H EALTHY MIND IN HEALTHY BODY – RESULTS OF THE IN - PATIENT METABOLIC MONITORING CLINIC L ITTLEBROOK H OSPITAL, D ARTFORD S Satisha, B G Girishchandra, C Nwosu, O Iyi-Ojo, M Ivanov, and V Delaffon

B ACKGROUND Long term antipsychotic treatment is a risk factor to develop the metabolic syndrome 1 People with the metabolic syndrome are at increased risk of developing diabetes mellitus and cardiovascular disease as well as increased mortality 2 Regular monitoring of metabolic parameters is advised for all patients prescribed long term antipsychotics, however there is evidence that this monitoring is suboptimal 3.

NICE GUIDELINES Monitor and record the following regularly and systematically throughout treatment, but especially during titration: efficacy, including changes in symptoms and behaviour side effects of treatment, taking into account overlap with some of the clinical features of schizophrenia adherence physical health Monitor the physical health of people with schizophrenia at least once a year.

A IMS To assess existent practice of monitoring metabolic parameters against minimal acceptable criteria. To ascertain changes in practice following implementation of the in-patient metabolic monitoring clinic using audit methodology.

M ETHODS The audit standard was that all such patients should, as a minimum, have their blood pressure, body mass index (BMI), waist circumference, blood glucose (or HbA1c), and plasma lipids measured at baseline for new prescriptions and at least once a year thereon. A baseline audit was carried out examining records of all patients admitted to acute wards at Littlebrook Hospital between February and March 2012 and prescribed regular antipsychotics. A weekly in-patient metabolic monitoring clinic was set up in November 2012 during which patients prescribed regular antipsychotics were reviewed and metabolic parameters completed where missing. Two re-audit cycles were carried out over a 4 week period in November 2012 and Feb 2013.

R ESULTS The numbers of patients included in the baseline and re-audit period were and 48 respectively; the proportion of males was (n =17) 35%, (n = 22) 50% and (n = 20) 42% respectively. There were improvements in the documentation of a history of Diabetes Mellitus (67% to 98%), Hypertension (61% to 98%) and Hypercholesterolemia(67% to 98%) during the first re-audit cycle. This improvement was sustained during the second re audit cycle and the corresponding figures were DM 100%, HTN 100%, 100% HC. At baseline and during the first re-audit cycle, monitoring of blood pressure was 98% and 100% at the second reaudit cycle. The proportion of patients who received monitoring for metabolic parameters increased following the initiation of the in-patient metabolic monitoring clinic - BMI (39% to 91%, 92%), waist circumference (0% to 91%, 56%), blood glucose (or HbA1c) (56% to 96%, 88%) and plasma lipids (56% to 98%, 75%).

M ETABOLIC P ARAMETERS

M ETABOLIC P ARAMETERS MEASURED

D OCUMENTATION OF MEDICAL COMORBIDITIES

R ECOMMENDATIONS To continue the in-patient metabolic monitoring clinic for patients prescribed regular antipsychotic medication on acute wards at Littlebrook Hospital. To carry out a survey of patients who have attended the in-patient metabolic monitoring clinic for feedback. To consider setting up similar clinics for the other acute in-patient hospitals within KMPT. To carry out further re-audits at 6 monthly intervals in order to maintain good practice and improve on areas of deficiencies.

R EFERENCES 1. Eapen V, John G Weight gain and metabolic syndrome among young patients on antipsychotic medication: what do we know and where do we go? Australas Psychiatry 19: 232– Trevisan M, Liu J, 2. Bahsas FB, Menotti A. Syndrome X and mortality: a population-based study. Am J Epidemiol.1998;148: Barnes TR, Paton C, Cavanagh MR, Hancock E, Taylor DM; UK Prescribing Observatory for Mental Health. 3. A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophr Bull 2007; 33: 1397–403.

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