Not Enough Psychiatric Patients Are Screened for Metabolic Syndrome

A study published in BMJ Open suggests that screening for metabolic syndrome among patients taking antipsychotic medications occurs far less frequently than recommended by the guidelines.

While a quality improvement program (QIP) at the center of the research may have been partly responsible for a significant improvement in screening for metabolic syndrome in the United Kingdom, there is still a significant gap in screening for these susceptible patients.

Among the many troubling aspects of schizophrenia and other mental illnesses is the fact that mortality due to physical illness is significantly higher than in the healthy population. Patients suffering from schizophrenia have mortality rates 2 to 3 times higher than the general population, and life expectancy is shorted by 15 to 20 years.

The researchers note that approximately 60% of this excess mortality is due to physical illness and is due, in part, to the fact that physical illnesses in these patients may be under-diagnosed and/or sub-optimally treated. Other reasons include illness-related factors such as physical inactivity, cigarette smoking, excess alcohol consumption and poor diet.

“However, treatment with antipsychotic medication is also a contributory factor, not least because of the metabolic side effects, including weight gain,” the study authors observed. “Hypertension, central obesity, raised fasting glucose and dyslipidemia, when clustered together, are highly predictive of cardiovascular disease and type 2 diabetes. Individuals who have at least three of these risk factors have been described as having metabolic syndrome (MS).”

While MS can be difficult to manage, there are several approaches to treating it, including improvements in lifestyle, increased diet and exercise, and potentially switching to an antipsychotic with a lower liability for such adverse effects.

“The multivariable results suggested that being prescribed a depot/long-acting antipsychotic preparation as the only antipsychotic medication, a known diagnosis of diabetes, and a known diagnosis of dyslipidemia were all independently associated with having all MS measurements documented. But patients receiving only a depot antipsychotic were less likely to have all four measurements documented,” the authors wrote.

Some of the barriers to screening in practice included uncertainty as to whether such physical health screening was the responsibility of the psychiatric team rather than a primary care clinician, a lack of confidence in the interpretation of abnormal screening results and limited access to basic equipment such as a tape measure and weighing scales. “Another possible explanation for the relatively low level of screening is that clinicians may target patients for the assessment of metabolic side effects rather than routinely screen all patients prescribed continuing antipsychotic medication,” the researchers noted.