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Regular monitoring detects metabolic changes in patients on antipsychotics

Diseases and IllnessesDiabetesHeart DiseaseMedicineHarvard Medical SchoolMedicaidCraig Miller

Q: My daughter has schizophrenia. The psychiatrist at her mental health center prescribed an antipsychotic drug. I know some of these drugs increase the risk of diabetes and heart disease. What sort of clinical monitoring do you advise?

A: Schizophrenia may raise the risk of diabetes and heart disease. That's true whether or not the person is taking antipsychotic medicine. So clinical monitoring is a good idea for everyone.

Antipsychotics can add to the problem. Many of them cause weight gain, especially clozapine (Clozaril) and olanzapine (Zyprexa). Being overweight can increase the risk of diabetes. Lipid levels may also rise, boosting the risk of heart disease.

Monitoring should not be too hard. But a recent survey showed that less than one-third of Medicaid patients get the monitoring they need.

Why are the numbers so low? People with schizophrenia often find it hard to get to the doctor. Many don't have a primary care doctor.

Also, the typical psychiatrist's office is not set up to do this kind of monitoring. The same is true in community mental health centers.

Published guidelines first ask doctors to get personal and family medical history. Regular checks of height, weight, waist circumference and blood pressure are recommended. Blood tests can show the glucose (sugar) and lipid (cholesterol and triglyceride) levels.

This may sound like a lot. But it's the same way doctors evaluate anyone at risk for heart disease or diabetes.

Many psychiatrists picture a health care system that has better integration of medical and psychiatric care. But we're not there yet.

So for now, the best strategy is to make sure your daughter sees a primary care doctor regularly. The psychiatrist and primary care doctor can work together to monitor her overall health.

(Michael Craig Miller, M.D., is an Assistant Professor of Psychiatry at Harvard Medical School and an associate physician at Beth Israel Deaconess Medical Center, Boston, Mass. He is a Senior Medical Editor at Harvard Health Publications.)

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