Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study

An energy deficit has been implicated in the pathogenesis of
schizophrenia and other mood, behavioural and psychotic disorders, both
nutrient and oxygen being needed for ATP resynthesis by oxidative
phosphorylation. An energy deficit might be present all the time or more
commonly only when the demand for energy from ATP hydrolysis exceeds the
capacity for ATP resynthesis by oxidative phosphoprylation in a timely
manner. An increase in mitochondrial membrane permeability, which is a
function of omega three fatty acid composition, and accompanying
uncoupling of oxidative phosphorylation might be an especially important
cause of an energy deficit in schizophrenics.

The beneficial effects of Coenzyme Q10 supplements, which promote ATP
resynthesis, in the Prader-Willi syndrome suggest that not only
neuropsychiatric disorders but also obesity might be the product of an
unsatisfied demand for ATP resynthesis. Neurotransmitter release and
replenishment of neurotransmitter pools may also be compromised by an
energy deficit and contribute to the development of neuropsychiatric
disorders.

Many of the drugs being used to treat schizophrenia, other
psychiatric disorders and cardiovascular diseases have the potential to
cause an energy deficit or make the existing diseases worse. The
possibility that psychotropic drugs are acting as chemical coshes and
compounding the severity of the diseases or even creating new ones is very
real. The pathogenesis of all neuropsychiatric disorders and
cardiovascular diseases and their treatments need to be reviewed with some
urgency within the context of mitochondrial function.

1. Drug or weight gain? Bernard Corenblum (5 August 2002) Rapid
response to reference 4.

2. Atypical antipsychotics and glucose dysregulation Detlef Degner,Dr.,
Stefan Kropp,Renate Grohmann,Eckhart Rüther (2 October 2002) Rapid
response to reference 4

3. Impaired fasting glucose in drug naive schizophrenia Jogin H Thakore
(11 February 2003) Rapid response to reference 4

4. Assessment of independent effect of olanzapine and risperidone on risk
of diabetes among patients with schizophrenia: population based nested
case-control study Carol E Koro, Donald O Fedder, Gilbert J L'Italien,
Sheila S Weiss, Laurence S Magder, Julie Kreyenbuhl, Dennis A Revicki, and
Robert W Buchanan BMJ 2002; 325: 243

5. Madness, hyperhomocysteinemia, metabolic rate and body temperature
Richard G Fiddian-Green bmj.com/cgi/eletters/325/7378/1433#28469, 6 Jan
2003

6. Neuropsychiatric disorders in porphria and methylmalonic acidosis
Richard G Fiddian-Green bmj.com/cgi/eletters/320/7250/1647#28812, 16 Jan

7. Judy WV, Stogsdill WW, Judy JS. CoQ10 in the management of low
energy and delayed development in children with Prader-Willi syndrome.
Proceedings Third World Conference of the International Coenzyme Q10
Association, London, November 2002 pp34-35.

Competing interests:  
None declared