Recent guidelines and consensus statements recommend stringent monitoring of metabolic function in individuals receiving antipsychotic drugs. We aimed prospectively to study the evolution of metabolic dysfunction in a cohort of antipsychotic-treated subjects with severe mental illness from across the diagnostic spectrum. We also investigated monitoring practices for metabolic disease and cardiovascular risk.

A prospective cohort study of 106 community-treated psychiatric patients from across the diagnostic spectrum from the Northeast of England. Detailed anthropometric and metabolic assessment was undertaken.

A high prevalence of undiagnosed and untreated metabolic disease was present at baseline assessment. Mean follow-up time was 599.3 (SD ± 235.4) days. Body mass index (p<0.005) and waist circumference (p<0.05) had significantly increased at follow-up, as had the number of individuals who were either overweight or obese. Fifty-three per cent of individuals had hypertriglyceridemia, and 31% had hypercholesterolemia, but only 7% were receiving lipid-lowering therapy. A number of individuals on ‘high risk’ drugs with regard to glucose homeostasis disorders reverted from impaired fasting glucose to normoglycemia during the follow-up period. Monitoring practices were poor. Recording of measures of adiposity occurred in 0% of individuals, and >50% of subjects had neither blood glucose nor lipids monitored during the follow-up period.

This cohort has a high prevalence of metabolic disease and heightened cardiovascular risk. Despite the publication of a number of recommendations regarding physical health screening in this population, monitoring rates are poor, and physical health worsened during the 19 month follow-up period.