Screen to Intervene; establishing a dedicated metabolic clinic for patients with chronic mental illness in an Irish Metal Health Service

Abstract

Introduction People with serious mental illness exhibit higher morbidity and mortality rates of chronic diseases than the general population. Objectives The aim of this study was to establish a dedicated clinic for patients with chronic mental illness to monitor physical health in accordance with best practice guidelines. Methods Patients were invited to attend the metabolic clinic. The following areas were examined: Personal and family history of cardiovascular disease, diet, exercise, smoking. Mental state examination, waist circumference, BP, pulse, ECG and BMI. Laboratory tests including U+E, LFTs, HbA1c, Lipid profile and other tests as appropriate such as serum lithium. AIMS scale, HoNOS and WHOQOL-BREF scales as additional indicators of global health. Results A total of 80 patients attended during 3.5 years of clinic. Mean age was 54.9 years (SD:13.81) at first contact and 45% were females. Mean years in the service was 19.66 (SD:11.54) and mean number of previous hospital admissions was 4.4 (SD:5.63). Metabolic syndrome was present in 42% at first assessment and 20% had at least one new physical abnormality identified during the clinic. A statistically significant difference was found for the psychological domain of the WHOQOL-BREF and the HoNOs particularly at third assessment. (β=4.64, Wald x2=7.38, df:1, p=0.007, CI:1.3-8.1, β =-.889, Wald x2=4.08, df:1, p=0.043, CI: -1.752 to-.026) respectively. Conclusions The results show a high prevalence of physical health conditions in this cohort, some of which represent a new diagnosis. This implicates better allocation of existing resources for screening and early detection, and potential to run joint clinics with primary care. Disclosure No significant relationships.

Keywords

• Metabolic
• chronic mental illness
• physical health