RE: Type 2 diabetes - how psychology changes physiology(part 1 - character introduction)
I enjoy your approach to research--very methodical. I appreciate especially your reminder that correlation does not equal causation--a leap too often made in many contexts.
However, I do have a couple of questions. I worked with schizophrenic and bipolar adolescents and so had some familiarity with the side effects that accompanied drug treatment. Diabetes is one unfortunate side effect, as is weight gain (these two are generally related). Is it not possible that the correlation between these psychiatric disorders and diabetes may have as much (or more) to do with drug treatment as with the illness?
Also, the association between PTSD and diabetes may actually have a connection to childhood abuse. It seems that susceptibility to PTSD varies widely. One of the factors that increases susceptibility is childhood abuse. So the PTSD and the diabetes (in many instances) both become a consequence of early abuse and may just be links in a chain of events begun years before.
I think my favorite part of your blog is your advice to be easy on the kids. It seems that if we fail at that, a whole host of ills may befall our children.
Thankyou.
You are right antipsychotics do increase the risk of diabetes. However they do not explain the complete picture. What it seems like that odd ratio of getting diabetes is anyway high in schizophrenia compared to general population. It is even higher in patients taking medication. For instance see this study. But then we still have to be careful because the lifestyle and even the risky behaviour that comes along with the disease also adds to it.
However I completely agree that whatever happens in early childhood sets a chain of events in action. It more likely that schizophrenia or bipolar share a common pathogenesis with diabetes, rather than being cause of it. However the lifestyle choices and treatment in these conditions are add ons to diabetic pathology.
The tragedy of schizophrenia, and the need to understand the biological roots of this disorder, were clear to me when I taught. My students all carried some sort of psychiatric diagnosis. I can recall in particular one girl who was heavily medicated because she struggled to silence the voices that competed with mine in the classroom. Her need for medication was obvious and yet this treatment dulled her to the point where she was almost incapable of absorbing material. I saw many students gain weight quickly under a drug regimen. Terrible trade--particularly in people so young. A lifetime burden.
I think better understanding of the pathogenesis is definitely the way forward. We know so much and we know so little.
As for the legacy of parenting on children--I'm a mother. Neither of my children (now grown) accuses me of child abuse :) but my mistakes weigh on me as the years pass. When we raise our children we need the energy of youth and the wisdom of age, but nature doesn't give us those together, does it?
I don't think I can put it in any better words. And in that young energetic age we still think we are so wise. But as we grow old we realize how wrong we have been.
And I completely agree with you that we need to learn a lot about schizophrenia. I mean I don't know why to begin with we even tried to separate body's physiology from psychology. All drugs ever developed focused on treating behavioural symptoms. I mean for a long time we didn't really consider the fact that both metabolic disorders and psychology could share same pathogenesis. It is only recently that studies started calling for metabolic care of mentally ill patients. Now I can also see papers testing in details affects of antipsychotic on weight gain and glucose clearance. The drug development testing this in animal testing phase. In fact I was most surprised to see the clinical trial for metformin for patients on antipsychotics. Looks quite promising too. Surprisingly, I have not the doctor treating a friend mine prescribing it. And she has been gaining weight as well. Not sure if it is the isolated case or no one on antipsychotic drugs receives the precautionary measure?
Your sincere feeling for those who suffer is very much appreciated. It's reassuring to see science tempered with humanity.