Setting

This audit is likely to be relevant to all psychiatrists and can be carried out in both in-patient and out-patient settings. It may be particularly relevant in general adult psychiatry.

Background

Some psychiatric illnesses tend to predispose patients to metabolic syndrome, which is a cluster of cardiovascular risk factors. In addition, several psychotropic medications have been linked to an elevated risk of metabolic syndrome.

Standards

There are currently no guidelines specific to the metabolic syndrome. The standards set by the International Diabetes Federation (IDF) (2006) were used. According to these, a principal criterion for metabolic syndrome is central obesity, defined in relation to waist circumference, with ethnicity- and genderspecific values. However, if a person's body mass index (BMI) exceeds 30 kg/m2, central obesity can be assumed and waist circumference does not need to be measured. Two of the following criteria also need to be met:

ᐅ raised triglyceride levels (over 1.7 mmol/l) or on treatment for this lipid abnormality

ᐅ reduced high-density lipoprotein (HDL) cholesterol levels (under 1.03 mmol/l in males or 1.29 mmol/l in females) or on treatment for this lipid abnormality

ᐅ raised blood pressure (systolic over 130 mmHg or diastolic over 85 mmHg) or on treatment for previously diagnosed hypertension

ᐅ raised fasting plasma glucose levels (over 5.6 mmol/l) or previously diagnosed type II diabetes.

The IDF states that once a diagnosis of metabolic syndrome has been made, patients should undergo a full cardiovascular risk assessment, including smoking status, in conjunction with the following:

ᐅ primary intervention – healthy lifestyle, with moderate calorie restriction (to achieve 5–10% loss of body weight in the first year) and change in diet, and moderate increase in physical activity

ᐅ secondary intervention – drug therapy, if required by people for whom lifestyle change is not enough, and who are considered to be at high risk for cardiovascular disease.

The target is that these interventions apply to all patients who meet the criteria for diagnosis.

Method

Data collection

The medical notes of all patients in the service were examined for documentation of the following parameters:

ᐅ waist circumference in centimetres

ᐅ blood pressure

ᐅ fasting blood tests (triglyceride, HDL cholesterol and glucose levels)

ᐅ psychiatric and medical diagnoses

ᐅ all current medication.