A prospective study of monitoring practices for metabolic disease in antipsychotic-treated community psychiatric patients.
BACKGROUND
Patients with severe mental illness are at increased risk for metabolic and cardiovascular disease. A number of recent guidelines and consensus statements recommend stringent monitoring of metabolic function in individuals receiving antipsychotic drugs.


METHODS
We conducted a prospective cohort study of 106 community-treated psychiatric patients from across the diagnostic spectrum from the Northeast of England to investigate changes in metabolic status and monitoring practices for metabolic and cardiovascular disease. We undertook detailed anthropometric and metabolic assessment at baseline and follow-up, and examined clinical notes and hospital laboratory records to ascertain monitoring practices.


RESULTS
A high prevalence of undiagnosed and untreated metabolic disease was present at baseline assessment. Mean follow-up time was 599.3 (SD +/- 235.4) days. Body mass index (p < 0.005) and waist circumference (p < 0.05) had significantly increased at follow-up, as had the number of individuals who were either overweight or obese. Fifty-three per cent of individuals had hypertriglyceridemia, and 31% had hypercholesterolemia, but only 7% were receiving lipid-lowering therapy. Monitoring practices were poor. Recording of measures of adiposity occurred in 0% of individuals, and > 50% of subjects had neither blood glucose nor lipids monitored during the follow-up period.


CONCLUSIONS
This cohort has a high prevalence of metabolic disease and heightened cardiovascular risk. Despite the publication of a number of recommendations regarding physical health screening in this population, monitoring rates are poor, and physical health worsened during the follow-up period.
Mackin
Paul
P
School of Neurology, Neurobiology and Psychiatry, Newcastle University, Newcastle upon Tyne, UK. paul.mackin@ncl.ac.uk
Bishop
David R
DR
Watkinson
Helen M O
HM
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D015228:Hypertriglyceridemia / Q000453:epidemiology; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012306:Risk
D014150:Antipsychotic Agents