A retrospective review of state sector outpatients (Tara Hospital) prescribed olanzapine: adherence to metabolic and cardiovascular screening and monitoring guidelines
Date
2011-01-28
Authors
Marsay, Carina
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Abstract
Introduction
Antipsychotics are used for the treatment of psychotic disorders, most commonly schizophrenia, as
well as mood disorders e.g. bipolar mood d isorder. The efficacy of the newer second generation
(atypical) antipsychotics is equivalent to first generation antipsychotics. The apparent advantage of the
second generation antipsychotics is related to their purported reduced side effect profile, thus making
them more desirable due to improved compliance and relapse prevention. The limiting factor with this
class of drugs, especially in the state sector in South Africa, has been the cost. However, reports of
treatment-emergent adverse events such as diabetes mellitus, diabetic ketoacidosis, hyperglycaemia
and dyslipidaemia in patients receiving second generation antipsychotics have increased in recent
times. This has lead to growing concern about the link between metabolic complications and their use,
with consequent reconsideration of the implications of prescribing.
Aims
The study aimed to establish the extent to which metabolic and cardiovascular screening and
monitoring has been undertaken on patients who have been prescribed olanzapine, a second generation
antipsychotic. Specifically the extent to which the American Diabetes Association Consensus
Conference monitoring protocols were being implemented in a specialist psychiatric South African
setting i.e.: at Tara: The H. Moross Centre’s outpatient department.
Objectives
The study objectives were to describe the demographic profile, clinical diagnosis and risk factors for
metabolic complications in a sample of patients receiving olanzapine. Further, to establish the extent to
which metabolic and cardiovascular screening and monitoring has been undertaken on patients
prescribed olanzapine as well as to what extent the patients’s demographics, diagnosis and metabolic
risk factors influenced the treating doctor’s adherence to screening guidelines.
Method
This study was undertaken at Tara: The H. Moross Centre (outpatient department). A convenience
sample of patients prescribed olanzapine were selected as the study group. The study involved a review
of case records. It was a retrospective descriptive study. Relevant data was entered on a data sheet,
designed for the study in accordance with the objectives and adapted from the American Diabetes
Association Consensus Development Conference on Antipsychotic Drugs, Obesity and Diabetes. The
data sheet is based on an existing protocol for monitoring metabolic status.
v
Frequencies for the presence or absence of evidence of screening or monitoring for metabolic
complications were established, as per American Diabetes Association monitoring protocol
requirements. Although the study involved outpatients, not all patients were intiated on olanzapine as
outpatients i.e. some of the prescribing was inpatient initiated.
Results
The sample comprised of 19 females and 20 males. 48.72% female and 51.28% male. The mean age of
females in the sample was 52.38 years (SD=16.20) and the mean age of males was 41.28 (SD=17.05)
years. The sample were predominantly single ( 61.54% n=24 ) with the majority being white (79.49%
n=31 ); most had either tertiarty (43% n=17 ) or secondary (53.85% n =21 ) level of education. Only
2.56% (n=1) had only primary level education. With regards to the diagnoses of patients in the sample,
17,95% (n=7) were diagnosed with bipolar 1 disorder, 7.69% (n=3) with major depressive disorder
with psychosis, 20,51% (n=8) schizoaffective disorder and 53,84% (n=21) with schizophrenia. The
percentage of screening for all the parameters was generally less than 20% and it continued to decline
to less than 20% until 4 months. The exception was weight, where frequency increased slightly over
time. Comparing inpatient vesus outpatient initiated treatment there were apparent differences in the
extent of screening i.e. greater for inpatient initiated treatment, specifically with respect to weight and
blood pressure.
Conclusion
The current study was conducted in a very specific setting, but the findings demonstrated an area
requiring attention i.e. adherence to acceptable clinical guidelines. Whilst one can only speculate on the
basis for non-adherence, having established the status quo, there is a requirement for an appropriate
strategy to address the deficit, given the implications of inadequate monitoring.
Description
MMed, Psychiatry, University of the Witwatersrand, Faculty of Health Sciences
Keywords
drug monitoring, olanzapine usage complications, psychotic disorders