Rapid-onset clozapine-induced loss of glycaemic control: Case report. Issue 3 (May 2017)

• Record Type: Journal Article
• Authors: Porras-Segovia, Alejandro; Krivoy, Amir; Horowitz, Mark; Thomas, George; Bolstridge, Mark; Ion, Dragos; Shergill, Sukhwinder S.
• Is Part Of: BJPsych open. Volume 3:Issue 3(2017)
• Page Start: 138
• Page End: 140
• Publication Date: 2017-05
• Subjects: Psychiatry -- Periodicals; Mental health -- Periodicals; 616.89005
• DOI: 10.1192/bjpo.bp.117.004481
• Languages: English
• ISSNs: 2056-4724

Abstract

Abstract : Clozapine has proved to be an effective antipsychotic for the treatment of refractory schizophrenia – characterised by the persistence of symptoms despite optimal treatment trials with at least two different antipsychotics at adequate dose and duration – but its use is hampered by adverse effects. The development of clozapine-induced diabetes is commonly considered to arise as part of a metabolic syndrome, associated with weight gain, and thus evolves slowly. We present the case of an individual with refractory schizophrenia and metformin-controlled diabetes who developed rapid-onset insulin-dependent hyperglycaemia immediately after starting clozapine. Given the refractory nature of his illness, the decision was made to continue clozapine and manage the diabetes. This case supports the existence of a more direct mechanism by which clozapine alters glycaemic control, aside from the more routine slow development of a metabolic syndrome.