Schneiderhan Mark E, Batscha Catherine L, Rosen Cherise
Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, Minnesota 55812-3003, USA.
Pharmacotherapy. 2009 Aug;29(8):975-87. doi: 10.1592/phco.29.8.975.
To assess the usefulness of a metabolic risk screening program, including point-of-care glucose testing, to quantify baseline metabolic risk in outpatients receiving antipsychotics.
Retrospective, cross-sectional, cohort study.
University-affiliated department of psychiatry clinic.
A total of 92 adult outpatients (49 women, 43 men; mean +/- SD age 38.96 +/- 12 yrs) who were receiving antipsychotics and had undergone screening for metabolic syndrome at the clinic during 2004-2007.
Patient data were recorded on a metabolic screening checklist by a pharmacist or nurse. The checklist captured demographics, vital signs (height, weight, body mass index [BMI], blood pressure, waist and hip circumference, point-of-care random glucose level), personal and family knowledge of current illnesses (diabetes mellitus, hypertension, hyperlipidemia), modifiable risk factors (smoking, alcohol, level of activity), current drug therapy, and recommendations to the psychiatrist. The patient population who underwent screening included 49 African-Americans (53%), 21 Caucasians (23%), 16 Hispanics (17%), and 6 Asians (7%). Diagnoses were documented for 88 patients: schizophrenia or schizoaffective disorder in 53 patients (60%), and bipolar disorder and major depressive disorder was equally divided in the remaining 35 patients (40%). Of 89 patients (three patients had missing data on waist circumference), 63 (71%) met criteria for level 1 metabolic risk (abdominal obesity); of these 63 patients, 38 (60%) met criteria for level 2 risk (abdominal obesity plus hypertension). Patients with a random glucose level greater than 140 mg/dl had a higher likelihood for being at level 2 risk than level 1 risk (chi(2)=5.99, df=1, p=0.014). Women had a significantly higher likelihood for level 1 metabolic risk compared with men (chi(2)=5.99, df=1, p=0.019). African-Americans had a significantly higher likelihood of level 1 risk (p=0.026) and BMI greater than 30 kg/m(2) (p=0.003) compared with Caucasians. Patients with a BMI greater than 30 kg/m(2) had a significantly higher likelihood of diabetes (p=0.006), hypertension (p=0.03), and hyperlipidemia (p=0.05). Overall, 5 (5%) of the 92 patients met criteria for prediabetes risk.
Point-of-care metabolic risk screening, done with a systematic interprofessional team approach, can provide clinicians with a practical method for identifying metabolic risk in patients prescribed antipsychotics.
评估一项代谢风险筛查项目（包括即时血糖检测）在量化接受抗精神病药物治疗的门诊患者基线代谢风险方面的实用性。
回顾性横断面队列研究。
大学附属医院精神科门诊。
共有92例成年门诊患者（49例女性，43例男性；平均±标准差年龄38.96±12岁），他们在2004年至2007年期间接受抗精神病药物治疗，并在该诊所接受了代谢综合征筛查。
患者数据由药剂师或护士记录在代谢筛查清单上。该清单记录了人口统计学信息、生命体征（身高、体重、体重指数[BMI]、血压、腰围和臀围、即时随机血糖水平）、个人及家族当前疾病（糖尿病、高血压、高脂血症）知识、可改变的风险因素（吸烟、饮酒、活动水平）、当前药物治疗情况以及给精神科医生的建议。接受筛查的患者群体包括49名非裔美国人（53%）、21名白种人（23%）、16名西班牙裔（17%）和6名亚洲人（7%）。88例患者有诊断记录：53例（60%）为精神分裂症或分裂情感性障碍，其余35例（40%）双相情感障碍和重度抑郁症各占一半。在89例患者中（3例患者腰围数据缺失），63例（71%）符合1级代谢风险标准（腹型肥胖）；在这63例患者中，38例（60%）符合2级风险标准（腹型肥胖加高血压）。随机血糖水平大于140mg/dl的患者处于2级风险的可能性高于1级风险（χ²=5.99，自由度=1，p=0.014）。与男性相比，女性处于1级代谢风险的可能性显著更高（χ²=5.99，自由度=1，p=0.019）。与白种人相比，非裔美国人处于1级风险的可能性显著更高（p=0.026）且BMI大于30kg/m²的可能性更高（p=0.003）。BMI大于30kg/m²的患者患糖尿病（p=0.006）、高血压（p=0.03）和高脂血症（p=0.05）的可能性显著更高。总体而言，92例患者中有5例（5%）符合糖尿病前期风险标准。
采用系统的跨专业团队方法进行即时代谢风险筛查，可为临床医生提供一种识别服用抗精神病药物患者代谢风险的实用方法。
