Bitter István, Czobor Pál, Tombor László
Department of Psychiatry and Psychotherapy, Semmelweis University, 1083 Budapest, Hungary.
Brain Sci. 2025 May 13;15(5):499. doi: 10.3390/brainsci15050499.
BACKGROUND/OBJECTIVES: Type 2 diabetes mellitus (T2DM) and impaired glucose metabolism are more prevalent among patients with schizophrenia than in the general population. The incidence of T2DM is associated with lifestyle factors that are often influenced by the negative symptoms of schizophrenia; comorbid T2DM may contribute to the reduced life expectancy observed in patients with schizophrenia. The existing literature reveals a scarcity of data regarding the potential causal relationship between T2DM and negative symptoms.
A scoping review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, utilizing the PubMed database to identify clinical studies investigating the association between T2DM and the negative (but not cognitive) symptom domain of schizophrenia. Subsequently, the reference lists of these identified publications were searched.
Seventeen publications were included. There is evidence supporting the association between impaired glucose tolerance and increased negative symptoms in patients with first-episode psychosis, and several studies indicate that poorer glucose metabolic status correlates with more severe negative symptoms. Patients with T2DM and chronic schizophrenia, however, had milder negative symptom scores compared to those without diabetes, although this association was less pronounced than in early disease stages.
There is insufficient confirmatory evidence regarding the potential causality of T2DM on the negative symptoms of schizophrenia. Further, preferably prospective studies are needed to explore the complex and potentially causal relationship between T2DM and negative symptoms of schizophrenia. If T2DM were found to have a causal relationship with negative symptoms or to exacerbate pre-existing symptoms, it could lead to significant changes in therapeutic approaches for schizophrenia.
背景/目的：2型糖尿病（T2DM）和糖代谢受损在精神分裂症患者中比在普通人群中更为普遍。T2DM的发病率与生活方式因素有关，而这些因素往往受精神分裂症阴性症状的影响；合并T2DM可能导致精神分裂症患者预期寿命缩短。现有文献显示，关于T2DM与阴性症状之间潜在因果关系的数据匮乏。
按照PRISMA（系统评价和Meta分析的首选报告项目）标准进行了一项范围综述，利用PubMed数据库确定调查T2DM与精神分裂症阴性（而非认知）症状领域之间关联的临床研究。随后，检索了这些已确定出版物的参考文献列表。
纳入了17篇出版物。有证据支持首发精神病患者糖耐量受损与阴性症状增加之间的关联，多项研究表明，较差的糖代谢状态与更严重的阴性症状相关。然而，与无糖尿病的患者相比，T2DM和慢性精神分裂症患者的阴性症状评分较轻，尽管这种关联不如疾病早期阶段明显。
关于T2DM对精神分裂症阴性症状潜在因果关系的确定性证据不足。此外，需要开展进一步的前瞻性研究，以探索T2DM与精神分裂症阴性症状之间复杂且潜在的因果关系。如果发现T2DM与阴性症状存在因果关系或加剧现有症状，可能会导致精神分裂症治疗方法的重大改变。
