia: childhood trauma--a critical review. Schizophrenia bulletin, 33(1), 3–10.
https://doi.org/10.1093/schbul/sbl053
D'Souza RS, Aslam SP, Hooten WM. Extrapyramidal Side Effects. [Updated 2025 Jan
. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK534115/
Annamalai, A., & Tek, C. (2015). An overview of diabetes management in schizophrenia
patients: office based strategies for primary care practitioners and endocrinologists.
International journal of endocrinology, 2015, 969182. https://doi.org/10.1155/2015/969182
Suvisaari, J., Keinänen, J., Eskelinen, S., & Mantere, O. (2016). Diabetes and
Schizophrenia. Current diabetes reports, 16(2), 16.
https://doi.org/10.1007/s11892-015-0704-4
Ryan, M. C., Collins, P., & Thakore, J. H. (2003). Impaired fasting glucose tolerance in
first-episode, drug-naive patients with schizophrenia. The American journal of psychiatry,
(2), 284–289. https://doi.org/10.1176/appi.ajp.160.2.284
Holt, R. I., Bushe, C., & Citrome, L. (2005). Diabetes and schizophrenia 2005: are we any
closer to understanding the link?. Journal of psychopharmacology (Oxford, England),
(6 Suppl), 56–65. https://doi.org/10.1177/0269881105058379
Chien, I. C., Hsu, J. H., Lin, C. H., Bih, S. H., Chou, Y. J., & Chou, P. (2009). Prevalence
of diabetes in patients with schizophrenia in Taiwan: a population-based National Health
Insurance study. Schizophrenia research, 111(1-3), 17–22.
https://doi.org/10.1016/j.schres.2009.04.003
Bresee, L. C., Majumdar, S. R., Patten, S. B., & Johnson, J. A. (2010). Prevalence of
cardiovascular risk factors and disease in people with schizophrenia: a population-based
study. Schizophrenia research, 117(1), 75–82.
https://doi.org/10.1016/j.schres.2009.12.016
Ratliff, J. C., Palmese, L. B., Reutenauer, E. L., Liskov, E., Grilo, C. M., & Tek, C. (2012).
The effect of dietary and physical activity pattern on metabolic profile in individuals with
schizophrenia: a cross-sectional study. Comprehensive psychiatry, 53(7), 1028–1033.
https://doi.org/10.1016/j.comppsych.2012.02.003
Brown, S., Birtwistle, J., Roe, L., & Thompson, C. (1999). The unhealthy lifestyle of
people with schizophrenia. Psychological medicine, 29(3), 697–701.
https://doi.org/10.1017/s0033291798008186
Strassnig, M., Brar, J. S., & Ganguli, R. (2003). Nutritional assessment of patients with
schizophrenia: a preliminary study. Schizophrenia bulletin, 29(2), 393–397.
https://doi.org/10.1093/oxfordjournals.schbul.a007013
Zhuo, C., Zhang, Q., Wang, L., Ma, X., Li, R., Ping, J., Zhu, J., Tian, H., & Jiang, D.
(2024). Insulin Resistance/Diabetes and Schizophrenia: Potential Shared Genetic
Factors and Implications for Better Management of Patients with Schizophrenia. CNS
drugs, 38(1), 33–44. https://doi.org/10.1007/s40263-023-01057-w
Subramaniam M, Chong SA, Pek E. Diabetes mellitus and impaired glucose tolerance in
patients with schizophrenia. Can J Psychiatry. 2003;48:345–347. doi:
1177/070674370304800512.
Dayabandara, M., Hanwella, R., Ratnatunga, S., Seneviratne, S., Suraweera, C., & de
Silva, V. A. (2017). Antipsychotic-associated weight gain: management strategies and
impact on treatment adherence. Neuropsychiatric disease and treatment, 13, 2231–2241.
https://doi.org/10.2147/NDT.S113099
Simpson, M. M., Goetz, R. R., Devlin, M. J., Goetz, S. A., & Walsh, B. T. (2001). Weight
gain and antipsychotic medication: differences between antipsychotic-free and treatment
periods. The Journal of clinical psychiatry, 62(9), 694–700.
https://doi.org/10.4088/jcp.v62n0906
Sudar, F. P., Zekerallah, S. S., Paulzen, M., Mathiak, K., & Gaebler, A. J. (2025).
Unraveling antipsychotic induced weight gain in schizophrenia–A proof-of-concept study
exploring the impact of the cumulative historical occupancy of different receptors by
antipsychotics. Psychiatry Research, 348, 116452.
Teff, K. L., Rickels, M. R., Grudziak, J., Fuller, C., Nguyen, H. L., & Rickels, K. (2013).
Antipsychotic-induced insulin resistance and postprandial hormonal dysregulation
independent of weight gain or psychiatric disease. Diabetes, 62(9), 3232–3240.
https://doi.org/10.2337/db13-0430
Kallur, A., Yoo, E., Bien-Aime, F., & Ammar, H. (2022). Diagnostic Overshadowing and
Pain Insensitivity in a Schizophrenic Patient With Perforated Duodenal Ulcer. Cureus,
(2), e21800. https://doi.org/10.7759/cureus.21800
Anderson, K. K., & Kurdyak, P. (2017). Factors Associated with Timely Physician
Follow-up after a First Diagnosis of Psychotic Disorder. Canadian journal of psychiatry.
Revue canadienne de psychiatrie, 62(4), 268–277.
https://doi.org/10.1177/0706743716673322
Gorczynski, P., Firth, J., Stubbs, B., Rosenbaum, S., & Vancampfort, D. (2017). Are
people with schizophrenia adherent to diabetes medication? A comparative
meta-analysis. Psychiatry research, 250, 17–24.
https://doi.org/10.1016/j.psychres.2017.01.049
Ali, S., Santomauro, D., Ferrari, A. J., & Charlson, F. (2023). Schizophrenia as a risk
factor for cardiovascular and metabolic health outcomes: a comparative risk assessment.
Epidemiology and psychiatric sciences, 32, e8.
https://doi.org/10.1017/S2045796023000045
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E.,
Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., Burstein, R., Murray, C. J., &
Vos, T. (2013). Global burden of disease attributable to mental and substance use
disorders: findings from the Global Burden of Disease Study 2010. Lancet (London,
England), 382(9904), 1575–1586. https://doi.org/10.1016/S0140-6736(13)61611-6
Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental
illness. The lancet. Psychiatry, 3(2), 171–178.
https://doi.org/10.1016/S2215-0366(15)00505-2
Jindal, R., MacKenzie, E. M., Baker, G. B., & Yeragani, V. K. (2005). Cardiac risk and
schizophrenia. Journal of psychiatry & neuroscience : JPN, 30(6), 393–395.
DE Hert, M., Schreurs, V., Vancampfort, D., & VAN Winkel, R. (2009). Metabolic
syndrome in people with schizophrenia: a review. World psychiatry : official journal of the
World Psychiatric Association (WPA), 8(1), 15–22.
https://doi.org/10.1002/j.2051-5545.2009.tb00199.x
Castle, D., & Li, A. (2023). Physical health monitoring for people with schizophrenia.
Australian prescriber, 46(4), 75–79. https://doi.org/10.18773/austprescr.2023.024
Smith, D. J., Langan, J., McLean, G., Guthrie, B., & Mercer, S. W. (2013). Schizophrenia
is associated with excess multiple physical-health comorbidities but low levels of
recorded cardiovascular disease in primary care: cross-sectional study. BMJ open, 3(4),
e002808. https://doi.org/10.1136/bmjopen-2013-002808
Mueser, K. T., & McGurk, S. R. (2004). Schizophrenia. Lancet (London, England),
(9426), 2063–2072. https://doi.org/10.1016/S0140-6736(04)16458-1
Jarvis G. E. (2007). The social causes of psychosis in North American psychiatry: a
review of a disappearing literature. Canadian journal of psychiatry. Revue canadienne de
psychiatrie, 52(5), 287–294. https://doi.org/10.1177/070674370705200503
Agerbo, E., Byrne, M., Eaton, W. W., & Mortensen, P. B. (2004). Marital and labor market
status in the long run in schizophrenia. Archives of general psychiatry, 61(1), 28–33.
https://doi.org/10.1001/archpsyc.61.1.28
First, M. B., & Tasman, A. (2004). DSM-IV-TR mental disorders: Diagnosis, etiology, and
treatment. (No Title).
Green M. F. (1996). What are the functional consequences of neurocognitive deficits in
schizophrenia?. The American journal of psychiatry, 153(3), 321–330.
https://doi.org/10.1176/ajp.153.3.321
Ringen, P. A., Engh, J. A., Birkenaes, A. B., Dieset, I., & Andreassen, O. A. (2014).
Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic
review of epidemiology, possible causes, and interventions. Frontiers in psychiatry, 5,
https://doi.org/10.3389/fpsyt.2014.00137
Chang, J., Kim, J. A., Kim, K., Choi, S., Kim, S. M., Nam, Y. Y., Park, S., Goo, A. J., &
Park, S. M. (2020). Association of antipsychotics adherence and cardiovascular disease
among newly diagnosed schizophrenia patients: A national cohort among Koreans. Asian
journal of psychiatry, 52, 102161. https://doi.org/10.1016/j.ajp.2020.102161
Andor, M., Dehelean, L., Arnăutu, D. A., Neagu, M. N., Nistor, D., Manea, M. M.,
Romosan, A. M., & Kundnani, N. R. (2024). Schizophrenia and Heart Health: Are
Antipsychotics a Friend or Foe?. Journal of personalized medicine, 14(8), 814.
https://doi.org/10.3390/jpm14080814
Samanidis, G. (2024). Current Challenges in Diagnosis and Treatment of Cardiovascular
Disease. Journal of Personalized Medicine, 14(8), 786.
https://doi.org/10.3390/jpm14080786
Riera-Molist, N., Assens-Tauste, M., Roura-Poch, P., Guimerà-Gallent, M., Santos-López,
J. M., Serra-Millas, M., Frau-Rosselló, N., Gallego-Peña, E., & Foguet-Boreu, Q. (2023).
A Cardiovascular Risk Optimization Program in People With Schizophrenia: A Pilot
Randomized Controlled Clinical Trial. Journal of psychiatric practice, 29(6), 456–468.
https://doi.org/10.1097/PRA.0000000000000743
Wang, N., Fulcher, J., Abeysuriya, N., Park, L., Kumar, S., Di Tanna, G. L., Wilcox, I.,
Keech, A., Rodgers, A., & Lal, S. (2020). Intensive LDL cholesterol-lowering treatment
beyond current recommendations for the prevention of major vascular events: a
systematic review and meta-analysis of randomised trials including 327 037 participants.
The lancet. Diabetes & endocrinology, 8(1), 36–49.
Downloads
Posted
Categories
License
Copyright (c) 2026 Bhavya Aluri
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
