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Hypertension and high cholesterol levels in psychotic patients often go untreated

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13 April 2017

​Half of the people in the Netherlands with a psychotic disorder and metabolic problems such as serious hypertension or raised cholesterol levels are not receiving adequate treatment. The antipsychotic drugs they take can increase their risk of developing a metabolic disorder. The guidelines are not adhered to adequately, as health professionals are often unaware of the higher risk run by psychotic patients. These are the findings of a study carried out by psychologist Jojanneke Bruins at the UMCG. An article about her research has been published today in the Journal of Clinical Psychiatry.

For her research, Bruins monitored 1,259 patients with a psychotic disorder. They all underwent a series of three ROM screenings (an annual screening for psychiatric patients). Antipsychotic drugs are known to increase the risk of metabolic problems. In her research, Bruins studied the level of treatment these patients received for their metabolic disorders. She concentrated on high blood pressure, diabetes and raised lipid levels. It is the first time that patients from this group have been monitored for such a long time.

Half of the metabolic problems go untreated
Bruins’ research showed that over half of the psychotic patients in her group had a metabolic disorder. After three ROM screenings, half of the patients suffering from metabolic disorders had still not been treated, even if the first screening had revealed a heightened risk. This was true of patients with a slightly higher risk as well as those with serious hypertension or high cholesterol levels. Young patients in particular received insufficient treatment for their metabolic disorder.

Failure to adhere to guidelines
International guidelines for treating metabolic risk factors are already in place. They contain criteria specifying the point at which a risk is deemed high enough to require treatment with drugs. Bruins concludes that the guidelines are not being complied with. According to her, this is because there is too little attention for, and awareness of, metabolic risks in psychiatry, and confusion about who is responsible for treating these problems if they arise. Bruins: ‘The guidelines state that in principle, the GP is responsible for treating metabolic disorders, including in psychiatric patients.This doesn’t seem to be clear to everyone and furthermore, patients still need to be referred to their GP by a psychiatric health professional.’ Bruins also suspects that psychiatrists and GPs are not always fully aware of the extra risk these patients run.

Improve the integration of ROM screening
Bruins would like to improve integration of the results of the annual ROM screenings into day-to-day practice. She thinks that this would improve the standard of individual care and help patients to recover.