Complex interactions exist between mental illness, antipsychotic medication and cardiovascular risk factors. The purported causal relationship between atypical antipsychotics and diabetes has been particularly newsworthy.
Evidence points to multiple causal factors. Schizophrenic patients have an underappreciated risk of cardiovascular disease which tends to be under treated. Antipsychotic drugs seem to be associated with increased risk of diabetes (and its associated dyslipidemias) and the risk varies among agents. Multiple mechanisms are involved including increased appetite and weight gain, effects on histaminic and cholinergic receptors and direct effects on the pancreas.
Recent evidence suggests that the use of antipsychotic agents for behavioral problems associated with dementia is associated with adverse cardiovascular outcomes.
The benefits of medications may outweigh the metabolic risks in many patients. In such cases a thorough baseline assessment of cardiovascular risk factors coupled with close monitoring during treatment is essential.
The topic is thoroughly covered in this review from Clinical Diabetes.