Lack of Cardiovascular Screening in Patients Taking Antipsychotics

Findings from a recent study suggest that few adults taking antipsychotic medications are being screened for abnormalities in lipids in accordance with recommendations from The American Diabetes Association and American Psychiatric Association.

Researchers found the largest screening gap in patients age 40 and younger. It has been previously suggested that early detection and intervention is effective for this group when additional cardiovascular risk is present, according to a study published in JAMA Psychiatry.

Due to increased risks for diabetes, high cholesterol, high blood pressure, and heart disease, patients with serious mental illnesses die 20 to 30 years earlier than patients without these illnesses. Antipsychotic medication increases that risk.

"Antipsychotic medications are associated with substantial weight gain, as well as changes in insulin sensitivity and lipid metabolism, which increase the risk of diabetes and cardiovascular disease," said lead author of the study Elaine Morrato, DrPH, MPH, CPH.

The study included 9361 Medicaid patients to discover factors associated with not having annual glucose and lipid testing during treatment with antipsychotics, according to the study.

Researchers found that approximately 75% of patients had a prescriber who was not practicing in a Community Mental Health Center. Approximately 50% started antipsychotic treatment with a non-behavioral healthcare physician.

Federal and state initiatives to reduce cardiovascular disease among these patients were focused on physiatrists in a community mental health setting, according to the study.

Researchers noted that the highest population who lacked testing was adults 40-years-old and younger with few chronic conditions.

A potential reason for low rates of testing could be due to conflicting information about whether young adults should be tested or not.

Some guidelines prioritize screening for adults with schizophrenia or bipolar disorder and some guidelines call for testing of all patients. Some guidelines also prioritize screening based on age, ethnicity, and other risk factors, according to the study.

Researchers wrote that integration of behavioral health into primary care services is needed, as is clearing up any ambiguity for the screening guidelines. Increased clarity is important to make the most efficient use of resources, improve screening rates, and reduce the rate of cardiovascular disease, the researchers conclude.