Community Adherence to Schizophrenia Treatment and Safety Monitoring Guidelines

Keller, William R.; Fischer, Bernard A.; McMahon, Robert P.; Meyer, W.; Blake, Melissa; Boyer, Robert

doi:10.1097/nmd.0000000000000093

Cited by 11 publications

(6 citation statements)

References 30 publications

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“…Despite the evidence that weight gain increases morbidity and mortality and reduces adherence, only one third to half are adequately monitored for the metabolic side effects of antipsychotics. 44 …”

Section: Introductionmentioning

confidence: 99%

Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

Dayabandara¹,

Hanwella²,

Ratnatunga³

et al. 2017

NDT

241

179

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Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and cerebrovascular morbidity and mortality, reduced quality of life and poor drug compliance. This narrative review discusses the propensity of various antipsychotics to cause weight gain, the pharmacologic and nonpharmacologic interventions available to counteract this effect and its impact on adherence. Most antipsychotics cause weight gain. The risk appears to be highest with olanzapine and clozapine. Weight increases rapidly in the initial period after starting antipsychotics. Patients continue to gain weight in the long term. Children appear to be particularly vulnerable to antipsychotic-induced weight gain. Tailoring antipsychotics according to the needs of the individual and close monitoring of weight and other metabolic parameters are the best preventive strategies at the outset. Switching to an agent with lesser tendency to cause weight gain is an option, but carries the risk of relapse of the illness. Nonpharmacologic interventions of dietary counseling, exercise programs and cognitive and behavioral strategies appear to be equally effective in individual and group therapy formats. Both nonpharmacologic prevention and intervention strategies have shown modest effects on weight. Multiple compounds have been investigated as add-on medications to cause weight loss. Metformin has the best evidence in this respect. Burden of side effects needs to be considered when prescribing weight loss medications. There is no strong evidence to recommend routine prescription of add-on medication for weight reduction. Heterogeneity of study methodologies and other confounders such as lifestyle, genetic and illness factors make interpretation of data difficult.

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Section: Introductionmentioning

confidence: 99%

Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

Dayabandara¹,

Hanwella²,

Ratnatunga³

et al. 2017

NDT

241

179

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“…Although the need for monitoring of patients treated with psychotropic drugs is widely recognized, adherence to monitoring guidelines is often found to be suboptimal . For example, monitoring rates of metabolic parameters such as weight, glucose, and lipids in patients using antipsychotic drugs have been found not to correspond with advice given in CPGs, posing unnecessary risks of morbidity to patients …”

Section: Introductionmentioning

confidence: 99%

Compliance with the guidelines for laboratory monitoring of patients treated with lithium: A retrospective follow‐up study among ambulatory patients in the Netherlands

et al. 2019

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Objectives Laboratory monitoring of patients using lithium is important to prevent harm and to increase effectiveness. The aim of this study is to determine compliance with the guidelines for laboratory monitoring of patients treated with lithium overall and within subgroups. Methods Patients having at least one lithium dispensing for 6 months or longer between January 2010 and December 2015 were identified retrospectively using data from the Dutch PHARMO Database Network. Laboratory monitoring was defined as being compliant with the Dutch Multidisciplinary Clinical Guideline Bipolar Disorders when lithium serum levels, creatinine and thyroid‐stimulating hormone (TSH) had been measured at least every 6 months during lithium use. Results Data were analyzed from 1583 patients with a median duration of 7‐ to 6‐months period of lithium use. Results indicated that patients had been monitored over 6‐month period for lithium serum levels 65% of the time, for creatinine 73% of the time and for TSH 54% of the time. Just over one seventh (16%) of patients had been monitored in compliance with the guidelines for all three parameters during total follow‐up. Especially males, patients aged below 65 years, patients receiving prescriptions solely from general practitioners, prevalent users of lithium, patients without interacting co‐medication, and patients without other days with laboratory measurements had been monitored less frequently in compliance with the guidelines. Conclusions A considerable proportion of patients had not been monitored in accordance with the guidelines. Further research is needed to understand the reasons for noncompliance and to implement strategies with the ultimate goal of optimizing safety and effectiveness for patients treated with lithium.

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“…A recent study found that, while community mental health centers generally conform to the 2003 Patient Outcomes Research Team treatment recommendations, conformance with Mount Sinai Conference recommendations for monitoring somatic health was followed less than 50% of the time. 18 …”

Section: Discussionmentioning

confidence: 99%

“… 16 , 17 Reports on the Schizophrenia Patient Outcomes Research Team treatment recommendations and the Mount Sinai Conference Safety Monitoring recommendations suggest that patients in community mental health centers are not adequately monitored by their health care providers for medical comorbidities, including metabolic diseases. 18 Differences between AAs in terms of efficacy and tolerability call for an individualized treatment approach. Although treatment guidelines exist, including the US and International guidelines (American Psychiatric Association 12 and World Federation of Societies of Biological Psychiatry 19 ), it is still not possible to know in advance which antipsychotics are most efficacious for any individual patient; heterogeneity of treatment response results in patients commonly being sequentially treated with different antipsychotic medications in order to find the optimum choice of medication for the individual patient.…”

Section: Introductionmentioning

confidence: 99%

Lack of tolerable treatment options for patients with schizophrenia

Citrome

Eramo

François

et al. 2015

NDT

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PurposeAtypical antipsychotics (AAs), an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE) or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options.Patients and methodsAE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined.ResultsA high proportion of patients (>80%) were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60%) and obesity (>40%). From the nine treatment options available, the number of optimal choices for individual patient segments were limited based on their prior history, including those with cardiometabolic and cardiovascular comorbidities (four); experiencing prolactin elevation-related problems (seven); needing to avoid excessive sedation (four); or at risk of extrapyramidal symptoms or akathisia (two). Options were then further restricted among patients in more than one segment when multiple pre-index AE risk factors were combined.ConclusionWhen combining patient risk profile with antipsychotic AE profile, physicians may quickly run out of tolerable treatment options for individual patients, despite the availability of many AAs, suggesting a need for additional treatment options with better tolerability and without compromising efficacy.

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Community Adherence to Schizophrenia Treatment and Safety Monitoring Guidelines

Cited by 11 publications

References 30 publications

Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

Compliance with the guidelines for laboratory monitoring of patients treated with lithium: A retrospective follow‐up study among ambulatory patients in the Netherlands

Lack of tolerable treatment options for patients with schizophrenia

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