The Link Between Schizophrenia and Diabetes

The association between schizophrenia and diabetes has been recognized for more than a century. The prevalence of diabetes is increased 2- to 3-fold in patients with schizophrenia. This relationship is specific to type 2 diabetes mellitus (T2DM); type 1 diabetes mellitus, an autoimmune disease, is less common in patients with schizophrenia. Factors that contribute to comorbidity between schizophrenia and T2DM include:

  • illness susceptibility: the mechanisms remain unclear but include the thrifty phenotype hypothesis, autonomic hyperactivity, and potential cellular and genetic links
  • lifestyle: diet, physical inactivity, and cigarette smoking
  • antipsychotic use
  • social health determinants, such as income, housing, and food insecurity.

The relative contribution of factors underlying this association is unknown; it is likely that they all contribute. Nevertheless, based on information from our facility’s metabolic monitoring database, depending on demographic variables, such as ethnicity and cigarette smoking, 20% to 30% of patients with schizophrenia will develop diabetes or prediabetes during the course of psychiatric treatment.

When evaluating a patient’s risk for a cardiac event, we consider having a diabetes diagnosis equivalent to having had a myocardial infarction. Likely, the high prevalence of T2DM among schizophrenia patients and challenges in managing diabetes and prediabetes underlies these patients’ reduced life expectancy. Self-care, a cornerstone of diabetes management, is challenging for patients with schizophrenia because of deficits in executive functioning, working memory, and motivation, coupled with negative symptoms and social and economic disadvantages that often accompany schizophrenia.

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by Tony Cohn, MB, ChB, MSc, FRCPC

Nail Biting: Mental Disorder Or Just A Bad Habit?

Do you bite your nails? For 30 years, I did. We nail biters can be “pathological groomers” — people for whom normal grooming behaviors, like skin picking or hair pulling, have become virtually uncontrollable.

But psychiatry is changing the way it thinks about pathological grooming, and these changes will be reflected in the American Psychiatric Association’s DSM, short forDiagnostic and Statistical Manual of Mental Disorders. A new version is coming out early next year, and it puts pathological grooming in the same category as another disorder you’ve probably heard of: obsessive compulsive disorder, or OCD.

This rethinking gives pathological groomers some new ways to think about those behaviors.

I can tell you the exact moment I became a nail biter. I was 6 years old, watching my mom get dressed for work. She paused to mull something over, chewing on a nail. My reaction: “How cool! How grown-up! I think I’ll try it.”

I never stopped. It was embarrassing — like wearing your neuroses on your sleeve. At parties, I learned to wrap my fingers all the way around my wine glass, so that my nails faced my chest. I hated filling out forms in public places.

Recently, something happened that made me finally quit biting my nails. I’ll get to that in a bit. But I was feeling quite pleased with myself when I showed them to Carol Mathews, a psychiatrist at the University of California, San Francisco. “Your cuticles are pushed back. It’s not bad. Looks like you’re a recovered nail biter is what I’d say,” she pointed out.

Mathews specializes in pathological grooming — a group of behaviors that includes nail biting, hair pulling, called trichotillomania, and skin picking, known as dermatillomania.

“They are behaviors that stem from normal grooming — the kind of thing that most animals do and is evolutionarily adaptive, right?” says Mathews.

But in pathological groomers, those behaviors go haywire. Instead of being triggered by, say, a hangnail, the pathological nail biter is triggered by driving, reading or feeling stressed out. “After a while, the behavior becomes untriggered,” says Mathews. “It becomes just an automatic behavior that has no relationship to external stimuli at all.”

Until recently, the DSM treated pathological grooming a bit like an afterthought and put it in a catch-all category called “not otherwise classified.” But the new DSM proposes to lump together pathological groomers and those with mental disorders like OCD. That includes people who wash their hands compulsively or have to line up their shoes a certain way.

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Shootings Expose Cracks in U.S. Mental Health System

Some states, like Minnesota, make it difficult, or even illegal, to force a person into treatment for a mental illness without proof the person is a threat to him or herself or others.

MINNEAPOLIS (AP) — Andrew Engeldinger’s parents pushed him for two years to seek treatment for what they suspected was mental illness, but even though he became increasingly paranoid and experienced delusions, there was nothing more they could do.

Minnesota law doesn’t allow people to be forced into treatment without proof that they are a threat to themselves or others. Engeldinger’s parents were horrified last week, when their 36-year-old son went on a workplace shooting spree that led to the deaths of a Minneapolis sign company’s owner, several of his employees and a UPS driver. Engeldinger then killed himself.

“They wanted him to get treatment. They wanted him to get help,” said Sue Abderholden, the executive director of the Minnesota chapter of the National Alliance on Mental Illness, who has acted as a family spokeswoman.

She added: “You’re not going to convince someone they’re ill if they don’t want to believe it.”

This is a problem faced by many friends and relatives of people suffering from mental illness, along with the police officers and health care providers to whom they turn for help. While a small number of people with mental illness commit acts of violence, the difficulty of securing treatment and ensuring it is successful — and the catastrophic consequences of failure — are common threads that often link such outbursts.

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by Patrick Condon, Associated Press

Wednesday, Oct 10th at 3 pm — Join NIMH Director Tom Insel For Online Chat

Part of Science magazine’s live web series ScienceLive. Dr. Insel joins a distinguished panel discussing the challenges of developing novel therapies for mental illness.

What is a Conservatorship? – What Everyone Needs to Know

Conservator: A protector of interests of an incompetent person: a person or institution responsible for protecting the interests of a legal incompetent.

That’s one way to put it.  But we all know there are a lot of ways to define a conservatorship and some of them are not ones we want to hear. Sometimes patients in psych wards are told another tune and can be lead to believe one thing when really a conservatorship is something entirely different.

“Do you know what a conservatorship is?”

“No.  I don’t understand that word.” 

“A conservatorship means you have a person that is assigned to you.  Like a guardian.  And they help make decisions to do what’s best for you.”

“So, like a guardian.  OK.”  She nodded. (Excerpt taken from “Inside the Insane.”)

“Like a guardian.”  Sounds promising, right? Ah, no. It’s interesting how many patients in acute inpatient psych wards don’t know what a conservatorship is and how it pertains to their life; especially when they are conserved by the Public Guardian (PG.)

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By Erica Loberg, PsychCentral

6 Ways To Keep Going When Your Goal Seems Out Of Reach

When you first get the big idea, you’re excited. Maybe you’re going to finally run that marathon, or write the Great American Novel, or spend the summer in France.

Yay you! That excitement gets you through the early phase, whether it’s running a couple miles a day, creating a detailed plot outline, or putting yourself on a strict budget and researching house-sitting opportunities in Paris.

But somewhere around the time you can’t seem to run ten miles without stopping, or you’re struggling with chapter seven, or you’ve spent so many nights home watching free shows on the Internet and eating Tuna Surprise you think you might poke your eyes out with a fork, you start having second thoughts.

You wonder if it wouldn’t be easier to give up your big idea and go back to your old life. One where your knees don’t hurt, you don’t care that your novel’s characters aren’t doing anything interesting, and you can afford to go out for dinner and a movie.

How do you keep going when your goal seems as far off as another universe?

You’ve hit what everyone hits – the motivation drain of the middle.

Beginnings and endings are where the energy is. When you start something new you’re pumped up, excited to get going. All the things you need to do to make your goal happen are new, and you take them on with joy and enthusiasm.

Endings have their own energy surges. You’re close to the finish line and can practically feel the relief at being done, plus the pride and happiness of getting the thing you’ve been aiming for all that time.

Middles are tough. They’re where your enthusiasm flags, and you may be tired and lose sight of why you went after your big idea in the first place. The middle is where most people give up.

You don’t have to. You just need to a) know you’ll hit a slowdown, and b) give yourself strategies to get through it.

Here are six you can use to keep going when your goal seems out of reach:

by Deonne Kahler


We Have Partnered With “The Houston Walk For Mental Health Awareness” on October 20, 2012–Please join us for this incredible event!

Mission Statement:

The Houston Walk for Mental Health is a community based event to raise awareness and funding for Harris County non-profit agencies and programs that provide mental health services.

Vision Statement:

For those struggling under the weight of Depression or a mental illness, past failures, or harmful relationships, every day living can feel like a death sentence.  The physical, mental and emotional suffering steals the heart out of life and if left untreated, will ultimately destroy them.  There is help and there is hope, but you can only find this by reaching outside yourself.  The Walk for Mental Health is a celebration of the hope of life after mental illness and a call to action by people in our community.

Learn more:

On the day of the walk (at Stude Park), Saturday October 20th, 2012,  on-site registration and packet pick-up will open at 7 AM.

Walk will start at 8 AM sharp by Mayor Annise Parker.

The Walk for Mental Health Awareness Luncheon will be held on Friday, October 19th, 2012 from 11:30 am to 1 pm at The United Way Community Resource Center at 50 Waugh Drive, Houston.

Martha McCrory, MT-BC, CPRP, the director of psychiatric rehabilitation services at the Menninger Clinic will provide an interactive presentation at noon on “Wellness and Creating Balance in Your Life.”

The luncheon is sponsored by The Menninger Clinic and is open to all registered walkers and interested members of the community.  Lunch will be provided.  Please RSVP to Bree Scott at or 713-275-5060 as seating is limited.

Eli Lilly Will Fund Your Tuition – Free Money!

How Do I Apply for a Lilly Reintegration Scholarship?

To download the 2013-2014 application, please click here.

Please note, you must have Adobe Acrobat Reader to access the PDF, you can download it for free here:


In order to be eligible for consideration for the Lilly Reintegration Scholarship, applicants must:

Be diagnosed with bipolar, schizophrenia, schizophreniform or schizoaffective disorder

Be currently receiving medical treatment for the disease, including medications and psychiatric follow-up

Be actively involved in rehabilitative or reintegrative efforts, such as clubhouse membership, part-time work, volunteer efforts or school enrollment

Complete an application package that includes an application form, essay, transcripts (if applicable), recommendation forms from three references and school financial requirements.

Please click here to download a Lilly Reintegration Scholarship FAQ sheet.


The Lilly Reintegration Scholarship program is designed to offer financial assistance for a wide range of educational opportunities in which students work to attain a certificate or degree.* Eligible programs include:

  • High school equivalency programs
  • Trade or vocational school programs
  • Associate degrees
  • Bachelor degrees
  • Graduate degrees

* Please note, noncredit, online and distance learning courses are not covered under the scholarship.

For more information please contact us via:

Phone: 800-809-8202
Mail: Lilly Secretariat
PMB 327
310 Busse Highway
Park Ridge, IL 60068-3251

Words Matter: Mental Disorders Are Named After Symptoms, Not Causes

NIMH just reached a milestone — our first grant was awarded 65 years ago last month. Rather than celebrating, this anniversary has been allowed to pass quietly. With so much progress in genomics and neuroscience, we at NIMH have mostly been trying to keep up. But these kinds of anniversaries afford a good time to take stock — all of us at NIMH would be remiss not to consider how far we have come since 1947. There have been many achievements: Nobel Prizes, great technologies, new treatments, and a vast enterprise for exploring the brain and behavior. But looking back is also sobering. Our original charge, from President Truman, was simply an executive order to fix the problems of America’s returning veterans who were struggling with “shell shock” or “combat neurosis.” Last month, we received another Presidential executive order. The topic – you guessed it: PTSD and TBI. Mission not accomplished.

During the same decades when scientific discovery has led to the eradication of many infectious diseases, has converted childhood leukemias from 95% fatal to 95% curable, and has reduced cardiovascular mortality by nearly 70%, our success rate with PTSD has been no better than our success at reducing war or trauma. In fact, for all mental disorders, while we have treatments, we lack cures, we lack vaccines, and we lack diagnostic biomarkers. Most of all, we lack a rigorous understanding of the disorders, at least on a par with our understanding of infectious diseases, childhood cancer, or cardiovascular disease. We need better science at every level from molecular biology to social science. Serendipity helps, but science, science that is rigorous and deliberate and even disruptive, is our North Star. That is why NIMH uses as its tag line that “research = hope.”

But there are many barriers to progress, not all of them are scientific. Some involve policy, some involve poverty, and remarkably, some are simply linguistic. In mental health, we are stymied by our language. The most obvious linguistic problem can be found in our current diagnostic terms, what my predecessor Steve Hyman has called “fictive categories.” Terms like “depression” or “schizophrenia” or “autism” have achieved a reality that far outstrips their scientific value. Each refers to a cluster of symptoms, similar to “fever” or “headache.” But beyond symptoms that cluster together, there should be no presumption that these are singular disorders, each with a single cause and a common treatment. Recall that Bleuler, who first introduced the term schizophrenia over a century ago, referred to “the schizophrenias.” And with new genetic discoveries, scientists are beginning to describe “the autisms,” a group of neurodevelopmental disorders of diverse causes.

Those who constructed the DSM were looking for a common language to describe symptoms, not a common biology or a common treatment. As someone who entered psychiatry pre-DSM-3, I can attest to the value of a common language. But there have been costs as well. In DSM-4, for instance, the diagnostic criteria for depression require 5 of 9 features, so it would be possible for two people with 1 of 9 criteria in common to have this same diagnosis. Not exactly “precision medicine,” but this approach has delivered diagnostic reliability. What is missing is validity. DSM never presumed to confer validity or explanatory value, but the field has imbued these symptom clusters with biological meaning, perhaps understandable in the absence of biomarkers or diagnostic tests. Ironically, this linguistic oversight has precluded the development of biomarkers that might confer validity. One reason we do not have biomarkers for mental disorders is our presumption that the biomarker is only valid if it maps on to a “fictive category,” rather than developing diagnostic categories based on the experimental data, as proposed by RDoC, our version of “precision medicine.”

Language traps us in even more subtle ways. There is no shortage of problematic words in our field. The term “stigma” may perpetuate a sense of being victimized with the unintended consequence of increasing discrimination and exclusion. There is an interesting ongoing debate about calling PTSD a “disorder” when it is unequivocally an injury. And conversely, for some in the autism community, a presumption that autism is an injury when much of the evidence points to autism as a neurodevelopmental disorder.

As a provocative question for our 65th birthday, I was recently asked if we should continue to be identified as NIMH when we study mental disorders more than mental health? Does the inclusion of “mental health” in our name (in contrast to the National Cancer Institute, the National Institute for Allergy and Infectious Diseases, the National Institute for Neurological Disorders and Stroke) reveal an ambivalence about our mission to transform the understanding and treatment of mental illness, especially serious mental illness? There is no ambivalence, but I appreciate the spirit of the question.

Some linguistic problems are easily solved. We can improve our current diagnostic categories via RDoC. We can find words that improve on “stigma.” Other linguistic issues, like the name of our institute, require literally an act of Congress. But on all of these issues, we need a broad conversation to help us understand how our language may be holding us back, limiting not only our impact but our imagination. Words matter, often in ways that are both subtle and profound.

By Thomas Insel, National Institute of Mental Health (NIMH)

Schizophrenia and Homelessness: My Brother Didn’t Make It to 60

Today would have been my brother’s 60th birthday.

Shariff Billy Nyad died three years ago, age 57, having lived most of his adult life on the streets of Boston. For those of you who are familiar with mental illness in your family, you will recognize this story.

Shariff. Let’s start there. My brother, three years younger than myself, two years older than our little sister Liza, came to our parents when he was about eight. He told them he meant no disrespect. His given name, William, was a fine name, he said. And he had given it several years. William, Willie, Bill, Billy. He had tried them all but they simply were not working.

So my parents asked if he had a name that was right.

And he did. Shariff. And he called himself Shariff the rest of his life.
Until the end. Then he reverted to Billy.

Shariff was the smartest of our family, by far. He wrote a book at the age of 11, titled The Jewels of the Everglades. Elementary school classes used to come to our house to visit his collection of tree snails and hear his lectures on their particularities.

He would stay up all night through most of his youth. I could hear him talking to his imaginary friends through the central air conditioning system. I suppose all the signs of schizophrenia were there but it was a different era. We just thought of Shariff as bookish, anti-social.

Then we interpreted his first few years away from home, dropping out of Boston University after only a short while, as hippie, druggie time. Again, we were naive.

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by  Diana Nyad, Huffington Post