Health

Reviews of the association between psychotic disorder, the metabolic syndrome, diabetes, and antipsychotic drugs con-clude that there is a need for active, routine physical health screening of patients ’ prescribed antipsychotic drugs. From published guidelines, we derived the audit standard that all such patients should, as a minimum, have their blood pres-sure, body mass index (BMI) (or other measure of obesity such as waist circumference), blood glucose (or HbA1c), and plasma lipids measured at least once a year. We con-ducted an audit of the clinical records of 1966 eligible patients under the care of 48 multidisciplinary, assertive outreach clinical teams in 21 mental health services across the United Kingdom. This revealed a recorded measure-ment within the previous year for blood pressure in 26% of the patients, obesity in 17%, blood glucose (or HbA1c) in 28 % and plasma lipids in 22%, with all 4 meas-ures documented in 11%. In the total national sample, 6% had a documented diagnosis of diabetes, 6 % hypertension, and 6 % dyslipidemia. Extrapolating from the prevalence of these disorders in similar populations suggests that for ev-ery patient with a known diagnosis of diabetes, another had not been recognized, for every known case of hypertension, 4 had been missed, and for every known case of dyslipide-mia, 7 had been missed. The responses of the clinical teams to a questionnaire yielded information on obstacles to screening in routine practice, revealing uncertainty about whose responsibility this was, a lack of confidence about the interpretation of abnormal screening results, and limited access to basic equipment. Key words: metabolic syndrome/obesity/diabetes/ dyslipidemia/hypertension/psychosi