Schizophrenia and Diebetes Mellitus - Article Example

TOPIC: SCHIZOPRENIA AND DIABETES MELLITUS (NAME) (COURSE NAME) (INSTITUTIONS NAME) 20th NOVEMBER 2008 The first article for analysis is about Differential Medication Adherence among Patients with Schizophrenia and Cormobid Diabetes and Hypertension. The article was written by John, D. et al and was issued on February 2007, volume 58, issue number 2 on page 207-12. The objective of the research was to determine how global characteristics affect adherence across all medications in a regimen, making medication-specific risk factors for adherence problems less important. (John, et al. 2007) To do this, medication adherence was examined among schizophrenia patients with comorbid physical conditions in order to have a consistence across therapeutic classes. In order to perform the above research study, the authors sampled I, 686 national veterans according to use of medication for schizophrenia, hypertension and diabetes. Medical Possession Ratios (MPRs) was used to asses the adherence to each medical type. The impacts of medication type on adherence as well as the effect of other medication characteristics such as the average days of medication supplied per refill, patient’s sociodemographic characteristics and health service use were studied using the multilevel logistic models. The results of the above research study conducted by John and his fellow researchers revealed that adherence was diffidently correlated across the different types of medication. (Ryan, Van, and Lakshmi, 2008). Only 13% and 16% of the variance in patients hypoglycemic and antihypertensive MPRs were explained by the information about antipsychotic adherence. In addition, the unadjusted analyses revealed that patients were more likely to have poorer adherence (MPR less than .8) to their antipsychotics (35%) than to their hypoglycemic (29%) or antihypertensive medications (26%). This study shows that patients suffering with chronic conditions such as diabetes, hypertension and schizophrenia must regularly take medications if they intend to avoid adverse health outcomes. Many patients however, do not adhere to the instructions given to them about pharmacotherapy although self-care plans routinely emphasize the importance of appropriate medication use thus many patients fall short of achievable health goals as a result. Although patients have been informed about the effects of non-adherence to medication, adherence behaviors remains poorly understood overall. This is from the multiple studies that have been documented in the past about adherence to antipsychotic medications among patients with schizophrenia. The authors note that adherence to medication among the patients is often considered to be a patient-level attribute under the assumption that most determinants of adherence affect all treatments in a regimen similarly. The beliefs of the patients are however, crucial in the determination of the side effects and the necessity of specific medications which influences the way patients decide to adhere to medications. However, the authors observes that it has been impossible and little is known about the extent to which schizophrenia patients with comorbid physical illness vary in their adherence across types of drugs or the characteristics of prescriptions associated with adherence levels. Using the medical records of Veterans Affairs (VA) national patient registry, variation in medication adherence across drug types in a large sample of patients receiving schizophrenia as well as diabetes and hypertension were examined. The results indicated that patients with schizophrenia did not adhere to medications for comorbid problems since they did not see any symptomatic benefit of these treatments. Thus patients with cormobid diabetes and schizophrenia appeared to be selective in the type of medication they used. Many patients were found to adhere to antipsychotic medications than medications for their other conditions after analyses adjusted for day’s supply. The authors noted that this reflected the intrapatient variation in adherence to greater value placed on controlling symptoms of schizophrenia. The second article is a journal of Psychiatric and Neuroscience written by Ryan Lieshout and Lackshmi Voruganti volume 33 Issues No.5. and it is about Diabetes mellitus during pregnancy and increased risk of schizophrenia in offspring: a review of the evidence and putative mechanisms. The objective of the study was to identify converging themes from the hypothesis of the neurodevelopment of pathphysiology and schizophrenia of diabetic pregnancy as well as examining mechanisms by which diabetes mellitus in a pregnant mother may increase the risk of schizophrenia in offspring. To carry out this study, the review of relevant publications on epidemiologic and clinical studies of diabetic pregnancy neurodevelopmental aspects of schizophrenia was conducted. The results of the study indicated that babies born of mothers who experienced diabetes mellitus during pregnancies are 7 times likely to develop schizophrenia as compared with those who were not exposed to diabetic during their pregnancy stage. 3 prenatal mechanisms were established through which maternal hyperglycemia could predispose to schizophrenia in adult life. The three stages include oxidative stress, hypoxia and increased inflammation. Hyperglycemia alters lipid metabolism, affects mitochondrial structure, oxidative stress, causes in neuronal architecture and derangements in neural cell processes and results in premature specialization before neural tube closure. The study also showed that the molecular mechanisms underlying the processes include the generation of lipid peroxide intermediates and excess oxyradicals as well as reductions in polyunsaturated fatty acids levels. The polyunsaturated fatty acids are known to cause increased lowered gamma-aminobutyric and dopaminergic acidergic activity. (Lindenmayer, et al, 2001 62:30-38) The combination of hypoxia and hyperglycemia in pregnancy was also observed to alter immune function which includes increased tumor necrosis factor-alpha, upregulation of other proinfammatory cytokines and C-creative protein. In addition, the author of the article observed that maternal hyperglycemia could have a lasting effect on fetal cellular physiology which would result into stress vulnerability. The above events that occur during prenatal period were also associated with obstetric complications such as growth abnormalities of the fetus and increased susceptibility to infections during prenatal period. The article indicates that diabetes mellitus is on the increase particularly in younger women of child-bearing potential which calls for further studies in the same field in order to alleviate the risks associated with diabetes mellitus in pregnant women. To carry out the study the author formulated the hypothesis to the effect that neurodevelopmental is widely recognized as the most comprehensive and influential explanation of the etiopathogenesis of schizophrenia. The article stipulated causative factors, a series of putative mechanisms and an integrative framework capable of generating testable hypotheses. (Mukherjee, et al. 1989, pp 1-49) As a result, a believe has been created that relates interaction between multiple susceptibility genes and one or more environmental insults during pre-and perinatal brain development which results in impaired neuronal integrity and connectivity setting off a cascade of events that extend in adult life. Thus the article explores the effect of environmental “first hit” imposed by the intrauterine environment of maternal DM in conjunction with the fetus genetic endowment and how this might increase the risk for schizophrenia. In exploring the effects of maternal DM in pregnancy the article stipulated that DM is number one cause of complications with up to 7% pregnancies experiencing DM complications. The effects of maternal hyperglycemia were also found to vary with severity and time of onset of DM. Furthermore, the study established that insulin from the mother does not cross the placenta hence pancreatic insulin output of the fetus is determined by the level of glucose in the maternal blood. In the study of maternal DM and schizophrenia in offspring, it was revealed that maternal DM is a risk factor for schizophrenia in the offspring. However, the author of the article observed that there was need for further studies in order to substantiate the above evidence. In the link between maternal DM and schizophrenia the author established an impressive number of studies accruing on the relation between complications during pregnancy and later development of schizophrenia. In conclusion, the study above indicates that mothers who have DM during pregnancy put their offspring at risk of developing schizophrenia during their adulthood. REFERENCES Lindenmayer, J. et al: Hyperglycemia associated with the use of atypical antipsychotics. J Clinical Psychiatry 2001; 62:30-38 Freeman, H, Resistance to insulin in mentally disturbed soldiers. Arch Neurol Psychiatry 1946, 56:74-78 Mukherjee, S. et al. Family history of type 2 diabetes in schizophrenic patients. Lancet 1989, pp 1-49 Ryan, J. Van, L. and Lakshmi, P. (2008). Diabetes mellitus during pregnancy and increased risk of schizophrenia in offspring: a review of the evidence and putative mechanisms. Journal of Psychiatry & Neuroscience: JPN, 33(5), 395-404. Retrieved November 25, 2008, from ProQuest Health and Medical Complete database. (Document ID: 1548813971). John, D. et al. (2007). Differential Medication Adherence Among Patients With Schizophrenia and Comorbid Diabetes and Hypertension. Psychiatric Services, 58(2), 207-12. Retrieved November 26, 2008, from ProQuest Health and Medical Complete database. (Document ID: 1239842161). Read More