Screening for the metabolic side effects of antipsychotic medication: findings of a 6-year quality improvement programme in the UK

Barnes, Thomas R. E.; Bhatti, Sumera; Adroer, Roma; Paton, Carol

doi:10.1136/bmjopen-2015-007633

Cited by 43 publications

(42 citation statements)

References 23 publications

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“…The proportion of patients assessed for metabolic side effects was relatively low compared with community-based patients with schizophrenia,25 26 perhaps partly due to the additional challenges associated with phlebotomy in people with ID.…”

Section: Discussionmentioning

confidence: 99%

Quality of prescribing of antipsychotic medication for people with intellectual disability under the care of UK mental health services: a cross-sectional audit of clinical practice

et al. 2016

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ObjectivesTo determine the prevalence and quality of antipsychotic prescribing for people with intellectual disability (ID).DesignA clinical audit of prescribing practice in the context of a quality improvement programme. Practice standards for audit were derived from relevant, evidence-based guidelines, including NICE. Data were mainly collected from the clinical records, but to determine the clinical rationale for using antipsychotic medication in individual cases, prescribers could also be directly questioned.Settings54 mental health services in the UK, which were predominantly NHS Trusts.ParticipantsInformation on prescribing was collected for 5654 people with ID.ResultsAlmost two-thirds (64%) of the total sample was prescribed antipsychotic medication, of whom almost half (49%) had a schizophrenia spectrum or affective disorder diagnosis, while a further third (36%) exhibited behaviours recognised by NICE as potentially legitimate targets for such treatment such as violence, aggression or self-injury. With respect to screening for potential side effects within the past year, 41% had a documented measure of body weight (range across participating services 18–100%), 32% blood pressure (0–100%) and 37% blood glucose and blood lipids (0–100%).ConclusionsThese data from mental health services across the UK suggest that antipsychotic medications are not widely used outside of licensed and/or evidence-based indications in people with ID. However, screening for side effects in those patients on continuing antipsychotic medication was inconsistent across the participating services and the possibility that a small number of these services failed to meet basic standards of care cannot be excluded.

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Section: Discussionmentioning

confidence: 99%

Quality of prescribing of antipsychotic medication for people with intellectual disability under the care of UK mental health services: a cross-sectional audit of clinical practice

et al. 2016

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“…16 Thus, the potential for psychotropic drugs to cause or to exacerbate metabolic syndrome in patients is not restricted to at-risk patients (eg, drug naive, first episode disease, and nonobese or young patients). 11 Because clinicians have been found to have a poor adherence to guidelines for metabolic monitoring worldwide, [27][28][29] there is a need for programs to help educate providers and to facilitate monitoring of these cardiometabolic risk factors. Beside, a poor quality of management of potential physical health problems in psychiatric patients has also been recognized.…”

Section: Discussionmentioning

confidence: 99%

Early changes of blood lipid levels during psychotropic drug treatment as predictors of long-term lipid changes and of new onset dyslipidemia

Delacrétaz¹,

Vandenberghe²,

Gholam‐Rezaee³

et al. 2018

Journal of Clinical Lipidology

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“…Currently, clinical guidelines for metabolic screening upon initiation or continuation of SGAs put forth that blood pressure, body mass index (BMI), blood glucose and lipids should be checked at least every six months. [131][132][133] This has been a highly positive and well-received step towards better considering the physical health outcomes in people with SMI. However, decades of research in the general population have shown that preventing conditions such as obesity and metabolic syndrome from ever arising is considerably more efficient than attempting to reverse their long-term consequences.…”

Section: Panel 2: Why Wait For Weight? Tipping the Scales Towards Prementioning

confidence: 99%

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

Firth

Siddiqi

Koyanagi

et al. 2019

The Lancet Psychiatry

973

1,093

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Executive SummaryThe poor physical health of people with mental illness is a multi-faceted, transdiagnostic, and global problem. Physical health disparities are observed across the entire spectrum of mental illnesses, in low, middle-and high-income countries. This stems from both a heightened risk of physical diseases in people with mental illness, along with their reduced access to adequate healthcare. The high rates of physical comorbidities (and typically-poor clinical management of this) drastically reduces life expectancy, and also increases the personal, social and economic burden of illness across the lifespan.This Commission has brought together an international team of researchers, clinicians, and key stakeholders from various backgrounds and professionally / personally-relevant experience, in order to summarize advances in understanding on this topic, and present clear directions for health promotion, clinical care and future research. The breadth and multifactorial nature of physical health disparities across the range of mental health diagnoses poses an almost limitless number of potential considerations. Therefore, rather than attempting to cover all of the different possible combinations of physical-mental comorbidities individually, the aim of this Commission was to: (i) establish highlypertinent aspects of physical health-related morbidity and mortality which apply transdiagnostically, (ii) highlight the common modifiable factors driving these disparities, (iii) present actions and initiatives for health policy and clinical services to address these issues, and (iv) identify promising areas for future research towards discovering novel solutions. This was addressed across 5 different Parts of the Commission: Parts 1 and 2 determined the scope, priorities and key targets for physical health improvement across multiple mental illnesses. Parts 3, 4 and 5 discussed emerging strategies and produced recommendations for improving physical health outcomes in people with mental illness. Leaders and contributors for each Part are shown in the Appendix (pg.1) . Part 1: 'Its more than premature mortality'Part 1 identified almost 100 systematic reviews/meta-analyses examining the prevalence of physical comorbidities in mental illness. Around 70% of the meta-research focused on cardiometabolic diseases; consistently reporting that mental illnesses were associated with 1.4-to 2-fold increased risk for obesity, diabetes and cardiovascular diseases compared to the general population. Although mostly studied in 'severe mental illness' ('SMI', and particularly psychotic disorders), the prevalence of cardiometabolic diseases was similarly elevated across a broad range of other diagnoses, including substance use disorders (SUDs), and 'common mental disorders' ('CMDs', such as depression and anxiety). Part 2: Key modifiable factors in health behaviours and health servicesPart 2 built on the findings of Part 1 with a hierarchal evidence synthesis of modifiable risk factors for physical diseases in mental illness. The bu...

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Screening for the metabolic side effects of antipsychotic medication: findings of a 6-year quality improvement programme in the UK

Cited by 43 publications

References 23 publications

Quality of prescribing of antipsychotic medication for people with intellectual disability under the care of UK mental health services: a cross-sectional audit of clinical practice

Quality of prescribing of antipsychotic medication for people with intellectual disability under the care of UK mental health services: a cross-sectional audit of clinical practice

Early changes of blood lipid levels during psychotropic drug treatment as predictors of long-term lipid changes and of new onset dyslipidemia

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

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