부산대학교 도서관

Metabolic syndromes constitute an important risk factor for mental disorders, and vice versa. We report a case of a woman in her fifties with schizophrenia and type 2 diabetes mellitus, who required involuntary admission to a local hospital after physically assaulting her brother. On admission, her HbA1c was 11.7%, and her blood glucose was 323 mg/dL. After initial treatment with oral risperidone, we offered the patient the option of treatment with risperidone long-acting injection (LAI). Since she was already accustomed to insulin injections, she willingly accepted our recommendation. We set up a post-discharge treatment plan involving biweekly visits to the hospital by the patient in the company of a community supporter. The medication consisted of treatment with trelagliptin, a dipeptidyl peptidase (DPP)-4 inhibitor designed for once-weekly administration (changed later to dulaglutide, a glucagon-like peptide (GLP)-1 analogue also designed for once-weekly injection), supervised by a home visit nurse. As a result of this treatment, she stabilized physically and mentally, and started enjoying daily activities such as drawing and cooking. Adherence with medication is critical for the stabilization of psychological symptoms and blood glucose levels. Long-acting hypoglycemic drugs as well as antipsychotic LAIs have recently been developed for this purpose. Further, general hospital psychiatrists can play an important role in collaborating with physicians and in mobilizing social resources to promote patients’ recovery while reducing the risk of exacerbation or complication of an existing condition.