Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-28T15:11:59.365Z Has data issue: false hasContentIssue false

Prioritising the physical health needs of patients on clozapine

Published online by Cambridge University Press:  02 January 2018

Sarah L. Ward
Affiliation:
Stobhill Hospital, Glasgow, Scotland, UK, email: Sarah.Ward@ggc.scot.nhs.uk
Selena Gleadow Ware
Affiliation:
Inverclyde Royal Hospital, NHS Greater Glasgow and Clyde
Ciara Kelly
Affiliation:
Leverndale Hospital, NHS Greater Glasgow and Clyde
Rights & Permissions [Opens in a new window]

Abstract

Type
Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2011

During an audit conducted between 2005 and 2007, we examined glucose and cholesterol monitoring in all patients on clozapine in Glasgow (n = 569). Using a computerised laboratory results system, we identified whether plasma glucose or cholesterol had been monitored in the preceding 12 months. Demographic data were comparable to the findings of Bolton, Reference Bolton1 with our patients having a mean age of 39 years and 73% being male. We were unable to determine whether blood samples were fasting, but we found only 46% (n = 263) had undergone glucose monitoring. Of these, 68 (26%) were ⩾ 7.8 mmol/l and 25 (10%) were >11 mol/l. In relation to cholesterol monitoring, only 192 individuals (34%) had been tested, of whom 123 (64%) had cholesterol ⩾5 mmol/l. Our findings and those of Bolton indicate that a significant number of patients on clozapine continue to be unmonitored in relation to important metabolic markers, and of those who are tested, a substantial proportion have abnormal results. These factors may be contributing to the increasing mortality gap faced by this group of patients with complexity. As Taylor et al Reference Taylor, Douglas-Hall, Olofinjana, Whiskey and Thomas2 demonstrated, standardised mortality rates are significantly increased in patients on clozapine, with a fourfold risk of dying compared with individuals receiving long-acting risperidone injection. Bolton advocates for specialist secondary care physical health clinics to ensure appropriate follow-up and to optimise communication with primary care. We are concerned that within the current economic climate, additional resources will not be made available for service development to address these needs. There is a remaining onus on mental health services to engage proactively and creatively within existing primary and secondary care services and in targeting early non-pharmacological intervention, for which there is an increasing evidence base. Reference Álvarez-Jiménez, Hetrick, González-Blanch, Gleeson and McGorry3

References

1 Bolton, PJ. Improving physical health monitoring in secondary care for patients on clozapine. Psychiatrist 2011; 35: 4955.CrossRefGoogle Scholar
2 Taylor, DM, Douglas-Hall, P, Olofinjana, B, Whiskey, E, Thomas, A. Reasons for discontinuing clozapine: matched, case-control comparison with risperidone long-acting injection. Br J Psychiatry 2009; 194: 165–7.CrossRefGoogle ScholarPubMed
3 Álvarez-Jiménez, M, Hetrick, SE, González-Blanch, C, Gleeson, JF, McGorry, PD. Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2008; 193: 101–7.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.