Psychiatrists urged to monitor metabolic changes in psychosis patients

By Eleanor McDermid, Senior medwireNews Reporter

Japanese psychiatrists are largely aware of the metabolic abnormalities that may arise from antipsychotic treatment, but most do not monitor their patients sufficiently, research shows.

“It is necessary for psychiatrists to acquire knowledge in this area and refer to recent medical reports to reduce the risk of metabolic adverse events among patients with schizophrenia,” say lead researcher Norio Sugawara (Hirosaki University School of Medicine, Japan) and colleagues.

Of the 2583 psychiatrists who responded to a survey, 47.6% said the frequency with which they monitored patients for metabolic abnormalities was based on their own clinical experience, with 24.6% basing it on guidelines or specialist advice and the remainder not basing monitoring frequency on any specific principles.

Yet just 20.6% of the participants thought they monitored their patients with sufficient frequency to detect changes in metabolic parameters such as blood glucose, lipid profile, blood pressure, and weight.

And psychiatrists varied as to how they defined metabolic changes with, for example, just 10.8% sometimes or usually using the Homeostasis Model Assessment-Insulin Resistance definition and thresholds for hypertension ranging from 130/85 mmHg to 160/100 mmHg.

Psychiatrists were most likely to conduct at least annual monitoring of blood glucose, followed by lipid profile and blood pressure. But despite more than 80% of psychiatrists expressing concern about the potential for blood glucose increases in patients taking antipsychotics, 24.7% of psychiatrists did not routinely monitor fasting blood glucose in outpatients and 23.7% did not do so in inpatients.

The psychiatrists also varied significantly as to how often they assessed patients’ weight, and whether they monitored the weight of all their patients or focused on a specific group, such as those with a personal or familial history of diabetes, or those taking certain antipsychotics. Just 4.5% of respondents said that they routinely monitored the weight of patients taking antipsychotics.

The researchers note that the psychiatrists who responded to the survey, who represented less than a third of those contacted, may be those with the most knowledge of and interest in this area. Awareness and monitoring of metabolic abnormalities could be different, and potentially poorer, in those who did not respond.

“Educational efforts and promoting the best practices of pharmacotherapy and monitoring will be needed for psychiatrists treating patients with schizophrenia,” concludes the team in PLoS One.

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