Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.
Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
PLoS One. 2018 Aug 21;13(8):e0200520. doi: 10.1371/journal.pone.0200520. eCollection 2018.
Somatic complications account for the majority of the 13-30 years shortened life expectancy in psychiatric patients compared to the general population. The study aim was to assess to which extent patients visiting outpatient departments for mood and anxiety disorders were monitored for relevant somatic comorbidities and (adverse) effects of psychotropic drugs-more specifically a) metabolic parameters, b) lithium safety and c) ECGs-during their treatment.
We performed a retrospective clinical records review and cross-sectional analysis to assess the extent of somatic monitoring at four outpatient departments for mood and anxiety disorders in The Netherlands. We consecutively recruited adult patients visiting a participating outpatient department between March and November 2014. The primary outcome was percentage of patients without monitoring measurements. Secondary outcomes were number of measurements per parameter per patient per year and time from start of treatment to first measurement.
We included 324 outpatients, of whom 60.2% were female. Most patients were treated for depressive disorders (39.8%), anxiety disorders (16.7%) or bipolar or related disorders (11.7%) and 198 patients (61.1%) used at least one psychotropic drug. For 186 patients (57.4%), no monitoring records were recorded (median treatment period 7.3 months, range 0-55.6). The median number of measurements per parameter per year since the start of outpatient treatment for patients with monitoring measurements was 0.31 (range 0.0-12.9). The median time to first monitoring measurement per parameter for patients with monitoring measurements was 3.8 months (range 0.0-50.7).
Somatic monitoring in outpatients with mood and anxiety disorders is not routine clinical practice. Monitoring practices need to be improved to prevent psychiatric outpatients from undetected somatic complications.
与普通人群相比，精神科患者的预期寿命缩短了 13-30 年，这主要归因于躯体并发症。本研究旨在评估在荷兰四家情绪和焦虑障碍的门诊部门，接受心境和焦虑障碍治疗的患者，其躯体共病和（不良）精神药物作用的监测程度，具体来说，包括 a）代谢参数，b）锂安全性和 c）心电图。
我们对荷兰四家情绪和焦虑障碍的门诊部门进行了回顾性临床病历审查和横断面分析，以评估躯体监测的程度。我们连续招募了 2014 年 3 月至 11 月期间参加门诊治疗的成年患者。主要结局是无监测测量的患者比例。次要结局是每位患者每年每个参数的测量次数和从治疗开始到第一次测量的时间。
我们共纳入 324 名门诊患者，其中 60.2%为女性。大多数患者患有抑郁障碍（39.8%）、焦虑障碍（16.7%）或双相或相关障碍（11.7%），198 名患者（61.1%）至少使用了一种精神药物。186 名患者（57.4%）未记录监测记录（中位治疗期 7.3 个月，范围 0-55.6 个月）。有监测记录的患者，自门诊治疗开始以来，每个参数的年测量次数中位数为 0.31（范围 0.0-12.9）。有监测记录的患者每个参数的首次监测测量时间中位数为 3.8 个月（范围 0.0-50.7 个月）。
情绪和焦虑障碍门诊患者的躯体监测并非常规临床实践。需要改进监测措施，以防止精神科门诊患者出现未被发现的躯体并发症。
