Skip to main content
×
×
Home

Audit of metabolic syndrome in adults prescribed clozapine in community and long-stay in-patient populations

  • David Morgan (a1), Matthew Sargeant, Jude Chukwuma and Gwenllian Hughes (a2)
Abstract
Aims and Methods

To calculate the prevalence of metabolic syndrome in patients receiving clozapine in community and long-stay in-patient settings. Patients were assessed using measures specified by the Expert Panel of the US National Cholesterol Education Program.

Results

The prevalence of the metabolic syndrome was calculated as 53% in the community groups and 11% in the in-patient group, although both sample sizes (particularly the in-patient group) were small. Women were more frequently affected than men in the community population.

Clinical Implications

The higher percentage of metabolic syndrome in the community patients receiving clozapine has implications with respect to physical health. The reasons for the lower percentage in the in-patient group are unclear. Our findings point to a possible difference in the physical health of long-stay psychiatric in-patients and patients in the community.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Audit of metabolic syndrome in adults prescribed clozapine in community and long-stay in-patient populations
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Audit of metabolic syndrome in adults prescribed clozapine in community and long-stay in-patient populations
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Audit of metabolic syndrome in adults prescribed clozapine in community and long-stay in-patient populations
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Hide All
Allison, D., Mentore, J., Moonseong, H., et al (1999) Antipsychotic-induced weight gain: a comprehensive research synthesis. American Journal of Psychiatry, 156, 16861696.
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, et al (2004) Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care, 27, 596601.
British Medical Association & Royal Pharmaceutical Society of Great Britain (2006) British National Formulary (March issue). BMJ Books & Pharmaceutical Press.
Brown, S. (1997) Excess mortality of schizophrenia: a meta-analysis. British Journal of Psychiatry, 171, 502508.
CACI/TNS (2006) Health of the Nation Report (http://www.caci.co.uk/acorn/downloads/Health%20of%20Nation%20Report.pdf).
Disability Rights Commission (2006) Equal Treatments: Closing the Gap. Disability Rights Commission.
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285, 24862497.
Fenton, W. & Chavez, M. (2006) Medication induced weight gain and dyslipidaemia in patients with schizophrenia. American Journal of Psychiatry, 163, 16971704.
Kane, J., Honifeld, G., Singer, J., et al (1988) Clozapine for the treatment resistant schizophrenic. Archives of General Psychiatry, 45, 789796.
Lakka, H., Laaksonen, D., Lakka, T., et al (2002) The metabolic syndrome and total and cardiovascular disease mortality in middle aged men. JAMA, 288, 27092716.
Lamberti, S., Olson, D., Crilly, J., et al (2006) Prevalence of the metabolic syndrome among patients receiving clozapine therapy. American Journal of Psychiatry, 163, 12731276.
Newcomer, J. (2005) Second-generation (atypical) antipsychotics and metabolic effects. A comprehensive literature review. CNS Drugs, 19 (suppl 1) 193.
Smith, H. & White, T. (2004) Low glycaemic index diet in patients prescribed clozapine: pilot study. Psychiatric Bulletin, 28, 292294.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 10 *
Loading metrics...

Abstract views

Total abstract views: 36 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 19th July 2018. This data will be updated every 24 hours.

Audit of metabolic syndrome in adults prescribed clozapine in community and long-stay in-patient populations

  • David Morgan (a1), Matthew Sargeant, Jude Chukwuma and Gwenllian Hughes (a2)
Submit a response

eLetters

Audit Fidelity

Alexis R Bowers, Specialist Registrar in Old Age Psychiatry
26 June 2008

Morgan et al‘s (Psychiatric Bulletin, May 2008, 32, 174-177) audit regarding the use of clozapine raises a number of interesting points regarding the prescription and ongoing monitoring of patients taking these agents. Unfortunately the term ‘audit’ is used loosely here and your readers couldbe forgiven for thinking that an audit is just a ‘survey’ from this article.

Clinical audit is a quality improvement process that aims to improve patient care and outcomes by carrying out a systematic review and implementing change. An audit consists of an initial evaluation of a practice area against an agreed standard. Results are then fed back and afurther survey is performed to see if changes in practice have resulted inthe standards being met (audit cycle). This study therefore represents a service evaluation rather than a clinical audit. The only exception wouldbe if the initial evaluation showed 100% concordance with best practice standards and therefore no change would be necessary.

Trainees need to be aware that audit usually involves a change in practice rather than just reporting practice.

Dr Alexis Bowers MBBS MRCPsych Specialist Registrar in General Adult Psychiatry, Central and North West London NHS Foundation Trust, Park RoyalCentre for Mental Health , Central Way, London, NW10 7NS.

Email: dralexisbowers@hotmail.com

Declaration of interest: None

1.Audit of metabolic syndrome in adults prescribed Clozapine in community and long-stay in-patient populations. D Morgan et al, Psych Bulletin May 2008,32,174-177
... More

Conflict of interest: None Declared

Write a reply

When is an Audit not an Audit?

Rajesh Alex, Speciality Trainee Psychiatry
16 June 2008

The paper by D. Morgan et al (Psych Bulletin May 2008,32,174-177), which looked at the prevalence of metabolic syndrome in community and inpatients, appears to be the first of its kind in UK. It came out with very interesting findings relevant to our clinical practice. This paper was presented in our local journal club and it aroused a lot of discussions. Even though the paper was described as an audit it does not seems to fulfil the criteria for an audit. The aim of the study was to calculate the prevalence of metabolic syndrome in adults prescribed Clozapine in thecommunity and long-stay in-patient populations. This does not fall within the remit of an audit. The National Institute for Clinical Excellence (NICE) describes audit as “a quality improvement process that aims to improve patient care and outcomes by carrying out a systematic review and implementing change.” An audit measures what is actually happening. Thus it is difficult to appreciate how such a study could be labelled as an audit.

References

1.Audit of metabolic syndrome in adults prescribed Clozapine in community and long-stay in-patient populations. D Morgan et al, Psych Bulletin May 2008,32,174-177.

2.National Institute for Clinical Excellence (NICE), Principles of Best Practice in clinical audit, March 2002.

Dr Rajesh Alex Speciality Trainee year-3 PsychiatryOpal Centre,St Catherine's HospitalTickhill roadDoncasterDN4 8QNemail:rajesh.alex@rdash.nhs.uk

Dr Eric Avevor, Consultant PsychiatristOpal Centre,St Catherine's HospitalTickhill roadDoncasterDN4 8QNemail:eric.avevor@rdash.nhs.uk

Dr Maureen O'Leary, Consultant PsychiatristOpal Centre,St Catherine's HospitalTickhill roadDoncasterDN4 8QNemail:andrea.taylor@rdash.nhs.uk

Dr Evelyn AvevorSpeciality Trainee year-3Macclesfield District General HospitalVictoria RoadMacclesfieldCheshireemail:eavevor@tiscali.co.uk
... More

Conflict of interest: None Declared

Write a reply

When is an Audit not an Audit?

Rajesh Alex, Speciality Trainee Psychiatry
16 June 2008

The paper by D. Morgan et al (Psych Bulletin May 2008,32,174-177), which looked at the prevalence of metabolic syndrome in community and inpatients, appears to be the first of its kind in UK. It came out with very interesting findings relevant to our clinical practice. This paper was presented in our local journal club and it aroused a lot of discussions. Even though the paper was described as an audit it does not seems to fulfil the criteria for an audit. The aim of the study was to calculate the prevalence of metabolic syndrome in adults prescribed Clozapine in thecommunity and long-stay in-patient populations. This does not fall within the remit of an audit. The National Institute for Clinical Excellence (NICE) describes audit as “a quality improvement process that aims to improve patient care and outcomes by carrying out a systematic review and implementing change.” An audit measures what is actually happening. Thus it is difficult to appreciate how such a study could be labelled as an audit.

References

1.Audit of metabolic syndrome in adults prescribed Clozapine in community and long-stay in-patient populations. D Morgan et al, Psych Bulletin May 2008,32,174-177.

2.National Institute for Clinical Excellence (NICE), Principles of Best Practice in clinical audit, March 2002.

Dr Rajesh Alex Speciality Trainee year-3 PsychiatryOpal Centre,St Catherine's HospitalTickhill roadDoncasterDN4 8QNemail:rajesh.alex@rdash.nhs.uk

Dr Eric Avevor, Consultant PsychiatristOpal Centre,St Catherine's HospitalTickhill roadDoncasterDN4 8QNemail:eric.avevor@rdash.nhs.uk

Dr Maureen O'Leary, Consultant PsychiatristOpal Centre,St Catherine's HospitalTickhill roadDoncasterDN4 8QNemail:andrea.taylor@rdash.nhs.uk

Dr Evelyn AvevorSpeciality Trainee year-3Macclesfield District General HospitalVictoria RoadMacclesfieldCheshireemail:eavevor@tiscali.co.uk
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *