Physical Health and Drug Safety in Individuals with Schizophrenia

Abstract

Background: While antipsychotic medications are the mainstay of therapy for individuals with schizophrenia and psychotic disorders, their use is associated with adverse effects on physical health that require the attention and care of prescribers. Methods: We used the ADAPTE process to adapt existing guideline recommendations from the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the dosing of antipsychotics and antipsychotic polypharmacy, screening for adverse effects of antipsychotics, and management of metabolic and extrapyramidal side effects to the Canadian context. Results: Prescribers are encouraged to use the lowest effective dose and to avoid the routine use of multiple antipsychotics. Scheduled monitoring of body mass index, waist circumference, blood pressure, glucose, lipids, prolactin, electrocardiograms, and extrapyramidal symptoms is recommended. Lifestyle interventions are recommended to mitigate antipsychotic-induced weight gain. Prescribers should follow Canadian guidelines on the treatment of obesity, dyslipidemia, and diabetes. Recommendations on antipsychotic drug choice are made for users particularly concerned about extrapyramidal symptoms. Conclusion: Careful monitoring and attention by prescribers may mitigate adverse effects associated with antipsychotic medications.

The Prevalence and Factors Associated With Antipsychotic Polypharmacy in a Forensic Psychiatric Sample

“…Current Canadian guidelines in the treatment of individuals with schizophrenia advise limiting the use of multiple concurrent antipsychotics to the most exceptional and treatment resistant cases (1). Despite minimal evidence supporting the use of antipsychotic polypharmacy, it remains a common practice worldwide (1)(2)(3)(4). For example, Yang and colleagues (5) investigated the prevalence of antipsychotic polypharmacy in 15 countries in Asia and found the average rate of antipsychotic polypharmacy was 42.2%.…”

Influence of the use of atypical antipsychotics in metabolic syndrome

“…Por todas estas razones, se hace necesaria la implementación de sistemas de monitorización de todos los pacientes en tratamiento con antipsicóticos atípicos, ajustando bien la dosificación, evitando el uso de combinaciones múltiples de estos, controlando el peso, el índice de masa corporal, el perímetro abdominal, la presión arterial, los niveles de prolactina y realizando un electrocardiograma 26 . También se ha llevado a cabo este tipo de monitorización en pacientes penitenciarios, consiguiendo una disminución en la prevalencia del síndrome metabólico, así como una disminución en las prescripciones de neurolépticos con el transcurso del tiempo 27 .…”

“…For all these reasons, monitoring systems need to be implemented for all patients undergoing treatment with atypical antipsychotics, with adequate adjustments to dosage, avoiding the use of multiple combinations of antipsychotics, checking weight, BMI, abdominal circumference, blood pressure, prolactin levels and ECG tests 26 . This type of monitoring has been carried out on prison patients, and has brought about a decrease in the prevalence of metabolic syndrome, along with a drop in the number of prescriptions for neuroleptic drugs over time 27 .…”

Understanding Engagement with a Physical Health Service: A Qualitative Study of Patients with Severe Mental Illness

“…12 A call for action was issued by professional psychiatric organizations urging mental health services to address common medical comorbidities either by integration of basic physical health care into mental health services or by collaboration with primary and specialist care. 13,14 Designing, or redesigning, health-care processes from the patient's perspective has been a key concept in contemporary medical improvement efforts 15 and essential for creating successful and sustainable medical services for individuals with SMI. Some qualitative studies have detailed the difficulties patients with SMI face when accessing medical care in acute care settings such as stigma and communication difficulties.…”