关注代谢：针对改善早期和慢性精神病患者心代谢监测的靶向干预措施。
Minding metabolism: targeted interventions to improve cardio-metabolic monitoring across early and chronic psychosis.
机构信息
Tallaght University Hospital, Dublin, Ireland.
Psychosis Unit, Gavle, Sweden.
出版信息
Ir J Med Sci. 2022 Feb;191(1):337-346. doi: 10.1007/s11845-021-02576-5. Epub 2021 Mar 8.
BACKGROUND
Antipsychotics (APs) increase weight, metabolic syndrome, diabetes and cardiovascular disease. Guidelines recommend cardio-metabolic monitoring at initial assessment, at 3 months and then annually in people prescribed APs.
AIM
To determine the rates of cardio-metabolic monitoring in AP treated early and chronic psychosis and to assess the impact of targeted improvement strategies.
METHODS
Medical records were reviewed in two cohorts of first-episode psychosis (FEP) patients before and after the implementation of a physical health parameter checklist and electronic laboratory order set. In a separate group of patients with chronic psychotic disorders, adherence to annual monitoring was assessed before and 3 months after an awareness-raising educational intervention.
RESULTS
In FEP, fasting glucose (39% vs 67%, p=0.05), HbA1c (0% vs 24%, p=0.005) and prolactin (18% vs 67%, p=0.001) monitoring improved. There were no significant differences in weight (67% vs 67%, p=1.0), BMI (3% vs 10%, p=0.54), waist circumference (3% vs 0%, p=1.0), fasting lipids (61% vs 76% p=0.22) or ECG monitoring (67% vs 67%, p=1.0). Blood pressure (BP) (88% vs 57%, p=0.04) and heart rate (91% vs 65%, p=0.03) monitoring dis-improved. Diet (0%) and exercise (<15%) assessment was poor. In chronic psychotic disorders, BP monitoring improved (20% vs 41.4%, p=0.05), whereas weight (17.0% vs 34.1%, p=0.12), BMI (9.7% vs 12.1%, p=1.0), fasting glucose (17% vs 24.3%, p=0.58) and fasting lipids remained unchanged (17% vs 24.3%, p=0.58).
CONCLUSIONS
Targeted improvement strategies resulted in a significant improvement in a limited number of parameters in early and chronic psychotic disorders. Overall, monitoring remained suboptimal.
背景
抗精神病药物（APs）会增加体重、代谢综合征、糖尿病和心血管疾病的风险。指南建议在初始评估、3 个月时以及随后每年对服用 APs 的患者进行心血管代谢监测。
目的
确定在治疗早期和慢性精神病的患者中进行心血管代谢监测的比例，并评估有针对性的改进策略的影响。
方法
在实施身体健康参数检查表和电子实验室医嘱集之前和之后，对两组首发精神病（FEP）患者的病历进行了回顾。在另一组慢性精神病患者中，在提高认识的教育干预之前和 3 个月后，评估了对年度监测的依从性。
结果
在 FEP 中，空腹血糖（39% vs 67%，p=0.05）、糖化血红蛋白（0% vs 24%，p=0.005）和催乳素（18% vs 67%，p=0.001）监测得到改善。体重（67% vs 67%，p=1.0）、BMI（3% vs 10%，p=0.54）、腰围（3% vs 0%，p=1.0）、空腹血脂（61% vs 76%，p=0.22）或心电图监测（67% vs 67%，p=1.0）没有显著差异。血压（BP）（88% vs 57%，p=0.04）和心率（91% vs 65%，p=0.03）监测恶化。饮食（0%）和运动（<15%）评估较差。在慢性精神病患者中，BP 监测得到改善（20% vs 41.4%，p=0.05），而体重（17.0% vs 34.1%，p=0.12）、BMI（9.7% vs 12.1%，p=1.0）、空腹血糖（17% vs 24.3%，p=0.58）和空腹血脂无变化（17% vs 24.3%，p=0.58）。
结论
有针对性的改进策略导致在早期和慢性精神病中有限数量的参数显著改善。总体而言，监测仍不理想。
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