Disturbances of glucose metabolism associated with the use of psychotropic drugs: A post-mortem evaluation

- Antipsychotic and antidepressant treatment may be associated impaired glycemic control.
- Reported complications included diabetic ketoacidosis and, rarely, death.
- Diabetic ketoacidosis-related deaths may occur in undiagnosed diabetic cases.
- Former medication history of antipsychotics or antidepressants should always be investigated.

Treatment with atypical antipsychotic agents and tetracyclic antidepressants has been associated with impaired glycemic control. Reported complications have included new-onset diabetes mellitus, life-threatening diabetic ketoacidosis and, rarely, death. The study presented herein focuses on biochemical investigations of glucose metabolism in a series of medico-legal cases that revealed the presence of atypical antipsychotic agents (clozapine, olanzapine, quetiapine and risperidone) or mirtazapine at toxicology. Two different approaches were used. In one, 55 forensic autopsy cases (characterized by the presence of clozapine, olanzapine, quetiapine, risperidone and mirtazapine toxicologically identified) were retrospectively selected. In the second approach, 20 forensic autopsy cases that had a cause of death attributed to diabetic ketoacidosis were retrospectively selected. The combination of the results obtained from the first and second approaches allowed only one case of possibly drug-induced glucose metabolism disturbance (in one individual treated with mirtazapine who was not known to suffer from diabetes mellitus) to be identified. Though our results could raise the question of the benefit of systematizing postmortem biochemical investigation in situations of sudden death involving individuals treated with psychotropic drugs, the study stresses the importance of investigating all potentially relevant data (including the overall knowledge of medication history) in order to formulate appropriate hypotheses concerning the cause and pathogenesis of death.