Metabolic problems

'Metabolic syndrome' is a combination of truncal obesity, abnormal blood lipids, disturbed insulin and glucose metabolism, and high blood pressure; it is associated with the development of diabetes mellitus and coronary heart disease. It is more frequent in patients with schizophrenia than in the general population. It may be particularly contributed to by antipsychotic medication, especially some of the newer 'atypical' agents such as olanzepine, which seems to have appetite-stimulating qualities.

Case example

A young man of 21 developed the belief that his computer games were communicating with him by messages through the screen that only he could see. Some of the messages were transmitted 'directly into my mind'.

He had been an above-average student in his early teens, but his performance had declined and he had left school at 18 without qualifications. He had then attended a local college sporadically, but had dropped out, and seemed to have been at home with his family.

Most of the time since then he seemed to have spent in his room, playing computer games for several hours per day; he also consumed a good deal of cannabis, and this seemed to be regarded as normal in his home.

Admission to hospital followed a disturbance at his home when he smashed up the television and his room.

On admission, he had delusions about being controlled by computer games; during admission, it became clear that he was subject to auditory hallucinations, but would never say anything about them.

He was tried on various medications, but was observed to deteriorate; he appeared to develop thought blocking such that it was impossible to have a conversation: he would volunteer no speech, and questions were answered, after a pause of a second or two, by an uncomprehending 'Eh?'

He showed no response to standard medications (haloperidol) or to 'atypical' medications (olanzepine); he was then tried on clozapine, which, in conjunction with a rehabilitation placement, resulted in partial symptomatic and functional improvement, so that he was able to be discharged eventually to supported - warden controlled - accommodation.

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