Metabolic Monitoring and Intervention in Psychoses: How Are We Doing?



L. Riggin, C. Collins, P. Subramanian, J. Liu

Background: Patients with psychosis are at a significantly increased risk of cardiovascular disease related to metabolic syndrome, often due to antipsychotic use. Canadian Schizophrenia Guidelines recommend regular monitoring, and, more recently, recommends metformin to treat anti-psychotic induced weight gain. Aim: To determine the proportion of patients within a first-episode psychosis program (PEPP) who are receiving the gold standard of metabolic monitoring and intervention. Methods: 60 charts of PEPP patients were reviewed for demographic, treatment, and physical health parameters. Data was analyzed using Excel. Results: Of the patients reviewed, the mean age was 32, 98% were prescribed antipsychotics, 50% used a long-acting injectable, 10% were prescribed more than one antipsychotic, and 32% used additional non-psychotropic medication. In terms of annual monitoring completed, 57% had an annual weight, 60% blood pressure, 57% glucose monitoring and 72% lipid monitoring. 20% of patients gained weight and had an appropriate intervention (referral to endocrinology/dietitian). 27% of patients gained weight and did not have any intervention. Other patients either did not gain weight or did not have their weight recorded. The involvement of a case manager or an injection nurse improved rates of monitoring and intervention. Conclusions: There remains room for improvement in metabolic monitoring and intervention. Ideas proposed include having a kiosk in the outpatient wait-room where patients may be weighed, and blood pressure taken. Additionally, using a reminder within the electronic medical records may be possible to ensure improved physical health monitoring. Recommend continuous quality improvement measures.

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