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Psychiatric Disorders and Diabetes Mellitus
Reviewed by DAN HAUPT
Am J Psychiatry 2007;164:1442-1443. doi:10.1176/appi.ajp.2007.07071141
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edited by Maria Llorente, Julie Malphurs, and Denise Feil. Oxford, Taylor and Francis, 2007, 260 pp., $94.95.

Increasing concern is being focused on the risks of diabetes and heart disease in schizophrenia patients, but this appropriate concern has tended to overshadow the fact that comorbid diabetes is an issue in multiple neuropsychiatric conditions, including depression, bipolar disorder, and dementia. In recognition of this fact, this book provides a useful overview of diabetes and related management issues for clinicians wishing to familiarize themselves with the scope of this problem. This area is a major concern given the elevated rates of cardiovascular mortality observed in patients with serious mental illness.

Thirteen chapters provide concise reviews of the physiology of diabetes mellitus and its relation to mental illness, with chapters devoted to the high-priority areas of depression and schizophrenia. Subsequent chapters provide information on potential interventions with regard to assessment and management of diabetes in the context of mental illness.

In this rapidly expanding field, this book can provide clinicians unfamiliar with the core problems involved in managing diabetes in the setting of mental illness with a basic framework of how to conceptualize the main issues. However, given the rapid evolution of this field, it will be necessary to supplement each of the chapters with ongoing evaluation of the current literature. Given the length of time that the variety of psychiatric medications that are available have been in use, it is discouraging that our knowledge of their effects on risk factors for heart disease and diabetes is so incomplete. This is a major oversight that the field of psychiatry is actively seeking to address with increased research into the effects of medications on cardiometabolic risk factors, along with other potential contributors such as lifestyle and illness-related factors.

The authors do a good job of orienting readers to the health needs of people with mental illness. The focus in this area has now shifted to attempts to understand the reasons related to the poor implementation of established diabetes screening and management guidelines in people with mental illness. Despite clear evidence-based approaches that form the basis of public health campaigns, these approaches are not successfully being brought to the field of psychiatry. Likely reasons include the historical splitting apart of psychiatry from medicine that has resulted in decreased awareness, funding, and facilities for the receipt of medical care among people with serious mental illness.

This book will serve to increase awareness of these issues, which will be helpful as various organizations and health care systems identify how to address the disparities in health care for the mentally ill.

For more information on the evolving efforts of the APA and other organizations to advocate for our patients, clinicians will also benefit from reviewing current and upcoming publications from the APA and other organizations.

+Book review accepted for publication July 2007 (doi: 10.1176/appi.ajp.2007.07071141).

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