Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients

Lappin, Julia; Wijaya, Marlene; Watkins, Andrew; Morell, Rachel; Teasdale, Scott; Lederman, Oscar; Rosenbaum, Simon; Dick, Stephanie; Ward, Philip B.; Curtis, Jackie

doi:10.1016/j.schres.2018.02.035

Cited by 37 publications

(27 citation statements)

References 54 publications

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“…Dyslipidaemia has previously been reported to occur at particularly high rates with clozapine (Stroup et al 2016;Ingimarsson et al 2017); however, both FGA and SGA antipsychotic medications have been associated with lipid dysregulation (Buhagiar & Jabbar, 2019), as was demonstrated in this study. Hypertension was present at higher rates in the LAI antipsychotic group, albeit one recent study noted higher rates of hypertension in a cohort of clozapine patients (56%) than was noted in this study (Lappin et al 2018). However, this study again highlights the need for individuals treated with LAI antipsychotic medications to have this simple to measure investigation regularly performed (similar to the clozapine-treated cohort).…”

Section: Discussioncontrasting

confidence: 56%

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

Lydon

Vallely

Tummon

et al. 2020

Ir. j. psychol. Med.

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Objectives To examine the rate of monitoring of metabolic syndrome and actual rates of metabolic syndrome in two patient cohorts [clozapine treatment and long-acting injectable (LAI) antipsychotic] who are reviewed on an equally regular basis (1–4 weekly) for administration of treatment. Methods Clinical and laboratory data are examined on 119 patients treated with clozapine and 116 patients treated with LAI antipsychotic medications to determine the rates of metabolic syndrome and evidence of monitoring for metabolic syndrome in the previous 6 months. Individuals with insufficient data from these cohorts were invited to attend for metabolic screening to determine actual rates of metabolic syndrome in these two cohorts of patients. Results All metabolic parameters were monitored to a significantly greater extent in the clozapine cohort (>90%), compared to those treated with LAI antipsychotic medications (<50%) (blood pressure, weight, lipid and glucose levels; p < 0.001). Metabolic syndrome was present in 38.9% of those treated with clozapine compared to 31.1% of patients treated with LAI antipsychotic medications (X2 = 0.54, p = 0.46). Conclusions These findings suggest that a robust screening plan should be in place to monitor for metabolic syndrome in individuals treated with LAI antipsychotic medications. This screening should include measurement of body weight, waist circumference, fasting glucose, lipids and fasting insulin levels. Early recognition of abnormal metabolic parameters allows early intervention, therefore, improving long-term cardiovascular outcomes.

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Section: Discussioncontrasting

confidence: 56%

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

Lydon

Vallely

Tummon

et al. 2020

Ir. j. psychol. Med.

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“… 12 Clozapine is associated with high rates of cardio-metabolic risk factors which may be both under-detected and under-treated. 13 The prevalence of specific side effects changes during the course of treatment, and effective monitoring of clozapine side effects should take this into account.…”

Section: Introductionmentioning

confidence: 99%

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

Barnes

MacCabe

Kane

et al. 2020

Therapeutic Advances in Psychopharmacology

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Background: In addition to mandatory haematological monitoring, treatment guidelines recommend routine monitoring of adverse effects and physical health in patients prescribed clozapine. Methods: NHS trusts/healthcare organisations participated in a clinical audit in the context of a UK quality improvement programme addressing clozapine-prescribing practice. Results: Data relating to 6948 adult patients prescribed clozapine were submitted by 63 NHS trusts/healthcare organisations. Of 481 patients treated with clozapine for up to 18 weeks, there was documented pretreatment screening of blood pressure, heart rate and ECG in at least 90%, and body weight, plasma lipids, plasma glucose/glycated haemoglobin (HbA1c) and physical examination in approximately 80%. During the first 2 weeks of clozapine treatment there was documented daily measurement of both heart rate and blood pressure in 82% and body temperature in 77%. In a subsample of 411 patients, of the 72% who had weekly side-effect assessments documented in the first month of treatment, a structured assessment tool had been used in 29%. Treatment monitoring up to 18 weeks included an ECG in 90%, C-reactive protein (CRP) or creatine kinase in 42%, and troponin or B-type natriuretic peptide (BNP) in 29%. In the 5908 patients prescribed clozapine for at least 1 year, blood pressure and body weight/body mass index were documented in at least 80%, plasma lipids in 78% and plasma glucose in 73%, with an ECG in 55%. Two-thirds were prescribed medication to manage side effects of clozapine and one third of those with a diagnosis of schizophrenia were prescribed a second antipsychotic medication. Conclusion: The findings suggest that for most patients treated with clozapine in UK mental health services, physical health screening and side-effect monitoring follow recommended practice, but there was limited use of structured side-effect assessment tools. Monitoring for clozapine-induced myocarditis during the early risk period using markers of inflammation such as CRP, and cardiac damage such as troponin and BNP, was less consistent. This may partly reflect the variation in guideline recommendations for monitoring for myocarditis and partly the selected use of such tests when prompted by cardiac symptoms. The relatively common coprescription of medications for the majority of people on longer-term clozapine treatment may well further increase side-effect burden and physical health risks, reinforcing the need for continuing systematic monitoring.

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“…The high levels of physical morbidity and premature mortality among SMI populations are widely recognised, with a 15-year life expectancy reduction compared with people without SMI (23) . Recent studies documented the poor physical health of people with enduring SMI receiving clozapine (24) or longacting injectable (LAI) antipsychotics (25) .…”

mentioning

confidence: 99%

Prevalence and correlates of food insecurity in community-based individuals with severe mental illness receiving long-acting injectable antipsychotic treatment

et al. 2020

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People with severe mental illness (SMI) have numerous risk factors that may predispose them to food insecurity (FI); however, the prevalence of FI and its effects on health are under-researched in this population. The present study aimed to describe the prevalence of FI and its relationship to lifestyle factors in people with SMI. This cross-sectional study recruited people with SMI receiving long-acting injectable (LAI) antipsychotic medication from community services at three sites in Sydney, Australia. Assessments were completed on physical health and lifestyle factors. χ2 Tests, independent-samples t tests and binary logistic regression analyses were calculated to examine relationships between lifestyle factors and FI. In total, 233 people completed the assessments: 154 were males (66 %), mean age 44·8 (sd 12·7) years, and the majority (70 %) had a diagnosis of schizophrenia. FI was present in 104 participants (45 %). People with FI were less likely to consume fruits (OR 0·42, 95 % CI 0·24, 0·74, P = 0·003), vegetables (OR 0·39, 95 % CI 0·22, 0·69, P = 0·001) and protein-based foods (OR 0·45, 95 % CI 0·25, 0·83, P = 0·011) at least once daily, engaged in less moderate to vigorous physical activity (min) (OR 0·997, 95 % CI 0·993, 1·000, P = 0·044), and were more likely to smoke (OR 1·89, 95 % CI 1·08, 3·32, P = 0·026). FI is highly prevalent among people with SMI receiving LAI antipsychotic medications. Food-insecure people with SMI engage in less healthy lifestyle behaviours, increasing the risk of future non-communicable disease.

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Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients

Cited by 37 publications

References 54 publications

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

Prevalence and correlates of food insecurity in community-based individuals with severe mental illness receiving long-acting injectable antipsychotic treatment

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