A prospective study of metabolic disease and monitoring practices in antipsychotic-treated community psychiatric patients

Abstract

Background and aims

Recent guidelines and consensus statements recommend stringent monitoring of metabolic function in individuals receiving antipsychotic drugs. We aimed prospectively to study the evolution of metabolic dysfunction in a cohort of antipsychotic-treated subjects with severe mental illness from across the diagnostic spectrum. We also investigated monitoring practices for metabolic disease and cardiovascular risk.

Methods

A prospective cohort study of 106 community-treated psychiatric patients from across the diagnostic spectrum from the Northeast of England. Detailed anthropometric and metabolic assessment was undertaken.

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. A number of individuals on ‘high risk’ drugs with regard to glucose homeostasis disorders reverted from impaired fasting glucose to normoglycemia during the follow-up period. 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 19 month follow-up period.