Antipsychotic use in psychotic disorders with impaired glucose tolerance
Year: 2026
Type: article
Abstract: Dear Editor, In the article titled “Amisulpride is the antipsychotic of choice in severe psychotic disorder with comorbid impaired glucose tolerance”,[1] the authors stressed not only the action of amisulpride as an antipsychotic that can safely be used in patients with impaired glucose tolerance (IGT) but also its role as an oral hypoglycemic agent in addition to its antipsychotic effect to conclude that amisulpride is a valuable treatment option for patients with severe psychotic disorders and comorbid IGT. We would like to submit that in addition to amisulpride, a few other antipsychotics can also be used in psychotic patients with IGT. These include atypical antipsychotics such as aripiprazole and ziprasidone in addition to typical antipsychotics such as haloperidol.[2] For starters, aripiprazole is beneficial in patients with diabetes and metabolic syndrome. A study conducted on the metabolic safety of aripiprazole showed an improvement in metabolic parameters in terms of glucose abnormalities in patients with IGT. Diabetes was found to have been reversed in some patients who were recently diagnosed after switching to treatment with aripiprazole. It also showed a combined effect on weight, blood pressure, glucose levels, and lipid profiles, thereby providing an all-round, more metabolically sound effect as monotherapy and as an adjunct to other antipsychotics.[3] Furthermore, aripiprazole has also been found to lower prolactin levels, normalizing elevated levels of prolactin caused using other antipsychotics,[3] whereas a well-known side effect of amisulpride is hyperprolactinemia. A study assessing the effect of ziprasidone on patients with chronic schizophrenia with diabetes found a significant reduction in fasting glucose levels, capillary blood glucose levels, weight, and body mass index (BMI). This study also found a reduction in the use of antidiabetic medication after changing the antipsychotic to ziprasidone.[4] Another study was conducted on patients who were being treated with clozapine for over 2 years and switched to ziprasidone. The patients were followed up over 24 weeks, and the results showed a significant improvement in glucolipid metabolism disorders caused by the use of clozapine.[5] In patients with psychotic illness who are predisposed to diabetes, it is advisable to consider drugs that are less likely to precipitate the condition, such as risperidone or other high-potency typical antipsychotics such as haloperidol, flupentixol, and trifluoperazine.[2] While metabolic derangements are associated with typical antipsychotics as well, it is important to consider the risk–benefit ratio of the drug and augmentation with metabolically safer medications along with adequate lifestyle management and regular evaluations. Authors’ contributions Writing original draft: DM. Conceptualization, editing, language correction: DM, SC, SR. All authors contributed substantially to the write-up of the article and all take responsibility of the content of the publication. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Industrial Psychiatry Journal
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $60
OpenAlex ID: W7128486864