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Research
Metabolic monitoring in veterans with schizophrenia-related disorders and treated with second-generation antipsychotics: Findings from a Veterans Affairs–based population
Chienning Hsu, MS; L. Douglas Ried, PhD; Michael A. Bengtson, MD; Patrick M. Garman, PharmD, MA, PhD; Joel R. McConkey, PharmD; Farzad Rahnavard
J Am Pharm Assoc (2003) 2008;48:393-400. doi:10.1331/JAPhA.2008.07007

Abstract

Objectives  To describe the proportions of veterans living with schizophrenia-related disorders monitored for dyslipidemia and hyperglycemia and to investigate whether the likelihood of metabolic dysregulation monitoring was influenced by veterans’ sociodemographic characteristics, preswitch pharmacologic treatment, and monitoring before the switch from one second-generation antipsychotic (SGA) to another.

Design  Retrospective, observational, descriptive study.

Setting  Veterans Affairs (VA) Healthcare System between October 1, 2001, and December 31, 2003.

Patients  1,826 veterans with schizophrenia-related disorders.

Intervention  Veterans who were dispensed two or more prescriptions for one of five SGAs (i.e., clozapine, olanzapine, quetiapine, risperidone, and ziprasidone) on the VA Healthcare System formulary were identified. Of these veterans, a subset that was switched from one SGA to another was identified. From this subset, veterans were identified who were on the first SGA continuously for at least 90 days before the index date and the new SGA for 180 or more days after. Finally, among these veterans, ICD-9 codes were used to identify veterans with a schizophrenia or schizoaffective disorder diagnosis (ICD-9 code 295.xx or 296).

Main outcome measures  Proportions of veterans with lipid (i.e., low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides) and blood glucose (i.e., fasting blood glucose [FBG], glycosylated hemoglobin [A1C]) laboratory results.

Results  Nearly 39% of the veterans had at least one of three lipid fractions monitored 6 months or less before their SGA switch and 59% during the 12 months after. The corresponding proportions of veterans monitored were 57% and 80% for FBG and 19% and 31% for A1C. Pharmacologic agent for metabolic dysregulation, monitoring during the 6 months before the switch, and age 50 years or older were significant predictors of monitoring after the SGA switch for all three laboratory parameters.

Conclusion  These findings serve as a benchmark for lipid and blood glucose monitoring among patients who switch SGA therapy. Veterans’ metabolic dysregulation was more likely to be monitored after SGA switch for those receiving pharmacologic treatment for metabolic dysregulation, monitored before the switch, and aged 50 years or older. Implementation of monitoring guidelines in daily practice is emphasized to ensure that individuals living with schizophrenia-related disorders and taking SGAs achieve optimal physical health.

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References

Garman PM, Ried LD, Bengtson MA, et al. Effect on lipid profiles of switching from olanzapine to another second-generation antipsychotic in veterans with schizophrenia.  J Am Pharm Assoc.  2007;47:373–8.[CrossRef]
 
Ried LD, McConkey JR, Bengtson MA.  Weight and blood pressure changes after switching second-generation antipsychotics in a population of veterans with schizophrenia-related disorders.  J Am Pharm Assoc.  2007;47:156–64.
 
Jin H, Meyer JM, Jeste DV.  Atypical antipsychotics and glucose dysregulation: a systematic review.  Schizophr Res.  2004;71:195–212.[PubMed]
 
Sernyak MJ, Gulanski B, Rosenheck R. Undiagnosed hyper-glycemia in patients treated with atypical antipsychotics.  J Clin Psychiatry.  2005;66:1463–7.[PubMed]
 
Correll CU, Frederickson AM, Kane JM, Manu P. Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs.  J Clin Psychiatry.  2006;67:575–83.[PubMed]
 
Marder SR, Essock SM, Miller AL, et al. Physical health monitoring of patients with schizophrenia.  Am J Psychiatry.  2004;161:1334–49.[PubMed]
 
Ryan MC, Collins P, Thakore JH.  Impaired fasting glucose tolerance in first episode, drug-naive patients with schizophrenia.  Am J Psychiatry.  2003;160:284–9.[PubMed]
 
Rice ME, Harris GT.  Psychopathy, schizophrenia, alcohol abuse, and violent recidivism.  Int J Law Psychiatry.  1995;18:333–42.[PubMed]
 
Casey DE.  Metabolic issues and cardiovascular disease in patients with psychiatric disorders.  Am J Med.  2005;118(suppl 2):15S–22S.[PubMed]
 
Caballero E. Obesity, diabetes, and the metabolic syndrome: new challenges in antipsychotic drug therapy.  CNS Spectr.  2003;8(11 suppl 2):19–22.[PubMed]
 
Saari KM, Lindeman SM, Viilo KM, et al. A 4-fold risk of metabolic syndrome in patients with schizophrenia: the Northern Finland 1966 Birth Cohort study.  J Clin Psychiatry.  2005;66:559–63.[PubMed]
 
Kahl KG.  The metabolic syndrome and mental illness: relevance, risk factors and practical consequences.  MMW Fortschr Med.  2005;147:32–4, 36.[PubMed]
 
Newcomer JW.  Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review.  CNS Drugs.  2005;19(suppl 1):1–93.[PubMed]
 
 American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes.  Diabetes Care.  2004;27:596–601.[PubMed]
 
Newcomer JW, Nasrallah HA, Loebel AD.  The Atypical Antipsychotic Therapy and Metabolic Issues National Survey: practice patterns and knowledge of psychiatrists.  J Clin Psychopharmacol.  2004;24(5 suppl 1):S1–6.[PubMed]
 
Buckley PF, Miller DD, Singer B, et al. Clinicians‘ recognition of the metabolic adverse effects of antipsychotic medications.  Schizophr Res.  2005;79:281–8.[PubMed]
 
 Expert Panel on Detection and Evaluation of Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).  JAMA.  2001;285:2486–97.[PubMed]
 
 Veterans Health Administration, Department of Defense. VHA/DOD clinical practice guideline for the management of dyslipidemia in primary care. Accessed at www.oqp.med.va.gov/cpg/DL/G/Lipids_v1.2.doc, August  2006.
 
Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.  N Engl J Med.  2005;353:1209–23.[PubMed]
 
Su KP, Wu PL, Pariante CM.  A crossover study on lipid and weight changes associated with olanzapine and risperidone.  Psychopharmacology (Berl).  2005;183:383–6.[PubMed]
 
Edlinger M, Baumgartner S, Eltanaihi-Furtmüller N, et al. Switching between second-generation antipsychotics: why and how? CNS Drugs.  2005;19:27–42.[PubMed]
 
 U.S. Department of Veterans Affairs. VA Information Resource Center (VIReC): VHA Decision Support System (DSS). Accessed at www.virec.research.va.gov/DataSourcesName/DSS/DSSintro.htm, May 15,  2007.
 
 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).  JAMA.  1993;269:3015–23.[PubMed]
 
 Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System: prevalence data, 2001. Accessed at http://apps.nccd.cdc.gov/brfss/page.asp?yr=2001&state=US&cat=CA#CA, August 1,  2006.
 
 National Committee for Quality Assurance. The state of health care quality: 2005 clinical indicators report. Accessed at www.healthpartners.com/files/28455.pdf, August 1,  2006.
 
Nasrallah HA, Meyer JM, Goff DC, et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline.  Schizophr Res.  2006;86(1–3):15–22.[PubMed]
 
Henderson D. Schizophrenia and comorbid metabolic disorders.  J Clin Psychiatry.  2005;66(suppl 6):11–20.[PubMed]
 
Cradock-O'Leary J, Young AS, Yano EM, et al. Use of general medical services by VA patients with psychiatric disorders.  Psychiatr Serv.  2002;53:874–8.[PubMed]
 
Snella KA, Canales AE, Irons BK, et al. Pharmacy- and community-based screenings for diabetes and cardiovascular conditions in high-risk individuals.  J Am Pharm Assoc.  2006;46:370–7.
 
Canales PL, Dorson PG, Crismon ML.  Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting.  Am J Health Syst Pharm.  2001;58:1309–16.[PubMed]
 
Jenkins MH, Bond CA.  The impact of clinical pharmacists on psychiatric patients.  Pharmacotherapy.  1996;16:708–14.[PubMed]
 
Nasrallah HA.  Metabolic findings from the CATIE trial and their relation to tolerability.  CNS Spectr.  2006;11(7 suppl 7):32–9.[PubMed]
 
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