Conclusion
Clinicians face regular dilemmas in trying to find the right balance between achieving control over the patient's mental illness and reducing the adverse effects associated with the prescribed medication. Whilst research in the area is ongoing, psychiatrists should perform regular general health monitoring (including screening for diabetes mellitus) in all patients with schizophrenia. In patients receiving concomitant antidiabetic therapy, caution should be exercised when changing from one SGA to another. Whilst more longitudinal data is required, a trial of alternative SGAs, including aripiprazole in those developing type 2 diabetes and impaired glucose tolerance may be a worthwhile therapeutic option.

Further research is required to determine the potential of aripiprazole to prevent complications or reverse metabolic abnormalities in those patients with pronounced disturbances at baseline. If present, these properties could enhance treatment options in patients receiving concomitant antidiabetic therapy and in those patients with treatment resistance on combination therapy with drugs known to have a poor safety profile [14].

Abbreviations
BMI: body mass index; SGA: second-generation antipsychotic.

Competing interests
MG has received sponsorship from Janssen Cilag, manufacturers of risperidone, Otsuka Pharmaeuticals, manufacturers of aripiprazole, and Eli Lilly, manufacturers of olanzapine, for attending various conferences and has received honoraria from the same firms for speaking and chairing meetings. No other potential conflict of interest relevant to this article was reported.

Authors' contributions
RLG, MG and NA participated in the sequence, alignment and drafted of the manuscript. All authors read and approved the final manuscript.

Consent
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Acknowledgements
We would like to thank Professor Steven Gough, Professor of Medicine and Consultant Physician at Birmingham University and University Hospital Birmingham for his valuable contribution to the development of this paper.