Abstract
Since the 1990s, the arrival of the new generation of antipsychotics, the atypical antipsychotics (AAP), heralded a new era in the management on psychotic patients as they are associated with much less side effects as the older drugs. However, the psychiatric community soon realized a new problem had emerged with these drugs, namely severe metabolic side effects. Several monitoring guidelines were soon published to guide treating physicians on how to deal with this issue. This study was aimed to assess adherence to the recommended guidelines by Malaysian doctors. Data concerning metabolic monitoring over 1 year were collected from 405 subjects newly started on AAP after June 2005, when the recommended guidelines were first implemented. Results showed that almost all the recommended tests/procedures were performed in less than 50% of patients during the recommended designated times. We recommend that the guidelines, which now serve only as a “guide”, be made a compulsory practice to safeguard the health of our patients. Key words: Atypical antipsychotics, metabolic syndrome, monitoring guidelines.
Highlights
The advent of the new generation of antipsychotics, the “atypical antipsychotics (AAP)” brought new hope in the field of psychiatry as they have been found to have equal therapeutic efficacy with the older conventional “typical antipsychotics” drugs but are associated with less extrapyramidal syndrome, tardive dyskinesia and elevated prolactin (Rafael and Rey, 2002)
Since the 1990s, the arrival of the new generation of antipsychotics, the atypical antipsychotics (AAP), heralded a new era in the management on psychotic patients as they are associated with much less side effects as the older drugs
Data concerning metabolic monitoring over 1 year were collected from 405 subjects newly started on AAP after June 2005, when the recommended guidelines were first implemented
Summary
The advent of the new generation of antipsychotics, the “atypical antipsychotics (AAP)” brought new hope in the field of psychiatry as they have been found to have equal therapeutic efficacy with the older conventional “typical antipsychotics” drugs but are associated with less extrapyramidal syndrome, tardive dyskinesia and elevated prolactin (Rafael and Rey, 2002). There are currently six AAP drugs approved by the US Food Drug Association which are clozapine olazapine, risperidone, quetiapine, aripiprazone and ziprasidone, with different prevalence of metabolic adverse effects. Risperidone and quetiapine are reported to have intermediate metabolic side effects while ziprasidone and aripiprazole are reported to have little or no significant occurrence of weight gain, diabetes or dyslipidemia (ADA-APA-AACE-NAASO Consensus Statement, 2004). This severe metabolic side effects associated with AAP drugs which lead to elevated risk of cardiovascular disease and increased mortality have made baseline investigations and regular metabolic parameters monitoring essential in patients on these drugs (Poulin et al, 2005)
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