Lipid Monitoring in Patients With Schizophrenia Prescribed Second-Generation Antipsychotics
Ellen M. Weissman, MD, MPH; Carolyn W. Zhu, PhD; Nina R. Schooler, PhD; Raymond R. Goetz, PhD; and Susan M. Essock, PhD
Objectives: Treatment with
second-generation antipsychotic (SGA) medications has been
linked with increased rates of the metabolic
syndrome (i.e., dyslipidemia, obesity, and
hyperglycemia). Several sets of published recommendations
now provide clinicians with guidelines for
monitoring metabolic parameters in individuals with
schizophrenia treated with SGAs. However, few data are available regarding actual metabolic
monitoring practices in this patient population. The
objectives of the study were to determine baseline lipid monitoring rates for individuals with
schizophrenia prescribed SGAs during the period
prior to the publication of monitoring guidelines and
to determine whether individuals with abnormal lipid levels received follow-up monitoring
sooner than individuals with normal levels.
Method: Lipid monitoring rates for 408
individuals with schizophrenia who were prescribed SGAs from October 1999 to October 2003
were examined using administrative data from a
Veterans Affairs facility. Survival analysis was used
to examine time to follow-up lipid measurement and to compare time to follow-up measure for
individuals with normal initial lipid levels
versus those with elevated initial lipid levels.
Results: Eighty-five percent of
individuals had at least 1 measurement for total cholesterol
or triglycerides in a 4-year period. Abnormal
initial measurements predicted significantly earlier
follow-up monitoring (p < .005 for total
cholesterol, p < .05 for triglycerides, p < .001 for
low-density lipoprotein cholesterol). However, median time
to follow-up measure was 304 days (approximately 10 months) for individuals with elevated
total cholesterol levels, which is too long for
optimal clinical follow-up.
Conclusion: Program managers and
clinicians should assess adequacy of monitoring and
support quality improvement initiatives in this area.
J Clin Psychiatry 2006;67(9):1323-1326
© Copyright 2006 Physicians Postgraduate Press, Inc.