ABSTRACT
The physical health of outpatients with severe mental illness (SMI) can be improved by changes in the health-care system. Analysis of current practice is necessary to develop these strategies. We compared the number of somatic health problems of outpatients with SMI with the frequency of consulting a general practitioner (GP). This was a cross-sectional study based on interviews, and records from the GP and the pharmacy. We checked whether Dutch community pharmacies had complete and correct information about the patients' medication. We observed that all patients (n = 118) had somatic problems in need of clinical attention. Patients who visited their GP less than once a year (35%, n = 42), had a mean of 2.8 somatic health problems. This was less than patients who consulted their GP more than once a year (P ≤ 0.01). In 37% of cases, the pharmacy did not have adequate information on the drug use. Many patients with SMI seemed to have insufficient contact with their GP for their somatic health problems. Insufficient information about the patients' medication suggested that the pharmacist and GP should increase exchange of information. Mental health nurses can take a lead in coordinating the care to improve somatic health for their patients.
Subject(s)
Delivery of Health Care/statistics & numerical data , Mental Disorders/complications , Outpatients/statistics & numerical data , Adult , Cross-Sectional Studies , Female , General Practitioners/statistics & numerical data , Humans , Interviews as Topic , Male , NetherlandsABSTRACT
OBJECTIVE: To investigate the prevalence of and risk factors for overweight and diabetes mellitus in long-stay psychiatric inpatients. METHOD: Statistical analysis of data collected from medical, laboratory, and pharmacy files. RESULTS: 80% of the 256 patients were suffering from schizophrenia or other psychotic disorders. The prevalence of diabetes mellitus was 15%. The prevalence of a disturbed glucose tolerance was 14%. Severe overweight (BMI > 30) was positively associated with the use of clozapine (odds ratio (OR) = 2.7; 95% confidence interval (CI): 1.31-5.75), but negatively with the diagnosis schizophrenia (OR = 0.4; 95% CI: 0.22-0.88). Diabetes mellitus was associated with severe overweight (OR = 3.5; 95% CI: 1.57-7.69). Caucasian patients were at a lower risk for diabetes mellitus (OR = 0.2; 95% CI: 0.08-0.54). CONCLUSIONS: In residential psychiatric patients, diabetes mellitus is especially associated with overweight and non-Caucasian origin. In this survey, the use of clozapine was associated with overweight, but not directly with diabetes mellitus. Diabetes mellitus is highly prevalent, which calls for screening for diabetes mellitus at regular intervals.
Subject(s)
Clozapine/adverse effects , Diabetes Mellitus/etiology , Glucose Intolerance/etiology , Obesity/etiology , Schizophrenia/complications , Adult , Clozapine/therapeutic use , Diabetes Mellitus/epidemiology , Ethnicity , Female , Glucose Intolerance/epidemiology , Humans , Inpatients , Male , Middle Aged , Obesity/epidemiology , Odds Ratio , Prevalence , Psychotic Disorders/drug therapy , Psychotic Disorders/epidemiology , Risk Factors , Schizophrenia/drug therapyABSTRACT
OBJECTIVE: To study the effect of the replacement of omeprazole by pantoprazole on clozapine metabolism in 13 psychiatric patients, who used both clozapine and omeprazole. METHOD: Retrospective study of the medical files. RESULTS: In comparison to smokers, a significant rise of the serum clozapine levels was observed in all non-smoking patients, whilst the daily dose of clozapine remained unchanged. This effect was probably caused by the discontinuation of enzyme induction of the cytochrome P450 enzyme 1A2 by omeprazole in non-smokers, whereas CYP1A2 remained induced in patients who smoked. CONCLUSION: Omeprazole only influenced clozapine metabolism in non-smokers. In none of the patients an adjustment of the clozapine dose was required.
