Byline: Chittaranjan. Andrade CME Questions A) Schizophrenia and bipolar disorder are both associated with an increased risk of weight gain, incident diabetes mellitus, and the metabolic syndrome; at least a part of the risk is mediated by iatrogenic factors such as atypical antipsychotic medication and mood stabilizers. The relationship between depression and diabetes mellitus has also been studied. With this background, mark True or False against each of the following statements: *Depression is associated with an increased risk of incident diabetes mellitus. *Diabetes mellitus is associated with an increased risk of incident depression. *Depression is associated with superior treatment adherence to antidiabetic measures. *In diabetic samples, inactive persons are less likely to be depressed. *In diabetic samples, depressed persons are more likely to be inactive. *In diabetic samples, long-term glycemic control is no different between depressed and nondepressed patients. B) Just as antidepressant augmentation strategies are employed in antidepressant-refractory depression, so too are antipsychotic augmentation strategies considered in antipsychotic-refractory schizophrenia. Lamotrigine is a broad-spectrum antiepileptic drug which has also demonstrated efficacy in the acute treatment of bipolar depression and in the maintenance therapy of rapid-cycling and nonrapid-cycling bipolar disorder. With this background, mark True or False against each of the following statements: *The rationale for the use of lamotrigine in schizophrenia is that the drug is a partial agonist at dopamine autoreceptors. *Lamotrigine augmentation of antipsychotic medication attenuates positive symptoms of schizophrenia. *Conventional doses of lamotrigine are associated with clinically significant increases in antipsychotic drug levels. *There is weak clinical evidence that lamotrigine augmentation may attenuate obsessive-compulsive disorder symptoms in patients with schizophrenia. CME Answers A) Depression and diabetes mellitus Answers: 1. True; 2. True; 3. False. 4. False; 5. True. 6. False. Mezuk et al.[sup] [1] described a systematic review and meta-analysis of the relationship between depression and Type 2 diabetes. They identified 13 prospective studies of depression which excluded diabetes at baseline, and 7 prospective studies of diabetes which excluded depression at baseline. They found that depression was associated with a 60% increased risk of new-onset diabetes (Relative Risk [RR], 1.60; 95% confidence intervals [CI], 1.37-1.88) and diabetes was associated with a 15% increased risk of new-onset depression (RR, 1.15; 95% CI, 1.02-1.30). Gonzalez et al.[sup] [2] described a systematic review and meta-analysis of the relationship between depression and treatment nonadherence in 47 studies of patients with type 1 and type 2 diabetes mellitus. They found that depression was significantly associated with treatment nonadherence; studies with better methodology demonstrated larger nonadherence effects. Lysy et al.[sup] [3] described a systematic review of the relationship between physical activity and depressed mood in Type 2 diabetes patients. They identified 10 cross-sectional studies and 2 trials. They found that, in adults with Type 2 diabetes, inactive persons were 1.72-1.75 times more likely to be depressed, and depressed persons were 1.22-1.90 times more likely to be inactive. Richardson et al .[sup] [4] examined the longitudinal effects of ICD-9 depression on glycemic control in 11,525 persons with Type 2 diabetes. The mean age of the sample was about 66 years. The sample was 97% male. The sample was followed up for a mean of 4.1 years. Depression was recorded in 6% of the sample. HbA1c values were found to be slightly (by a mean of 0.13%) but significantly higher in depressed persons at all time points during the study. These findings suggest that, in depressed patients who are not diabetic, efforts should be made to modify lifestyle risk factors for diabetes in order to reduce the risk of future diabetes; and these patients should be monitored so that diabetes, if incident, is detected early. …