Am J Psychiatry 161:1334-1349, August 2004
© 2004 American Psychiatric Association
Physical Health Monitoring of Patients With Schizophrenia
Stephen R. Marder, M.D.,
Susan M. Essock, Ph.D.,
Alexander L. Miller, M.D.,
Robert W. Buchanan, M.D.,
Daniel E. Casey, M.D.,
John M. Davis, M.D.,
John M. Kane, M.D.,
Jeffrey A. Lieberman, M.D.,
Nina R. Schooler, Ph.D.,
Nancy Covell, Ph.D.,
Scott Stroup, M.D., M.P.H.,
Ellen M. Weissman, M.D., M.P.H.,
Donna A. Wirshing, M.D.,
Catherine S. Hall, Pharm.D.,
Leonard Pogach, M.D.,
Xavier Pi-Sunyer, M.D., M.P.H.,
J. Thomas Bigger, Jr., M.D.,
Alan Friedman, M.D.,
David Kleinberg, M.D.,
Steven J. Yevich, M.D., M.P.H.,
Bonnie Davis, M.D., and
Steven Shon, M.D.
OBJECTIVE: Schizophrenia is associated with several chronic physical illnesses and a shorter life expectancy, compared with life expectancy in the general population. One approach to improving the health of patients with schizophrenia is to improve the monitoring of physical health that occurs in psychiatric settings. The authors discuss a consensus panel’s recommendations for improving the physical health monitoring of patients with schizophrenia who are treated in outpatient settings. METHOD: A consensus meeting including psychiatric and other medical experts assembled on October 17–18, 2002, to evaluate the existing literature and to develop recommendations for physical health monitoring of patients with schizophrenia. Conference participants reviewed the literature in the following areas: 1) weight gain and obesity; 2) diabetes; 3) hyperlipidemia; 4) prolongation of the QT interval on the ECG; 5) prolactin elevation and related sexual side effects; 6) extrapyramidal side effects, akathisia, and tardive dyskinesia; 7) cataracts; and 8) myocarditis. Experts for each topic area formulated monitoring recommendations that were discussed by all of the participants until a consensus was reached. RESULTS: Consensus recommendations included regular monitoring of body mass index, plasma glucose level, lipid profiles, and signs of prolactin elevation or sexual dysfunction. Information from monitoring should guide the selection of antipsychotic agents. Specific recommendations were made for cardiac monitoring of patients who receive medications associated with QT interval prolongation, including thioridazine, mesoridazine, and ziprasidone, and for monitoring for signs of myocarditis in patients treated with clozapine. Patients who receive both first- and second-generation antipsychotic medications should be examined for extrapyramidal symptoms and tardive dyskinesia. Patients with schizophrenia should receive regular visual examinations. CONCLUSIONS: The conference participants recommended that mental health care providers perform physical health monitoring that typically occurs in primary care settings for their patients who do not receive physical health monitoring in those settings. This change in usual practice is recommended on the basis of the conference participants’ belief that this additional monitoring will result in the earlier detection of common, serious risk factors that could, without detection and intervention, contribute to impaired health of patients with schizophrenia.
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