Abstract
BackgroundThe use of atypical antipsychotics which currently form the primary choice pharmacotherapy for several mental health conditions have been linked to cardiovascular and metabolic side effects. This systematic review aimed to investigate the barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines.MethodsA protocol-led (CRD-42018106002) systematic literature review was conducted by searching Medline, Embase, and PsycINFO databases 2003 until October 2019. Cochrane, Centre for Review and Dissemination (CRD) and PRISMA guidelines were followed. Studies investigating barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines were included.ResultsA total of 23 records were included. Key barriers included a) health-care system-related factors such as lack of knowledge and expertise amongst care providers, available resources, confusion around remit and roles, fragmentation of care such as across general practitioners and psychiatrists, and time constraints and b) patient-related factors such as disability resulting from mental health conditions, knowledge and skills of the patients.ConclusionBarriers to monitoring and management of cardiovascular and metabolic health of patients taking antipsychotic medicines are multidimensional. Apart from educational interventions directed to both patients and health-care professionals, the results suggest a need for the improvement of wider system-related factors to improve physical health of patients prescribed antipsychotic medicines.Clearer guidelines, clarity of remit and roles amongst service providers are necessary in addition to educational interventions directed at patients and health-care professionals in improving physical health monitoring, counselling and management of patients prescribed antipsychotic medicines.Trial registrationA protocol was developed and registered with PROSPERO as per PRISMA-P guidelines (CRD 42018106002).
Highlights
The use of atypical antipsychotics which currently form the primary choice pharmacotherapy for several mental health conditions have been linked to cardiovascular and metabolic side effects
Apart from educational interventions directed to both patients and health-care professionals, the results suggest a need for the improvement of wider system-related factors to improve physical health of patients prescribed antipsychotic medicines
Patients with severe mental illnesses such as schizophrenia are at dual disadvantage of being inherently predisposed to metabolic abnormalities and often this is worsened by the subsequent use of antipsychotics [1]
Summary
The use of atypical antipsychotics which currently form the primary choice pharmacotherapy for several mental health conditions have been linked to cardiovascular and metabolic side effects. Patients with severe mental illnesses face inequality in health and access to healthcare and face early deaths. A recent meta-analysis suggested that schizophrenia is associated with a weighted average of 14·5 years of potential life lost, with females being disadvantaged over males [1]. Atypical antipsychotics which currently form the primary choice pharmacotherapy for the management of psychotic episodes in schizophrenia, bipolar disorders and other several mental illnesses, have been linked to cardiovascular and metabolic side effects [1]. Patients with severe mental illnesses such as schizophrenia are at dual disadvantage of being inherently predisposed to metabolic abnormalities and often this is worsened by the subsequent use of antipsychotics [1]. Results from a meta-analysis assessing the prevalence of metabolic abnormalities between antipsychotic naïve patients and chronically treated found that the rate of individual metabolic abnormalities was significantly higher in the chronically treated group [3]
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