Schizoaffective disorder

Several neurologic, metabolic, sexual, endocrinologic, sedative, and cardiovascular adverse effects have been associated with the available antipsychotic medications. Patients with psychotic disorders, including schizoaffective disorder, are at higher risk for weight gain and metabolic syndrome. As such, routine monitoring of body mass index, blood glucose, and lipid panel are recommended. Baseline measures should be obtained before starting new medications.

In the UK, guidelines from the National Institute for Health and Care Excellence recommend that before children and young people ages 10 to 18 years are started on antipsychotic medication, they should have the following measurements: weight and height (which should be plotted on a growth chart); waist and hip circumference; pulse and blood pressure; fasting glucose and hemoglobin A1c (HbA1c); lipid profile; and prolactin level. They should also be assessed for any movement disorders, and have their nutritional status and level of physical activity evaluated.[79]National Institute for Health and Care Excellence. Psychosis and schizophrenia in children and young people: recognition and management. October 2016 [internet publication]. https://www.nice.org.uk/guidance/cg155

The clinician should also routinely assess for clinical symptoms of diabetes and, if clinically indicated, monitor fasting glucose and HbA1c levels to screen for emerging diabetes. In addition, medication-specific monitoring requirements might be recommended based on the individual risk profile of the different medications. For patients taking clozapine, baseline and follow-up regular white blood cell monitoring is required to screen for agranulocytosis. The schedule is every week for the first 6 months and every 2 weeks indefinitely after that.