title: Persistent Low Rates of Treatment of Metabolic Risk Factors in People With Psychotic Disorders: A PHAMOUS Study.
abstract: OBJECTIVE
  People with psychotic disorders have an increased metabolic risk and a shortened life expectancy compared to the general population. Two large studies showed that metabolic disorders were untreated in a majority of the patients. Since then, guidelines have urged monitoring of metabolic health. This study examined the course of metabolic disorders over time in people with psychotic disorders and investigated current treatment rates.
  
  
  METHODS
  A total of 1,259 patients with psychotic disorders, as defined by the DSM-IV, from 4 Dutch mental health institutions participated in 3 yearly assessments of the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS) between 2006 and 2014. Patients' metabolic parameters were measured, and the use of pharmacologic treatment for hypertension (systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg), dyslipidemia (5% ≤ Systematic COronary Risk Evaluation [SCORE] risk < 10% and low-density lipoprotein [LDL] cholesterol level ≥ 2.5 mmol/L or SCORE risk ≥ 10% and LDL cholesterol level ≥ 1.8 mmol/L and/or triglycerides ≥ 2.3 mmol/L), and hyperglycemia (hemoglobin A1c concentration > 7% and/or fasting glucose concentration ≥ 7.2 mmol/L) was recorded.
  
  
  RESULTS
  Prevalence of the metabolic syndrome, as defined by the National Cholesterol Education Program criteria, was > 50% at each assessment. On the basis of the European Society of Cardiology guidelines, pharmacotherapy for metabolic disorders was recommended for 52%-59% of the patients at each assessment. Treatment rates with antihypertensive (from 31% to 38%, P < .001) pharmacotherapy increased throughout the assessments. However, half of the patients were not treated for their metabolic risk factors while being monitored for 3 years or longer. Older patients were more likely to receive treatment, and patients who received treatment had lower blood pressure and lower cholesterol and triglyceride concentrations than patients not receiving the recommended treatment.
  
  
  CONCLUSIONS
  Metabolic risk factors are still seriously undertreated in people with psychotic disorders. Better adherence to and better implementation of guidelines about monitoring and treating metabolic disorders in psychiatry are crucial.
authors.affiliation: University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Research Center, Hanzeplein 1, CC72, 9713 GZ Groningen, The Netherlands. j.bruins@lentis.nl.|Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center Psychiatry, Groningen, The Netherlands.|Lentis Mental Health Organization, Groningen, The Netherlands.
authors.forename: Jojanneke
authors.initials: J
authors.lastname: Bruins
authors.affiliation: Department of Psychology, University of Groningen, Groningen, The Netherlands.|Department of Psychotic Disorders, GGZ Drenthe, Assen, Drenthe, The Netherlands.
authors.forename: Gerdina H M
authors.initials: GHM
authors.lastname: Pijnenborg
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Edwin R
authors.initials: ER
authors.lastname: van den Heuvel
authors.affiliation: Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center Psychiatry, Groningen, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Visser
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: Corpeleijn
authors.affiliation: Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center Psychiatry, Groningen, The Netherlands.|Lentis Mental Health Organization, Groningen, The Netherlands.
authors.forename: Agna A
authors.initials: AA
authors.lastname: Bartels-Velthuis
authors.affiliation: Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center Psychiatry, Groningen, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Bruggeman
authors.affiliation: Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center Psychiatry, Groningen, The Netherlands.|Research Department, Friesland Mental Health Services, Leeuwarden, Friesland, The Netherlands.
authors.forename: Frederike
authors.initials: F
authors.lastname: Jörg
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D008078:Cholesterol, LDL / Q000032:analysis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006306:Health Surveys; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000592:standards*; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D020380:Needs Assessment; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D018570:Risk Assessment; D012307:Risk Factors; D014280:Triglycerides / Q000032:analysis
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D014280:Triglycerides