How often should a full medical workup be done on a person with serious mental illness who is being treated with medications?

One essential area of concern is monitoring for metabolic and diabetic risk when prescribing second generation antipsychotics (SGAs). It is well established that patients with serious mental illness (SMI) have increased cardiac and diabetes vulnerability, which can lead to premature death in many people living with SMI. A large part of this risk is accounted for by side effects from SGAs and requires monitoring, collaboration and prevention. The risk of metabolic side effects is even greater for children and adolescents who are prescribed these medications. Research also shows that many children and adolescents are not monitored for these preventable and risky side effects. The same important metabolic risks can occur in adults and again, monitoring often falls short. It is important to understand both who is monitoring and addressing these risks between mental health prescriber and primary care physicians to avoid critical data slipping through the cracks. Monitoring is in the job description of both the mental health provider and the primary care physician even though the treatment of the condition (cardiac, diabetic, etc.) usually falls in the realm of the primary care physician. Coordination and collaboration between the entire treatment team–including the patient and the family–is essential for successful monitoring and the best patient outcomes.

If you are a leader, set up systems that capture measurable risks on a regular schedule like Hemoglobin A1C, cholesterol, blood pressure and weight/BMI in your EMR. Patient care will be improved as you monitor these results and share them with the PCP engaged in your patient’s care. The 2019 HEDIS Performance Measure Guides include measures that address children, adolescents, and adults who are prescribed antipsychotic medications.

Our field has been criticized for not taking care of this important aspect of care. Monitoring is not the only aspect of the use of cardiac and metabolic prevention when using SGAs. Creating a culture of wellness and prevention can also make a difference. For example, the In SHAPE program offers evidence-based and creative ways to engage people in prevention and self-care while taking SGAs.

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