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Minding metabolism: targeted interventions to improve cardio-metabolic monitoring across early and chronic psychosis.

Authors :
Kelly JR
Gounden P
McLoughlin A
Legris Z
O'Carroll T
McCafferty R
Marques L
Haran M
Farrelly R
Loughrey K
Flynn G
Corvin A
Dolan C
Source :
Irish journal of medical science [Ir J Med Sci] 2022 Feb; Vol. 191 (1), pp. 337-346. Date of Electronic Publication: 2021 Mar 08.
Publication Year :
2022

Abstract

Background: Antipsychotics (APs) increase weight, metabolic syndrome, diabetes and cardiovascular disease. Guidelines recommend cardio-metabolic monitoring at initial assessment, at 3 months and then annually in people prescribed APs.<br />Aim: To determine the rates of cardio-metabolic monitoring in AP treated early and chronic psychosis and to assess the impact of targeted improvement strategies.<br />Methods: Medical records were reviewed in two cohorts of first-episode psychosis (FEP) patients before and after the implementation of a physical health parameter checklist and electronic laboratory order set. In a separate group of patients with chronic psychotic disorders, adherence to annual monitoring was assessed before and 3 months after an awareness-raising educational intervention.<br />Results: In FEP, fasting glucose (39% vs 67%, p=0.05), HbA1c (0% vs 24%, p=0.005) and prolactin (18% vs 67%, p=0.001) monitoring improved. There were no significant differences in weight (67% vs 67%, p=1.0), BMI (3% vs 10%, p=0.54), waist circumference (3% vs 0%, p=1.0), fasting lipids (61% vs 76% p=0.22) or ECG monitoring (67% vs 67%, p=1.0). Blood pressure (BP) (88% vs 57%, p=0.04) and heart rate (91% vs 65%, p=0.03) monitoring dis-improved. Diet (0%) and exercise (<15%) assessment was poor. In chronic psychotic disorders, BP monitoring improved (20% vs 41.4%, p=0.05), whereas weight (17.0% vs 34.1%, p=0.12), BMI (9.7% vs 12.1%, p=1.0), fasting glucose (17% vs 24.3%, p=0.58) and fasting lipids remained unchanged (17% vs 24.3%, p=0.58).<br />Conclusions: Targeted improvement strategies resulted in a significant improvement in a limited number of parameters in early and chronic psychotic disorders. Overall, monitoring remained suboptimal.<br /> (© 2021. Royal Academy of Medicine in Ireland.)

Details

Language :
English
ISSN :
1863-4362
Volume :
191
Issue :
1
Database :
MEDLINE
Journal :
Irish journal of medical science
Publication Type :
Academic Journal
Accession number :
33683562
Full Text :
https://doi.org/10.1007/s11845-021-02576-5