Prioritising the physical health needs of patients on clozapine

During an audit conducted between 2005 and 2007, we examined glucose and cholesterol monitoring in all patients on clozapine in Glasgow (n = 569). Using a computerised laboratory results system, we identified whether plasma glucose or cholesterol had been monitored in the preceding 12 months. Demographic data were comparable to the findings of Bolton, ¹ with our patients having a mean age of 39 years and 73% being male. We were unable to determine whether blood samples were fasting, but we found only 46% (n = 263) had undergone glucose monitoring. Of these, 68 (26%) were ⩾ 7.8 mmol/l and 25 (10%) were >11 mol/l. In relation to cholesterol monitoring, only 192 individuals (34%) had been tested, of whom 123 (64%) had cholesterol ⩾5 mmol/l. Our findings and those of Bolton indicate that a significant number of patients on clozapine continue to be unmonitored in relation to important metabolic markers, and of those who are tested, a substantial proportion have abnormal results. These factors may be contributing to the increasing mortality gap faced by this group of patients with complexity. As Taylor et al ² demonstrated, standardised mortality rates are significantly increased in patients on clozapine, with a fourfold risk of dying compared with individuals receiving long-acting risperidone injection. Bolton advocates for specialist secondary care physical health clinics to ensure appropriate follow-up and to optimise communication with primary care. We are concerned that within the current economic climate, additional resources will not be made available for service development to address these needs. There is a remaining onus on mental health services to engage proactively and creatively within existing primary and secondary care services and in targeting early non-pharmacological intervention, for which there is an increasing evidence base. ³