Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-23T03:47:26.995Z Has data issue: false hasContentIssue false
  • English
  • Français

Establishing a physical health monitoring service for patients on depot antipsychotic medication

Published online by Cambridge University Press:  07 November 2016

M. Gill ,
K. McKenna ,
M. McCauley  and
M. Gulzar
M. Gill*
Affiliation:
Cavan Monaghan Mental Health Service, Acute Psychiatric Unit, Lower Ground Floor, Cavan General Hospital, Co. Cavan, Ireland
K. McKenna
Affiliation:
School of Nursing, Dundalk Institute of Technology, Dundalk, Co. Louth, Ireland
M. McCauley
Affiliation:
Louth/Meath Mental Health Service, Singleton House, Drogheda, Co. Louth, Ireland
M. Gulzar
Affiliation:
Cavan Monaghan Mental Health Service, Drumalee Primary Care Centre, Cootehill Rd, Co. Cavan, Ireland
*
*Address for correspondence: M. Gill , MB, BAO, BCh, MSc, MRCPsych, Consultant Psychiatrist, Cavan Monaghan Mental Health Service, Acute Psychiatric Unit, Cavan General Hospital, Cavan Co., Cavan, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of ~36 000 in Ireland.

Objectives

International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.

Methods

A cohort of patients receiving antipsychotics in long-acting injectable form was chosen. A twice-yearly, multidisciplinary health monitoring clinic was established. Evaluation involved an audit of medical records which measured the proportion of those attending the clinic who had blood test monitoring and physical parameters recorded.

Results

Before the clinic’s implementation, 30% of patients had evidence of some blood test monitoring, 9% had evidence of complete blood testing and one patient had evidence of physical health parameters having been recorded. One year after the implementation 78% of patients had evidence of some blood test monitoring, 61% had evidence of full blood test monitoring and 100% had evidence of physical parameters recorded.

Conclusions

The clinic was positively received by patients, and led to improved teamwork. Recommendations include organising concurrent psychiatric and phlebotomy clinics so that patients may avail of psychiatric review and blood testing at a single appointment. As a result of the increased focus on physical health monitoring, a similar project is planned to target all patients prescribed antipsychotics.

Keywords

Antipsychotic agentsbody mass indexhaematologic testsmental disorderspremature mortality
Type
Short Report
Information
Irish Journal of Psychological Medicine , Volume 38 , Issue 1: Themed Issue: Physical Health in Mental Illness , March 2021 , pp. 16 - 22
Copyright
© College of Psychiatrists of Ireland 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bainbridge, E, Gallagher, A, McDonald, G, McDonald, C, Ahmed, M (2011). General practitioners’ attitudes on who should manage metabolic dysregulations associated with antipsychotics. The Psychiatrist 35, 213–215.CrossRefGoogle Scholar
Beck, K, Stephenson, L, Brayford, B, Wilford, L, Potter, L, Suleman, S (2013). Every contact counts: audit investigating extent psychiatry trainees maximise opportunity for physical health assessment when admitting patients to psychiatric hospital. European Psychiatry 28, 1.CrossRefGoogle Scholar
Björkenstam, E, Ljung, R, Burström, B, Mittendorfer-Rutz, E, Hallqvist, J, Weitoft, GR (2012). Quality of medical care and excess mortality in psychiatric patients – a nationwide register-based study in Sweden. BMJ Open 2, 1.CrossRefGoogle ScholarPubMed
Cohn, TA, Sernyak, MJ (2006). Metabolic monitoring for patients treated with antipsychotic medications. Canadian Journal of Psychiatry 51, 492–501.CrossRefGoogle ScholarPubMed
De Hert, M, Cohen, D, Bobes, J, Cetkovich-Bakmas, M, Leucht, S, Ndetei, DM, Correll, CU (2011). Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 10, 138–151.CrossRefGoogle ScholarPubMed
Fazel, S, Wolf, A, Palm, C, Lichtenstein, P (2014). Violent crime, suicide, and premature mortality in patients with schizophrenia and related disorders: a 38-year total population study in Sweden. The Lancet Psychiatry 1, 44–54.CrossRefGoogle ScholarPubMed
Gonzalez, C, Ahammed, N, Fisher, R (2010). Improving physical health monitoring for out-patients on antipsychotic medication. The Psychiatrist 34, 91–94.CrossRefGoogle Scholar
Harris, EC, Barraclough, B (1998). Excess mortality of mental disorder. British Journal of Psychiatry 173, 11–53.CrossRefGoogle ScholarPubMed
Hasnain, M, Vieweg, WVR, Fredrickson, SK, Beatty-Brooks, M, Fernandez, A, Pandurangi, AK (2009). Clinical monitoring and management of the metabolic syndrome in patients receiving atypical antipsychotic medications. Primary Care Diabetes 3, 5–15.CrossRefGoogle ScholarPubMed
Holt, RIG, Bushe, C, Citrome, L (2005). Diabetes and schizophrenia 2005: are we any closer to understanding the link? Journal of Psychopharmacology 19, 56–65.CrossRefGoogle ScholarPubMed
Kendrick, T, Burns, T, Freeling, P, Sibbald, B (1994). Provision of care to general practice patients with disabling long-term mental illness: a survey in 16 practices. British Journal of General Practice 44, 301–305.Google ScholarPubMed
Lester, H (2005). Shared care for people with mental illness: a GP’s perspective. Advances in Psychiatric Treatment 11, 133–139.CrossRefGoogle Scholar
Marder, SR, Essock, SM, Miller, AL, Buchanan, RW, Casey, DE, Davis, JM, Shon, S (2004). Physical health monitoring of patients with schizophrenia. American Journal of Psychiatry 161, 1334–1349.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2014). Psychosis and Schizophrenia in Adults: Treatment and Management. National Institute for Health and Care Excellence: London.Google Scholar
Newcomer, JW (2007). Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. Journal of Clinical Psychiatry 68, 20–27.Google ScholarPubMed
Patel, M, David, A (2005). Why aren’t depot antipsychotics prescribed more often and what can be done about it? Advances in Psychiatric Treatment 11, 203–213.CrossRefGoogle Scholar
Royal College of Psychiatrists (2004). Good Psychiatric Practice. Council Report CR125, 2nd edn. Royal College of Psychiatrists: London.Google Scholar
Thornicroft, G (2011). Physical health disparities and mental illness: the scandal of premature mortality. British Journal of Psychiatry 199, 441–442.CrossRefGoogle ScholarPubMed
Waddell, L, Taylor, M (2008). A new self-rating scale for detecting atypical or second-generation antipsychotic side effects. Journal of Psychopharmacology 22, 238–243.CrossRefGoogle ScholarPubMed
Wildin, H, Najim, H (2013). Clinical outcomes of depot and well being clinic – results of physical health care checks. Psychiatria Danubina 25, s174–s177.Google Scholar
Windfuhr, K, Turnbull, P., While, D, Swinson, N, Mehta, H, Hadfield, K, Appleby, L (2011). The incidence and associated risk factors for sudden unexplained death in psychiatric in-patients in England and Wales. Journal of Psychopharmacology 25, 1533–1542.CrossRefGoogle ScholarPubMed