Monitoring and Management of Metabolic Risk Factors in Outpatients Taking Antipsychotic Drugs: A Controlled Study

Abstract

To evaluate the screening, monitoring, and management of metabolic risk factors and diseases in long-term antipsychotic users in relation to current practice guidelines and current standards of care as represented by a control group from an HIV clinic. We undertook a retrospective chart review of mental health clinic outpatients taking antipsychotic drugs long-term (cases) and HIV outpatients prescribed highly active antiretroviral therapy (control subjects). We included 99 mental health clinic patients and 98 HIV patients in the analysis. According to information available in the outpatient clinic chart, the 10-year coronary artery disease risk was computable for 28% of the mental health clinic patients (mean risk 11.9%) and for 90% of the HIV patients (mean risk 9.5%) (chi2 = 77.0, P < 0.001). Metabolic risk factors were less frequently documented in mental health clinic charts. All HIV clinic patients were screened for hypertension and diabetes, and 90% were screened for dyslipidemia, whereas this information was missing for 30%, 39%, and 60% of mental health clinic patients, respectively (P < 0.001 for all). Disease monitoring was also more comprehensive in HIV clinic charts (for example, 100% of HIV patients were monitored for lipids, compared with 71% of mental health clinic patients; P = 0.001). Improved efforts are needed in the somatic care of patients with bipolar disorder and schizophrenia who are taking antipsychotics, given that they typically have moderate-to-high risk for metabolic diseases.