Schizophrenia Bulletin Advance Access published online on May 4, 2007
Schizophrenia Bulletin, doi:10.1093/schbul/sbm038
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A UK Audit of Screening for the Metabolic Side Effects of Antipsychotics in Community Patients
2 Department of Psychological Medicine, Imperial College Faculty of Medicine, Charing Cross Campus, London W6 8RP, UK
3 Prescribing Observatory for Mental Health based at the Royal College of Psychiatrists' Centre for Quality Improvement, London E1 8AA, UK
4 Maudsley Hospital, South London and Maudsley NHS Trust, London SE5 8AZ, UK
1 To whom correspondence should be addressed; Division of Neuroscience and Mental Health, Imperial College, Charing Cross Campus, Reynold's Building, St Dunstan's Road, London W6 8RP, UK; tel: +44-207-386-1233; fax: +44-207-386-1216, e-mail: t.r.barnes{at}imperial.ac.uk.
Reviews of the association between psychotic disorder, the metabolic syndrome, diabetes, and antipsychotic drugs conclude that there is a need for active, routine physical health screening of patients' prescribed antipsychotic drugs. From published guidelines, we derived the audit standard that all such patients should, as a minimum, have their blood pressure, body mass index (BMI) (or other measure of obesity such as waist circumference), blood glucose (or HbA1c), and plasma lipids measured at least once a year. We conducted an audit of the clinical records of 1966 eligible patients under the care of 48 multidisciplinary, assertive outreach clinical teams in 21 mental health services across the United Kingdom. This revealed a recorded measurement within the previous year for blood pressure in 26% of the patients, obesity in 17%, blood glucose (or HbA1c) in 28% and plasma lipids in 22%, with all 4 measures documented in 11%. In the total national sample, 6% had a documented diagnosis of diabetes, 6% hypertension, and 6% dyslipidemia. Extrapolating from the prevalence of these disorders in similar populations suggests that for every patient with a known diagnosis of diabetes, another had not been recognized, for every known case of hypertension, 4 had been missed, and for every known case of dyslipidemia, 7 had been missed. The responses of the clinical teams to a questionnaire yielded information on obstacles to screening in routine practice, revealing uncertainty about whose responsibility this was, a lack of confidence about the interpretation of abnormal screening results, and limited access to basic equipment.
Keywords: metabolic syndrome / obesity / diabetes / dyslipidemia / hypertension / psychosis
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