A new systematic review conducted by a research team from Leicester suggests that psychiatrists are failing to carry out physical health checks for metabolic complications common in patients with mental illness, in particular those who are prescribed antipsychotics.

Many hospitals now have guidelines in place to ensure that patients on antipsychotics are monitored to check blood pressure, triglycerides, cholesterol, weight gain, glucose, lipids and glycosylated haemoglobin.

This systematic review and meta analysis identified studies examining routine metabolic screening practices in patients taking antipsychotics before and following the implementation of monitoring guidelines. They identified 48 relevant studies (involving over 290,000 patients in 5 countries):

• 39 studies focused on routine monitoring before guidelines were issued
• 9 reported post-guideline monitoring (7 compared changes in screening practices before and after guideline implementation)

In the 39 studies that evaluated monitoring in the absence of specific guidelines, they found monitoring levels to be well below the desired level:

• Blood pressure was monitored in 69% of patients
• Triglycerides 60%
• Cholesterol 42%
• Weight gain 48%
• Glucose 44%
• Lipids and glycosylated haemoglobin <25%)

Similar results were seen for US and UK studies and for inpatients and outpatients.

In the 7 studies that compared rates of monitoring in the same sample of patients before and after introduction of guidelines, only data on glucose monitoring were adequate for analysis. These showed that the overall rate of glucose testing rose from 32.8% to 48.2% after guidelines were introduced (relative risk 1.47; 95% CI 1.13 to 1.9).

The authors concluded:

In routine clinical practice, metabolic monitoring is concerningly low in people prescribed antipsychotic medication. Although guidelines can increase monitoring, most patients still do not receive adequate testing.

Mitchell AJ, Delaffon V, Vancampfort D, Correll CU, De Hert M. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med. 2011 Aug 10:1-23. [Epub ahead of print] [PubMed abstract]