Antipsychotics and Weight Gain: the Lurasidone Pathway

Members of the Network from Tees, Esk and Wear Valleys NHS FT (TEWV), Northumberland, Tyne and Wear NHS FT (NTW) and Cumbria Partnership NHS FT (CPFT) have collaborated to produce an algorithm to address the fact that our mental health patients’ illnesses often predispose them to metabolic syndrome and increased cardiovascular risk. This risk, combined with lifestyle factors, predisposes them to increased mortality.

Medications can add greatly to this problem so the protocol is designed to encourage changed prescribing behaviour, in particular reducing the use of weight gaining medication like some very commonly prescribed oral antipsychotics.

The Northern Treatment Advisory Group (NTAG) have agreed with and supported the Network algorithm but have not agreed to individually approve the use of Lurasidone. Their recommendation is that the individual Trusts should approve and use the algorithm and prescribe under their named patient basis protocols. TEWV have already discussed and approved the algorithm for use and are circulating it through their trust-wide clinical networks. Other organisations are encouraged to do the same. While the pathway was jointly developed, it can be freely adjusted to match circumstances in each Trust as they see fit. Where there are further developments on various aspects of the algorithm we will communicate these in the future.

Download the Lurasidone Pathway

Update June 2017 from Dr Angus Bell, Clinical Lead for Mental Health

The Cardiovascular Network and the Mental Health Network have been meeting to discuss the management of metabolic syndrome in Mental Health patients. We have jointly supported the Weight Management Prescribing Algorithm which was developed by the Clinical Network with representation from the 3 provider Trusts in the North, referencing the BAP guidelines for the management of Metabolic Syndrome in Psychosis.  This now needs to be embedded into each Trust’s clinical pathways and systems.

As part of that we specifically note that mental health prescribing has moved increasingly towards medications that, whilst efficacious in terms of symptom control, all have increasing problems with weight gain.  We recommend that Trusts have a renewed focus on patient safety with a view to preventing the harms caused by weight gain and subsequent cardiovascular disease.  Antipsychotics that have a lower propensity to cause weight gain should be actively considered from the beginning if we intend to make a difference in reducing excess mortality from cardiovascular disease suffered by our patients.

We are aware of a pilot initiative in Gateshead supported by the British Heart Foundation called House of Care which seeks to prepare and empower patients to engage in holistic conversations with their clinicians in Primary Care to maximise cardiovascular health. We are hoping to develop an extension of this project for Mental Health patients to see if it delivers benefits in terms of reduced risk. We envision a future model of care where Mental Health professionals are both actively aware of cardiovascular risk and contribute to the holistic management of cardiovascular disease by our Primary Care and Acute Care colleagues.

More information on the House of Care work can be found on the Year of Care website.