To Assess the Compliance of Monitoring Metabolic Symptoms Associated with Antipsychotics in an Inpatient Setting in a Tertiary Care Hospital in Karachi, Pakistan
American Journal of Psychiatry and Neuroscience
Volume 7, Issue 4, December 2019, Pages: 119-125
Received: Oct. 19, 2019;
Accepted: Nov. 12, 2019;
Published: Nov. 26, 2019
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Humera Saeed, Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
Maheen Batool, Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
Muhammad Shameel Khan, Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
Rabeeka Aftab, Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
Mohammad Zaman, Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
Mental health problems like schizophrenia, bipolar affective disorder and use of second generation antipsychotics (SGA) are linked to the risk of developing metabolic syndrome. The purpose of our study was to determine the level of compliance to monitoring metabolic symptoms associated with second generation antipsychotics according to the standards of NICE guidelines. Secondly, we aim to develop a workable standardized protocol. A total of 385 patients admitted to psychiatric ward from February 2015-January 2016 were included in the study. Case files were reviewed to obtain relevant clinical information. Assessment of height, weight, pulse, blood pressure, movement disorders, level of physical activity and nutritional status were measured in all patients. Fasting blood glucose was measured in 99 (26.5%), glycosylated hemoglobin (HbA1c) in 39 (10.4%), blood lipid profile in 44 (11.8%) and prolactin in 3 (0.8%) patients. Less than half of the patients (118, 31.6%) underwent ECG investigation. Slow titration of medication (331, 88.5%) and a trial at optimum dosage (343, 81.7%) were routinely seen. Overall physical health and patient well-being was recorded in the majority of subjects (310, 82. 9%). A significant number of physical and biochemical parameters were not routinely monitored. Our study reports findings consistent with previous literature. With this we hope to highlight important concerns and make recommendations, especially in country like Pakistan where these monitoring systems are non-existing. This will not only reduce the risk of a number of complications secondary to antipsychotic medications, but will also improve patient adherence and compliance to the pharmacological treatment.
Muhammad Shameel Khan,
To Assess the Compliance of Monitoring Metabolic Symptoms Associated with Antipsychotics in an Inpatient Setting in a Tertiary Care Hospital in Karachi, Pakistan, American Journal of Psychiatry and Neuroscience.
Vol. 7, No. 4,
2019, pp. 119-125.
Mehrul Hasnain WVRV. Clinical monitoring and management of the metabolic syndrome in patients receiving atypical antipsychotic medications.. Primary care Diabetes 3. 2009: 5-15.
Bozymski, K. M., Whitten, J. A., Blair, M. E. et al. Monitoring and Treating Metabolic Abnormalities in Patients with Early Psychosis Initiated on Antipsychotic Medications. Community Ment Health J (2018) 54: 717. https://doi.org/10.1007/s10597-017-0203-y
Priyanthi B. Gjerde et al. Increase in serum HDL level is associated with less negative symptoms after one year of antipsychotic treatment in first-episode psychosis. Schizophrenia Research. 2018; 197: 253-260.
Mary Coughlin et al. Enhancing metabolic monitoring for children and adolescents using second-generation antipsychotics. International Journal of Mental Health nursing. 2017; 27: 1188-1198.
Fanny Etchepare et al. Compliance of psychotropic drug prescription with clinical practice guidelines in older inpatients. Fundamental and Clinical Pharmacology. 2015; 30.
Lee Seng Esmond Seow. Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care. Comprehensive Psychiatry. 2017; 74: 196-203.
G. P Reynolds MJH, S. L. The 5-HT2C receptor and antipsychotic induced weight gain- mechanisms and genetics. J Psychopharmacology. 2006; 20: 15-8.
Roman Balõtšev. et al. Antipsychotic treatment is associated with inflammatory and metabolic biomarkers alterations among first-episode psychosis patients: A 7-month follow-up study. early intervention in Psychiatry. 2017: 13; 101-109.
Sarah Wakefield et al. Metabolic Monitoring of Child and Adolescent Patients on Atypical Antipsychotics by Psychiatrists and Primary Care Providers. American Journal of Therapeutics. 2019. DOI: 10.1097/MJT.0000000000000853.
Nasrallah H ME, J Meyer, Goff D, Davis S. Low rates of treatment for metabolic disorders in the CATIE schizophrenia trial at baseline: healthcare disparities in Schizophrenia. Neuropsychopharmacology. 2005; 165: 2631.
John APK, R.; Dragovic, M.; Lim, S. C.. Prevalence of metabolic syndrome among Australians with severe mental illness. The Medical journal of Australia. 2009; 190 (4): 176-9.
Narasimhan M RJ. Evidence-based perspective on metabolic syndrome and use of antipsychotics. Drug Benefit Trends. 2010; 22: 77-88.
Julie Kreyenbuhl et al. A Randomized Controlled Trial of a Patient-Centered Approach to Improve Screening for the Metabolic Side Effects of Antipsychotic Medications. Community Mental Health Journal. 2017; 53: 163-175.
J. Lee Pharm D Candidate et al. Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention. Journal of clinical Pharmacy and therapeutics. 2016; 41: 209-213.
Jennifer L. Mc Laren et al. Monitoring of Patients on Second-Generation Antipsychotics: A National Survey of Child Psychiatrists. Psychiatric services. 2017. https://doi.org/10.1176/appi.ps.201500553
Barnes TRE PC, Cavanagh M-R, Hancock E, Taylor DM. A UK audit of screening for metabolic side effects of antipsychotics in community.. Schizophrenia Bull 2007; 33: 1397-403.
Andrew Thompson S, Mario Álvarez-Jiménez, et al. Targeted Intervention to Improve Monitoring of Antipsychotic-Induced Weight Gain and Metabolic Disturbance in First Episode Psychosis, Australian and New Zealand Journal of Psychiatry, 45 (9). 740 - 748. ISSN 0004-8674.
Morrato EH DB, Hartung DM et al. Metabolic testing rates in three states Medicaid programs after FDA warnings and ADA/ APA recommendations for second generation antipsychotic drugs. Arch Gen Psychiatry 2010; 67: 17-24.
Walter G DA, Soh N et al. Side effects of second generation antipsychotics: The experiences, views and monitoring practices of Australian child psychiatrists. Australas Psychiatry 2008. 2008; 16: 253-62.
Tony a Cohn MJS. Metabolic Monitoring for patients treated with antipsychotic medications. Can J Psychiatry. 2006; 51 (8).
Nasrullah HA. Atypical antipsychotics induced metabolic side effects: Insights from receptor- binding profiles. Mol Psychiatry. 2008; 13: 27-35.
Mitchell AJ DV, Vancampfort D, Correll CU, De Hert M. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med. 2012; 42 (1): 125-47.
EH Morrato., Metabolic testing rates in 3 state Medicaid programs after FDA warnings andADA/APA recommendations for second-generation antipsychotic drugs. Archives of general. 2010, DOI: 10.1001/archgenpsychiatry.2009.179.
Dhamane, Amol D., et al, Metabolic monitoring of patients prescribed second- generation antipsychotics,. Journal of Psychiatric Practice®: September 2013- Vol 19- Issue 5-p 360- 37. doi: 10.1097/01.pra.0000435035.45308.03.
Haupt DW, Rosenblatt LC, Kim E, et al. Prevalence and predictors of lipid and glucose monitoring in commercially insured patients treated with second-generation antipsychotic. Psychiatry online, 2009 https://doi.org/10.1176/appi.ajp.2008.08030383
L Pereira. Monitoring of Metabolic Adverse Effects Associated With Atypical Antipsychotics Use in an Outpatient Psychiatric Clinic. 2018, Journal of Pharmacy.
Young SL TM, Lawrie SM.. “First do no harm.” A systematic review of the prevalence and management of antipsychotic adverse effects.. Psychopharmacology 2014; 29 (4): 353-62.
Morrato EH et al., Prevalence of baseline serum glucose and lipid testing in users of second-generation antipsychotic drugs: a retrospective, population-based study of Medicaid claims data. J Clin Psychiatry. 2008 Feb; 69 (2): 316-22.
Alberto et all, The metabolic syndrome- a new worldwide definition. The lancet, volume 336, Issue 9491, September 24, 2005.
Brixner D, Said Q, Kirkness C, et al.. Assessment of cardiometabolic risk factors in a national primary care electronic health record database. Value in Health. 2007; 10: S29–36.
Daniel. E Casey. Metabolic issues and cardiovascular disease in patients with psychiatric disorders. The American Journal of Medicine Supplements. Volume 118, Supplement 2, April 2005, Pages 15-22.
Parashar Pravin Ramanuj et al., Improving blood and ECG monitoring among patients prescribed regular antipsychotic medications. Ment Health Fam Med. 2013 Jan; 10 (1): 29–36.
M Y H Moosa et al. ECG changes in patients on chronic psychotropic medication. Department of Neurosciences, University of the Witwatersrand, Johannesburg. Volume 12 No. 3 September 2006 – SAJP.
TA Cohn et al, Metabolic monitoring for patients treated with antipsychotic medications. The Canadian Journal of Psychiatry, 2006.
Jesjeet Singh Gill et al. Adherence to metabolic monitoring guidelines in atypical antipsychotic treated subjects: Do physician comply? African Journal of Pharmacy and Pharmacology Vol. 6 (1), pp. 13-16, 8 January 2012.
Thomas R. E Barnes et al., A UK Audit of Screening for the Metabolic Side Effects of Antipsychotics in Community Patients. Schizophrenia Bulletin, Volume 33, Issue 6, November 2007, Pages 139-1403, https://doi.org/10.1093/schbul/sbm038.
Charles Mosinger et al,. Physician Patterns of Metabolic Screening for Patients Taking Atypical Antipsychotics: A Retrospective Database Study. Prim Care Companion J Clin Psychiatry. 2006; 8 (4): 220–223.
Paul Mackin et al., A prospective study of monitoring practices for metabolic disease in antipsychotic-treated community psychiatric patients. BMC Psychiatry 7, Article number: 28 (2007).
Ahsan Yaqoob Khan et al., To examine the extent of compliance to the proposed monitoring protocol among practicing psychiatrists for second generation antipsychotics. Department of Psychiatry & Behavioral Health, University of Kansas School of Medicine, Wichita, JPMA, Vol. 60, No. 6, June 2010.