Psychiatric-Medical ComorbidityPrevalence of baseline lipid monitoring in patients prescribed second-generation antipsychotics during their index hospitalization: a retrospective cohort study

BackgroundSecond-generation antipsychotics have been found to increase a patient's risk of dyslipidemia. Despite consensus statement recommendations for lipid monitoring, studies indicate that up to 90% of patients still do not have a baseline lipid panel prior to prescription of a second-generation antipsychotic.MethodsThis study retrospectively examined the prevalence of baseline lipid monitoring in patients prescribed second-generation antipsychotics during their index psychiatric hospitalization at Duke University Hospital between July 1, 2005, and July 1, 2010.ResultsSeventy patients were included in the study, with a mean age of 21.5±2.5 years. Of these patients, 22 (31.4%) had baseline lipid panels drawn during hospitalization. Lipid monitoring was statistically more frequent in males than in females (P=.01). Although not statistically significant, lipid monitoring was also more likely to occur among subjects who were African American (40%; P=.07) and with the prescription of olanzapine (50%; P=.07). About half of baseline lipid panels demonstrated either a low high-density lipoprotein or high triglycerides, indicating at least one risk factor for the metabolic syndrome.ConclusionThis study provides alarming evidence that, even in an academic setting with active discussions among psychiatrists regarding issues of metabolic risk and appropriate monitoring, adherence to American Psychiatric Association/American Diabetes Association consensus statement recommendations on rates of baseline lipid monitoring is disappointingly low in the absence of systems to encourage or automate best practice.