Teeluckdharry Sadira, Sharma Sujit, O'Rourke Elizabeth, Tharian Priyanka, Gondalekar Anjali, Nainar Feroz, Roy Meera
Birmingham and Solihull Mental Health NHS Foundation Trust, UK.
J Intellect Disabil. 2013 Sep;17(3):223-35. doi: 10.1177/1744629513495261. Epub 2013 Jun 25.
This audit was undertaken prospectively to examine the compliance of a group of psychiatrists against guidelines they developed for monitoring the onset of metabolic syndrome, a potential side effect of antipsychotic medication, especially second generation or atypical ones. Phase 1 of the audit was to set standards by a questionnaire survey of participating psychiatrists against Consensus Guidelines on monitoring (American Diabetic Association, 2004), which they favoured. The results led to modifying these guidelines to develop minimum acceptable standards against which their practice was audited in Phase 2. Although in Phase 1, 77% of the psychiatrists felt that they did some baseline recording, Phase 2 finding did not corroborate this--only 53.8% of the notes recorded the assessment of risk factors in personal history; 37.5% risk factors in family history; 31.7% baseline weight and 26.4% baseline blood sugar/lipid levels. In Phase 1, 85% of the psychiatrists thought that they carried out some of the recommended monitoring; our audit found the records of weight monitoring in 69.7% of the notes and blood sugar and lipids monitoring in 44.2%. People with intellectual disability have a shorter life expectancy and increased risk of early death when compared with the general population. Obesity is already a health issue for people with intellectual disability. We discuss the challenges faced by psychiatrists in implementing their own minimum acceptable standards and suggest measures to reduce the metabolic risk associated with antipsychotic medication through increasing awareness--use of information leaflets in accessible format, health promotion and use of side effect checklists and improving access--by working collaboratively with general practitioners utilising the forum of annual health checks.
本次审计是前瞻性进行的，旨在检查一组精神科医生对他们制定的监测代谢综合征发病情况指南的遵循情况。代谢综合征是抗精神病药物尤其是第二代或非典型抗精神病药物的一种潜在副作用。审计的第一阶段是通过对参与的精神科医生进行问卷调查，对照他们所青睐的《监测共识指南》（美国糖尿病协会，2004年）来设定标准。结果促使对这些指南进行修改，以制定最低可接受标准，并在第二阶段据此对他们的实践进行审计。尽管在第一阶段，77%的精神科医生认为他们进行了一些基线记录，但第二阶段的调查结果并未证实这一点——只有53.8%的记录中记载了对个人病史中风险因素的评估；37.5%记载了家族病史中的风险因素；31.7%记载了基线体重，26.4%记载了基线血糖/血脂水平。在第一阶段，85%的精神科医生认为他们进行了一些推荐的监测；我们的审计发现，69.7%的记录中有体重监测情况，44.2%的记录中有血糖和血脂监测情况。与普通人群相比，智障人士预期寿命较短，过早死亡风险增加。肥胖已经是智障人士面临的一个健康问题。我们讨论了精神科医生在实施他们自己的最低可接受标准时所面临的挑战，并建议通过提高认识——使用通俗易懂的信息传单、开展健康促进活动、使用副作用检查表以及改善就医途径——与全科医生合作利用年度健康检查这一平台，来降低与抗精神病药物相关的代谢风险。
