August 31, 2004

Doctors Recommendations for Monitoring Health

Physical health monitoring of patients with schizophrenia.

Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM, Kane JM, Lieberman JA, Schooler NR, Covell N, Stroup S, Weissman EM, Wirshing DA, Hall CS, Pogach L, Pi-Sunyer X, Bigger JT Jr, Friedman A, Kleinberg D, Yevich SJ, Davis B, Shon S.
Am J Psychiatry. 2004 Aug;161(8):1334-49.

Individuals with schizophrenia seem to have a 20% shorter life expectancy than the population and have more vulnerability to illnesses such as diabetes, coronary heart disease, hypertension, and emphysema. This could be because of lifestyle choices (eg poor dietary habits, obesity, high rates of smoking, alcohol and street drugs) and side effects from certain antipsychotic medications (prolactin elevation, cataract formation, movement disorders, sexual dysfunction, weight gain, onset of diabetes, increases in plasma lipids, and abnormal ECGs).

A conference was organized by some who believed that the health needs of people with schizophrenia who take antipsychotic medications are not adequately addressed by clinicians in specialty mental health programs or in primary care settings. This Mount Sinai Conference (2002) aimed to develop recommendations for the systematic health monitoring of individuals with schizophrenia for whom antipsychotic medication is prescribed. This was based on a consensus meeting of leading psychiatric and other medical experts who evaluated the existing literature and developed recommendations for physical health monitoring of patients with schizophrenia. They reviewed the following areas: 1) weight gain and obesity; 2) diabetes; 3) hyperlipidemia; 4) prolongation of the QT interval on the ECG; 5) prolactin elevation and related sexual side effects; 6) extrapyramidal side effects, akathisia, and tardive dyskinesia; 7) cataracts; and 8) myocarditis.

Their consensus recommendations were as follows: regular monitoring of body mass index, plasma glucose level, lipid profiles, and signs of prolactin elevation or sexual dysfunction. They recommend that information from monitoring should guide the selection of antipsychotic agents. Specific recommendations were also made for cardiac monitoring of patients who receive medications associated with QT interval prolongation, including thioridazine, mesoridazine, and ziprasidone, and for monitoring for signs of myocarditis in patients treated with clozapine. They suggested that patients who receive both older and newer antipsychotic medications should be examined for extrapyramidal symptoms and tardive dyskinesia and receive regular visual examinations.

It is worthwhile to retrieve this article and look through their specific recommendations (Table 1 in the article). This can help with being well informed during clinical appointments with doctors, especially since the conference recommended that mental health care providers be involved in performing physical health monitoring since not all patients receive such physical health monitoring in their primary care settings.

The consensus meeting on which this article is based did not receive financial support from the pharmaceutical industry. However, individual conference participants have disclosed support from various pharmaceutical companies. See the article for full list.

Click here to link to PubMed for this article

Author: Farzin Irani


Post a comment

Please enter this code to enable your comment -
Remember Me?
(you may use HTML tags for style)
* indicates required