BACKGROUND: Second-generation antipsychotics have been found to increase a patient's risk of dyslipidemia. Despite consensus statement recommendations for lipid monitoring, studies indicate that up to 90% of patients still do not have a baseline lipid panel prior to prescription of a second-generation antipsychotic. METHODS: This study retrospectively examined the prevalence of baseline lipid monitoring in patients prescribed second-generation antipsychotics during their index psychiatric hospitalization at Duke University Hospital between July 1, 2005, and July 1, 2010. RESULTS: Seventy patients were included in the study, with a mean age of 21.5±2.5 years. Of these patients, 22 (31.4%) had baseline lipid panels drawn during hospitalization. Lipid monitoring was statistically more frequent in males than in females (P=.01). Although not statistically significant, lipid monitoring was also more likely to occur among subjects who were African American (40%; P=.07) and with the prescription of olanzapine (50%; P=.07). About half of baseline lipid panels demonstrated either a low high-density lipoprotein or high triglycerides, indicating at least one risk factor for the metabolic syndrome. CONCLUSION: This study provides alarming evidence that, even in an academic setting with active discussions among psychiatrists regarding issues of metabolic risk and appropriate monitoring, adherence to American Psychiatric Association/American Diabetes Association consensus statement recommendations on rates of baseline lipid monitoring is disappointingly low in the absence of systems to encourage or automate best practice.
BACKGROUND: Second-generation antipsychotics have been found to increase a patient's risk of dyslipidemia. Despite consensus statement recommendations for lipid monitoring, studies indicate that up to 90% of patients still do not have a baseline lipid panel prior to prescription of a second-generation antipsychotic. METHODS: This study retrospectively examined the prevalence of baseline lipid monitoring in patients prescribed second-generation antipsychotics during their index psychiatric hospitalization at Duke University Hospital between July 1, 2005, and July 1, 2010. RESULTS: Seventy patients were included in the study, with a mean age of 21.5±2.5 years. Of these patients, 22 (31.4%) had baseline lipid panels drawn during hospitalization. Lipid monitoring was statistically more frequent in males than in females (P=.01). Although not statistically significant, lipid monitoring was also more likely to occur among subjects who were African American (40%; P=.07) and with the prescription of olanzapine (50%; P=.07). About half of baseline lipid panels demonstrated either a low high-density lipoprotein or high triglycerides, indicating at least one risk factor for the metabolic syndrome. CONCLUSION: This study provides alarming evidence that, even in an academic setting with active discussions among psychiatrists regarding issues of metabolic risk and appropriate monitoring, adherence to American Psychiatric Association/American Diabetes Association consensus statement recommendations on rates of baseline lipid monitoring is disappointingly low in the absence of systems to encourage or automate best practice.
Authors: Pablo Richly; Pablo López; Ezequiel Gleichgerrcht; Daniel Flichtentrei; María Prats; Ricardo Mastandueno; Julián Bustin; Marcelo Cetkovich-Bakmas Journal: World J Psychiatry Date: 2014-09-22