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Persistent Low Rates of Treatment of Metabolic Risk Factors in People With Psychotic Disorders: A PHAMOUS Study.
- Source :
-
The Journal of clinical psychiatry [J Clin Psychiatry] 2017 Sep/Oct; Vol. 78 (8), pp. 1117-1125. - Publication Year :
- 2017
-
Abstract
- Objective: People with psychotic disorders have an increased metabolic risk and a shortened life expectancy compared to the general population. Two large studies showed that metabolic disorders were untreated in a majority of the patients. Since then, guidelines have urged monitoring of metabolic health. This study examined the course of metabolic disorders over time in people with psychotic disorders and investigated current treatment rates.<br />Methods: A total of 1,259 patients with psychotic disorders, as defined by the DSM-IV, from 4 Dutch mental health institutions participated in 3 yearly assessments of the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS) between 2006 and 2014. Patients' metabolic parameters were measured, and the use of pharmacologic treatment for hypertension (systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg), dyslipidemia (5% ≤ Systematic COronary Risk Evaluation [SCORE] risk < 10% and low-density lipoprotein [LDL] cholesterol level ≥ 2.5 mmol/L or SCORE risk ≥ 10% and LDL cholesterol level ≥ 1.8 mmol/L and/or triglycerides ≥ 2.3 mmol/L), and hyperglycemia (hemoglobin A1c concentration > 7% and/or fasting glucose concentration ≥ 7.2 mmol/L) was recorded.<br />Results: Prevalence of the metabolic syndrome, as defined by the National Cholesterol Education Program criteria, was > 50% at each assessment. On the basis of the European Society of Cardiology guidelines, pharmacotherapy for metabolic disorders was recommended for 52%-59% of the patients at each assessment. Treatment rates with antihypertensive (from 31% to 38%, P < .001) pharmacotherapy increased throughout the assessments. However, half of the patients were not treated for their metabolic risk factors while being monitored for 3 years or longer. Older patients were more likely to receive treatment, and patients who received treatment had lower blood pressure and lower cholesterol and triglyceride concentrations than patients not receiving the recommended treatment.<br />Conclusions: Metabolic risk factors are still seriously undertreated in people with psychotic disorders. Better adherence to and better implementation of guidelines about monitoring and treating metabolic disorders in psychiatry are crucial.<br /> (© Copyright 2017 Physicians Postgraduate Press, Inc.)
- Subjects :
- Aged
Blood Glucose analysis
Blood Pressure Determination statistics & numerical data
Cholesterol, LDL analysis
Diagnostic and Statistical Manual of Mental Disorders
Female
Guideline Adherence standards
Health Surveys
Humans
Male
Middle Aged
Needs Assessment
Netherlands epidemiology
Prevalence
Risk Assessment
Risk Factors
Triglycerides analysis
Medication Therapy Management standards
Metabolic Syndrome diagnosis
Metabolic Syndrome drug therapy
Metabolic Syndrome epidemiology
Metabolic Syndrome psychology
Psychotic Disorders diagnosis
Psychotic Disorders epidemiology
Psychotic Disorders metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1555-2101
- Volume :
- 78
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The Journal of clinical psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 28406264
- Full Text :
- https://doi.org/10.4088/JCP.16m10831