CLINICAL HANDBOOK OF SCHIZOPHRENIA

434 VI. SPECIAL POPULATIONS AND PROBLEMSTABLE 41.5. ADA/APA Consensus on Antipsychotic Drugs: Monitoring Protocol for Patientson Second-Generation AntipsychoticsBaseline 4 weeks 8 weeks 12 weeks Quarterly Annually Every 5 yearsPersonal/family history × ×Weight (BMI) × × × × ×Waist circumference × ×Blood pressure × × ×Fasting plasma glucose × × ×Fasting lipid profile × × ×Note. More frequent assessments may be warranted based on clinical status. From American Diabetes Association,American Psychiatric Association, American Association of Clinical Endocrinologists, and North American Associationfor the Study of Obesity (2004). Copyright 2004 by the American Diabetes Association. Reprinted by permission.obesity, increased blood triglycerides (fats), elevated blood pressure, and insulin resistance.Due to the increased risk of persons with schizophrenia developing metabolic syndromewhen taking atypical antipsychotics, close health monitoring is important. It isrecommended that body mass index (BMI), waist circumference, plasma glucose level,and blood lipids be evaluated regularly. Before initiating or changing antipsychotic medications,BMI should be recorded and a fasting blood glucose should be obtained. Table41.5 summarizes the monitoring protocol for antipsychotic medications developed by aconsensus workgroup from the American Diabetic Association (ADA) and the AmericanPsychiatric Association (APA). For a detailed description of health monitoring for adultson antipsychotic medications, please refer to the Marder and colleagues (2004) consensusstatement (see References and Recommended Readings).KEY POINTS• Chronic medical conditions are common among persons with schizophrenia, and contributeto early mortality and poorer quality of life.• Effective management of medical conditions in persons with schizophrenia requires ongoingcollaboration and communication between mental health providers and primary careproviders.• Education and training in self-management of chronic medical conditions are important factorsin improving health outcomes.• Lifestyle factors (e.g., poor diet, overweight, lack of exercise, and smoking) are associatedwith a number of medical conditions that commonly affect persons with schizophrenia.• Focusing on improvements in lifestyle-related factors is essential to manage medical conditionseffectively in persons with schizophrenia.• Compared to the general population, persons with schizophrenia need additional encouragement,coaching, and monitoring to achieve a healthy lifestyle.• Persons with schizophrenia need individually tailored education about their medical condition(s)and associated health risks, signs of serious problems, medication regimens, andnutritional needs.• Regular contact with medical providers is important to ensure that regular screening testsare on schedule and that optimal treatment is provided.• Medication adherence is vital for effective chronic disease management, and adherencestrategies are similar for both psychiatric and medical medication, including reminders andmedication organizers.• It is critical for persons with serious mental illness and medical comorbidity to acquire theskills and knowledge necessary to effectively access both routine and emergency healthservices.