Journal
PSYCHOLOGICAL MEDICINE
Volume 42, Issue 1, Pages 125-147Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S003329171100105X
Keywords
Bipolar disorder; cardiovascular risk; diabetes; dyslipidaemia; guidelines; metabolic syndrome; monitoring; post-intervention; schizophrenia; screening
Categories
Funding
- Feinstein Institute for Medical Research
- National Institute of Mental Health (NIMH)
- National Alliance for Research in Schizophrenia and Depression (NARSAD)
- Ortho-McNeill/Janssen/JJ
- AstraZeneca
- Bristol-Myers Squibb
- Eli Lilly
- Janssen-Cilag
- Lundbeck JA
- Pfizer
- Sanofi Aventis
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Background. Despite increased cardiometabolic risk in individuals with mental illness taking antipsychotic medication, metabolic screening practices are often incomplete or inconsistent. Method. We undertook a systematic search and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) meta-analysis of studies examining routine metabolic screening practices in those taking antipsychotics both for patients in psychiatric care before and following implementation of monitoring guidelines. Results. We identified 48 studies (n=290 534) conducted between 2000 and 2011 in five countries; 25 studies examined predominantly schizophrenia-spectrum disorder populations; 39 studies (n=218 940) examined routine monitoring prior to explicit guidelines; and nine studies (n=71 594) reported post-guideline monitoring. Across 39 studies, routine baseline screening was generally low and above 50% only for blood pressure [69.8%, 95% confidence interval (CI) 50.9-85.8] and triglycerides (59.9%, 95% CI 36.6-81.1). Cholesterol was measured in 41.5% (95% CI 18.0-67.3), glucose in 44.3% (95% CI 36.3-52.4) and weight in 47.9% (95% CI 32.4-63.7). Lipids and glycosylated haemoglobin (HbA1c) were monitored in less than 25%. Rates were similar for schizophrenia patients, in US and UK studies, for in-patients and out-patients. Monitoring was non-significantly higher in case-record versus database studies and in fasting samples. Following local/national guideline implementation, monitoring improved for weight (75.9%, CI 37.3-98.7), blood pressure (75.2%, 95% CI 45.6-95.5), glucose (56.1%, 95% CI 43.4-68.3) and lipids (28.9%, 95% CI 20.3-38.4). Direct head-to-head pre-post-guideline comparison showed a modest but significant (15.4%) increase in glucose testing (p=0.0045). Conclusions. In routine clinical practice, metabolic monitoring is concerningly low in people prescribed antipsychotic medication. Although guidelines can increase monitoring, most patients still do not receive adequate testing.
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