Psychological Medicine

Original Articles

Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices

A. J. Mitchella1a2 c1, V. Delaffona1, D. Vancampforta3a4, C. U. Corrella5a6 and M. De Herta3

a1 Psycho-oncology, Leicester General Hospital, Leicestershire Partnership Trust, Leicester, UK

a2 Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, University of Leicester, UK

a3 UPC KUL campus Kortenberg, Belgium

a4 Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Heverlee, Belgium

a5 The Zucker Hillside Hospital, Glen Oaks, New York, USA

a6 Albert Einstein College of Medicine, Bronx, New York, USA


Background Despite increased cardiometabolic risk in individuals with mental illness taking antipsychotic medication, metabolic screening practices are often incomplete or inconsistent.

Method We undertook a systematic search and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) meta-analysis of studies examining routine metabolic screening practices in those taking antipsychotics both for patients in psychiatric care before and following implementation of monitoring guidelines.

Results We identified 48 studies (n=290 534) conducted between 2000 and 2011 in five countries; 25 studies examined predominantly schizophrenia-spectrum disorder populations; 39 studies (n=218 940) examined routine monitoring prior to explicit guidelines; and nine studies (n=71 594) reported post-guideline monitoring. Across 39 studies, routine baseline screening was generally low and above 50% only for blood pressure [69.8%, 95% confidence interval (CI) 50.9–85.8] and triglycerides (59.9%, 95% CI 36.6–81.1). Cholesterol was measured in 41.5% (95% CI 18.0–67.3), glucose in 44.3% (95% CI 36.3–52.4) and weight in 47.9% (95% CI 32.4–63.7). Lipids and glycosylated haemoglobin (HbA1c) were monitored in less than 25%. Rates were similar for schizophrenia patients, in US and UK studies, for in-patients and out-patients. Monitoring was non-significantly higher in case-record versus database studies and in fasting samples. Following local/national guideline implementation, monitoring improved for weight (75.9%, CI 37.3–98.7), blood pressure (75.2%, 95% CI 45.6–95.5), glucose (56.1%, 95% CI 43.4–68.3) and lipids (28.9%, 95% CI 20.3–38.4). Direct head-to-head pre–post-guideline comparison showed a modest but significant (15.4%) increase in glucose testing (p=0.0045).

Conclusions In routine clinical practice, metabolic monitoring is concerningly low in people prescribed antipsychotic medication. Although guidelines can increase monitoring, most patients still do not receive adequate testing.

(Received February 08 2011)

(Revised May 19 2011)

(Accepted May 19 2011)

(Online publication August 10 2011)


c1 Address for correspondence: A. J. Mitchell, Consultant in Psycho-oncology, Leicester General Hospital, Leicester Partnership Trust, Leicester LE5 4PW, UK. (Email: