Patients receive inadequate medical monitoring for prescribed drugs in psychiatric settings

New research from the University of Leicester demonstrates that psychiatrists are not offering adequate checks for metabolic complications that are common in patients with mental ill health - especially those prescribed antipsychotic medication.

Patients treated with antipsychotic medication, especially those with schizophrenia, have a high rate of metabolic problems, for example up to 60% have lipid abnormalities, 40% have high blood pressure, and 30% suffer from the metabolic syndrome. Some estimate that 90% of patients treated with antipsychotic medication have at least one metabolic risk factor. Given this, there are strong reasons why patients under psychiatric care should be offered regular monitoring.

Researchers from the University of Leicester in the UK, Kortenberg, Belgium and Albert Einstein College of Medicine, Bronx, New York reviewed 48 studies (involving almost 300,000 individuals) conducted between 2000-2011 in five countries. The work is published online today (Wednesday August 10) in Psychological Medicine. The full paper can be viewed online at http://journals.cambridge.org/psm/Mitchell

The research found that only blood pressure and triglycerides were measured in more than half of patients who were under psychiatric care. Cholesterol, glucose and weight checks were offered to less than half. Monitoring was similar in US and UK studies and for both inpatients and outpatients.

Dr Alex Mitchell, a consultant psychiatrist with the Leicestershire Partnership NHS Trust and a researcher at the University of Leicester, said: "This study highlights that psychiatrists are not always considering the metabolic complications of prescribed medication. Several guidelines highlight the need for regular medical checks (see Br J Psychiatry. 2011 Aug;199:99-105) but even after the release of guidelines, monitoring rates have remained low especially for those checks that need a blood test. Even in the most recent studies about a quarter of patients don't receive weight or blood pressure checks. One explanation is that responsibility is often lost between psychiatry and general practice. We recommend that mental health providers schedule physical health checks as a mandatory part of routine care."