Monitoring
Acute psychotic episodes often require hospitalisation. On discharge from hospital, patients with schizophrenia should have a follow-up appointment with a psychiatrist within 2 weeks. A crisis management plan involving the patient’s family/personal support network and community mental health services is recommended. Patients require regular long-term review and effective case management.
Schizophrenia is associated with an increased frequency of medical illnesses. It is also associated with a reduced life span of around 14.5 years compared with the general population, with an average reduction of 15.9 years for men and 13.6 years for women.[116] Although the net effect of treatment with antipsychotics appears to be a reduction in long-term mortality, managing the adverse effects of medications used to treat schizophrenia is crucial, as many of these further increase the risk of physical illness.[211] Monitor patients taking an antipsychotic for:[1]
Side effects of treatment and impact on functioning. Use a formal rating scale such as the Glasgow Antipsychotic Side Effect Scale.[122] Glasgow Antipsychotic Side-effect Scale Opens in new window
Signs of extrapyramidal movement disorders with antipsychotic medications. Use a formal rating scale such as the Abnormal Involuntary Movement Scale. Abnormal Involuntary Movement Scale Opens in new window
Weight; weekly for the first 6 weeks, then at 12 weeks, at 1 year, and then annually (plotted on a chart).
Waist circumference, annually.
Pulse and blood pressure at 12 weeks, at 1 year, and then annually.
Fasting blood glucose, HbA1c, and blood lipid levels at 12 weeks, at 1 year, and then annually.
Prolactin, as clinically indicated.[2]
ECG, as clinically indicated.[2]
Overall physical health, including smoking, exercise, and diet.
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