Managing antipsychotic induced metabolic syndrome to improve treatment adherence and quality of life in Gallatin County

Abstract

Atypical antipsychotics are prescribed for patients suffering from serious mental illnesses. As these medications have become more widely used over the past 3 decades, practitioners have started to become more aware of metabolic side effects caused by them. Metabolic syndrome is a term for alterations in baseline metabolic functioning which result in weight gain, hyperlipidemia, hypertension, insulin resistance, diabetes, and cardiovascular disease. A correlation between obesity and mortality exists within the population of individuals diagnosed with a severe mental illness taking atypical antipsychotics and has been reported as responsible for decreased life expectancy of up to 30 years. However, monitoring the physical side effects has been a significant barrier to successful management for these patients, often due to unclear practice direction between psychiatric and primary care providers. Many patients with metabolic syndrome experience exacerbations in their mental illness such as increased depression, anxiety, and isolation related to discomfort and decreased self-esteem, which can lead to medication nonadherence causing further complications. Patients experiencing emotional decline may be unable to participate in necessary lifestyle modifications without assistance, leading to the progression of metabolic syndrome. Such health related spirals contribute to the development of treatment resistance and poor patient outcomes. At the Gallatin Mental Health Center in Bozeman, MT, 23 patients taking atypical antipsychotics were provided a qualitative satisfaction survey about medications, treatment plans, and adherence, in addition to being offered an opportunity to make recommendations that could improve their overall health. In accordance with research and successful interventions internationally, a significant number of the patients in Bozeman have experienced metabolic changes, have difficulty remembering or understanding treatment goals, and would like assistance with lifestyle interventions. Using evidence based research and recommendations for metabolic syndrome prevention assessments and interventions a physical health assessment checklist for psychiatric nurses at Gallatin Mental Health was created. An assessment key to assist the nurse with the checklist, a prefabricated order set of interventions, and a simple care plan to guide best practice policy implementation will provide for better treatment adherence and improved quality of life for patients taking atypical antipsychotics in Gallatin County.