title: Community adherence to schizophrenia treatment and safety monitoring guidelines.
abstract: The 2003 Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations and the Mount Sinai Conference Safety Monitoring recommendations generated guidelines for pharmacological treatment of schizophrenia and monitoring of antipsychotic side effects. This study examined rate of recommendation adherence and impact of adherence on outcomes of outpatients with schizophrenia or schizoaffective disorder in community mental health centers. Clinical practice was assessed as conformant, nonconformant, or not applicable. Treatment practices were conformant for antipsychotic dose (83%); use of antiparkinsonian (97%), antidepressant (100%), and antianxiety agents (90%) but not clozapine for residual positive symptoms (31%); and monitoring weight gain (48%), glucose dysregulation (53%), hyperlipidemia (34%), or extrapyramidal symptoms (11%). Community mental health center treatment practices were largely conformant with the 2003 Schizophrenia PORT treatment recommendations. There is less evidence that patients who receive treatment in the community are adequately monitored for antipsychotic side effects per the Mount Sinai recommendations.
authors.affiliation: *Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore; and †VA Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD.
authors.forename: William R
authors.initials: WR
authors.lastname: Keller
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Fischer
authors.forename: Robert
authors.initials: R
authors.lastname: McMahon
authors.forename: Walter
authors.initials: W
authors.lastname: Meyer
authors.forename: Melissa
authors.initials: M
authors.lastname: Blake
authors.forename: Robert W
authors.initials: RW
authors.lastname: Buchanan
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000978:Antiparkinson Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010045:Outpatients; D017410:Practice Guidelines as Topic; D011618:Psychotic Disorders / Q000188:drug therapy*; D012559:Schizophrenia / Q000188:drug therapy*; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D001786:Blood Glucose