Skip to main content
×
×
Home

Audit of monitoring of the parameters of metabolic syndrome in patients on clozapine

  • John Tully (a1), Christina Sim (a1), Razi Hemani (a1), Malik Munir (a1), Nasir Khalil (a1) and Sabina Fahy (a1)...
Abstract
Aims and Method

High rates of metabolic syndrome exist among patients on clozapine. Monitoring its parameters facilitates interventions which may alleviate negative health consequences. We completed an audit of the monitoring of the parameters of metabolic syndrome in patients on clozapine. The results were compared with the Maudsley Guidelines for monitoring in patients on any antipsychotic medication.

Results

Initial audit showed high overall rates of concordance with guidelines for the frequency of measurement of blood pressure (91.8%), but much lower rates for measuring fasting blood glucose (43.2%) and lipid profile (52.7%), and no record of analysis of waist circumference. This prompted development of a formal protocol for measuring parameters. Repeat audit after 1 year showed marked improvement in rates of measurement.

Clinical implications

Implementation of relatively straightforward measures, such as the introduction of a one-page form on which to record parameters, can lead to a much improved rate of monitoring for metabolic syndrome. This should in turn prompt therapeutic interventions, which are discussed.

  • 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 monitoring of the parameters of metabolic syndrome in patients on clozapine
      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 monitoring of the parameters of metabolic syndrome in patients on clozapine
      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 monitoring of the parameters of metabolic syndrome in patients on clozapine
      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.
Corresponding author
John Tully (john.tully@slam.nhs.uk)
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Newcomer, JW. Metabolic syndrome and mental illness. Am J Manag Care 2007; 13: S1707.
2 National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). 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). Final report. Circulation 2002; 106: 3143–421.
3 Lakka, HM, Laaksonen, DE, Lakka, TA, Niskanen, LK, Kumpusalo, E, Tuomilehto, J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288: 2709–16.
4 Ford, ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005; 28: 1769–78.
5 Casey, DE, Haupt, DW, Newcomer, JW, Henderson, DC, Sernyak, MJ, Davidson, M, et al. Antipsychotic-induced weight gain and metabolic abnormalities: implications for increased mortality in patients with schizophrenia. J Clin Psychiatry 2004; 65 (suppl 7): 418.
6 Newcomer, JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs 2005; 19 (suppl 1): 193.
7 Allison, DB, Mentore, JL, Heo, M, Chandler, LP, Cappelleri, JC, Infante, MC, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 1999; 156: 1686–96.
8 Lund, BC, Perry, P, Brooks, JM, Arndt, S. Clozapine use in patients with schizophrenia and the risk of diabetes, hyperlipidaemia and hypertension: a claims based approach. Arch Gen Psychiatry 2001; 58: 1172–6.
9 Lamberti, JS, Olson, D, Crilly, JF, Olivares, T, Williams, GC, Tu, X, et al. Prevalence of the metabolic syndrome among patients receiving clozapine. Am J Psychiatry 2006; 163: 1273–6.
10 Ahmed, M, Hussain, I, O'Brien, SM, Dineen, B, Griffin, D, McDonald, C. Prevalence and associations of the metabolic syndrome among patients prescribed clozapine. Ir J Med Sci 2008; 177: 205–10.
11 Grundy, SM, Brewer, HB Jr, Cleeman, JI, Smith, SC Jr, Lenfant, C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004; 109: 433–8.
12 Straker, DO, Correll, CU, Kramer-Ginsberg, E, Abdulhamid, N, Koshy, F, Rubens, E, et al. Cost-effective screening for the metabolic syndrome in patients treated with second-generation antipsychotic medications. Am J Psychiatry 2005; 162: 1217–21.
13 Taylor, D, Paton, C, Kerwin, R. The Maudsley Prescribing Guidelines (9th edn). Taylor & Francis, 2007.
14 Covell, NH, Jackson, CT, Weissman, EM. Health monitoring for patients who have schizophrenia. Summary of the Mount Sinai Conference recommendations. Postgrad Med 2006; Spec No: 20–6.
15 Alberti, KG, Zimmet, P, Shaw, J. The metabolic syndrome – a new worldwide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006; 23: 469–80.
16 Katzmaryk, PT, Leon, AS, Wilmore, JH, Skinner, JS, Rao, DC, Rankinen, T, et al. Targeting the metabolic syndrome with exercise: evidence from the HERITAGE Family Study. Med Sci Sports Exerc 2003; 35: 1703–9.
17 Volek, JS, Feinman, RD. Carbohydrate restriction improves the features of metabolic syndrome. metabolic syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005; 2: 31.
18 Wang, SS, Subhi Ali, Y, Pearlman, JD, Talavera, F. Metabolic syndrome. Medscape Reference, 2012. Available online at: http://emedicine.medscape.com/article/165124-overview.
19 Rubins, HB. Triglycerides and coronary heart disease: implications of recent clinical trials. J Cardiovasc Risk 2000; 7: 339–45.
20 Barter, PJ, Rye, KA. Is there a role for fibrates in the management of dyslipidemia in the metabolic syndrome? Arterioscler Thromb Vasc Biol 2008; 28: 3946.
21 Shields, TM, Hennekens, CH. Management of metabolic syndrome: aspirin. Endocrinol Metab Clin North Am 2004; 33: 577–93.
Recommend this journal

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

BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • 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: 22 *
Loading metrics...

Abstract views

Total abstract views: 80 *
Loading metrics...

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

Audit of monitoring of the parameters of metabolic syndrome in patients on clozapine

  • John Tully (a1), Christina Sim (a1), Razi Hemani (a1), Malik Munir (a1), Nasir Khalil (a1) and Sabina Fahy (a1)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *