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At a minimum, the practice of responsible medicine requires that physicians who prescribe drugs whose  known severe adverse side effects are likely to cause their patients irreversible harm, requires that those physicians follow monitoring guidelines to ensure their patients’ safety. 

The second generation neuroleptics (antipsychotics such as Clozaril, Zyprexa, Risperdal, Guiedon, Seroquel, Abilify) are known to cause severe, potentially lethal adverse effects.  These include rapid metabolic changes, including acute weight gain, and interference with normal glucose metabolism. These changes lead to increased rates of cardiovascular disease and premature deaths.

In 2003, the FDA required a warning label about the diabetes risk for people prescribed second-generation antipsychotic drugs. The American Diabetes Association and the American Psychiatric Association (APA) recommended glucose and lipid screening and monitoring for all patients starting these drugs.

The drugs are widely misprescribed even for young children, whose safety is at high risk from those drug-induced metabolic changes.

Yet, studies examining monitoring rates for patients–young and old–who are prescribed these drugs, have consistently shown that psychiatrists fail to screen or monitor for either glucose or lipid levels in patients for whom they prescribe these drugs.  In 2008, Dr. Dan Haupt of Washington University, St. Louis, found that only 20% of patients prescribed antipsychotics were monitored for glucose levels, and only 10% had their lipids monitored.

The latest such study (Abstract NR7-51) was presented by Dr. Christina Mangurian, a University of California at San Francisco psychiatrist,  at the Annual Meeting of the American Psychiatric Association, May 7, 2012.  Her findings confirm the lack of metabolic screening and monitoring of patients prescribed antipsychotic drugs by psychiatrists–even as psychiatrists acknowledged that they should be doing the monitoring.  See:Metabolic Screening in Antipsychotic Users: Whose Job Is It? 

Dr. Haupt suggested that psychiatry suffers from an “identity crisis,” noting that: ”Historically these are people who have gone to medical school but have not viewed themselves as physicians in the same way as an internist would.”  See:  ADA: Metabolic Monitoring Guidelines for Antipsychotics Largely Unheeded

Vera Sharav

email sent to gianna kali from the AHRP

thank you:giannakali

related article-Disconnect Between Antipsychotic Prescribing and Metabolic Screening