CQAIMH - center for quality assessment and improvement in mental health


PREVIOUS MEASURE

Measure:

Bipolar Disorder: Screening for hyperlipidemia when atypical antipsychotic agent prescribed

Summary:

This measure assesses the percentage of patients diagnosed with bipolar disorder and treated with an atypical antipsychotic agent who received at least one assessment for hyperlipidemia within the initial 16 week period of treatment.

Clinical Rationale:

Dyslipidemia & Antipsychotic Medications

  • Body fat (BMI, but more specifically, visceral abdominal fat as evidenced in waist circumference) is a strong predictor of cardiovascular disease (1) 
  • Increased adiposity is associated with decreased insulin sensitivity and the initiation of insulin resistance syndrome (1,2)
  • Insulin resistance syndrome encompasses disturbances in lipid metabolism with a characteristic dyslipidemia that includes increases in fasting plasma triglyceride, and atherogenic changes in low-density lipoproteins (1)
  • Patients on antipsychotic treatment have been associated with increased risk for weight gain and metabolic dyslipidemia with elevations of triglyceride (2)

Monitoring of Lipid Regulation (3)

  • Six sets of metabolic monitoring guidelines for persons taking antipsychotic medications are currently recognized (Mount Sinai; Australia; American Diabetes Association-American Psychiatric Association; Belgium; United Kingdom)
  • Five groups unanimously recommend measuring fasting lipids with the United Kingdom group being silent on the issue
  • Adequate fasting is necessary to obtain a valid LDL and triglyceride levels.
  • Although baseline monitoring is indicated as soon as feasible, when it is possible, monitoring prior to antipsychotic treatment initiation is preferable as the results may influence antipsychotic choice, especially  when elevated risk factors are identified

Denominator Population:

Patients diagnosed with bipolar disorder and treated with an atypical antipsychotic agent

Data Sources:

  • Administrative data
  • Medical Record

Numerator Population:

Patients who are assessed for hyperlipidemia within 16 weeks after initiating treatment with an atypical antipsychotic agent

Data Source:

  • Medical Record

Initial Case-finding Guidance:

Patients with a diagnosis involving bipolar disorder
ICD9CM or DSM IV TR: 296.0x; 296.1x; 296.4x; 296.5x; 296.6x; 296.7; 296.80-82; 296.89; or 301.13

STABLE Resource Toolkit:

The STABLE National Coordinating Council has recommended metabolic monitoring when treating with antipsychotic agents.  The following documentation tool is available in the corresponding section of the STABLE Resource Toolkit.

  • Metabolic Monitoring Flow Sheet:  Brief documentation tool for office-based practice

References:

  1. Newcomer, JW, Medical Risk in Patients with Bipolar Disorder and Schizophrenia, J Clin Psychiatry 2006; 67 (suppl 9) 25-30
  2. Newcomer JW, Metabolic risk during antipsychotic treatment, Clin Ther. 2004 Dec; 26(12): 1936-46
  3. Cohn T, Sernyak M, Metabolic Monitoring for Patients Treated with Antipsychotic Medications, Can J Psychiatry, Vol 51, No 8, July 2006, 492-501

Copyright 2007 by the Center for Quality Assessment and Improvement in Mental Health