Metabolic monitoring of persons receiving antipsychotic medications in a community mental health setting

Objective: Second generation antipsychotic medications (SGAs) are associated with elevated rates of metabolic syndrome, which increases risk for diabetes and cardiovascular disease. Therefore, routine metabolic monitoring is recommended in community mental health settings. We describe a metabolic monitoring program implemented in an ethnically diverse, urban, public-sector assertive case management program. Methods: Clients receiving antipsychotics were invited to participate in semiannual monitoring of BMI, girth, blood pressure, heart rate, lipids, electrolytes, thyroid function and hemoglobin A1C. Data on demographics, medications, and metabolic indicators measured over two years were extracted from clinical records. Results: 72 clients (75% of those eligible) participated. 74% were male. 47% were Latino; 31% were White. 94% had schizophrenia-spectrum diagnoses. 94% received SGAs (aripiprazole 4%, clozapine 34%, risperidone 37%, quetiapine 30%, olanzapine 25%). 40% received 2 or more SGAs in combination. 30% received first generation antipsychotics. 85% received 2 or more classes of psychotropic medication. All metabolic indicators were elevated relative to population norms and were similar to other populations receiving antipsychotics. Among SGAs, risperidone, quetiapine and olanzapine were associated with increased BMI and girth, but not with other metabolic indicators. Clozapine was associated with increased risk on all indicators but thyroid function. Incomplete data on diagnoses and prescriptions related to cardiovascular disease and diabetes reflected difficulties coordinating with primary care. Conclusions: Metabolic monitoring is both necessary and feasible in outpatient community mental health settings. System enhancements are needed to manage metabolic data and increase collaboration with primary care providers in the care of persons receiving antipsychotic medications.