Guidance and performance of somatic management practices in patients with mental disorders

The life expectancy of patients with a mental disorder, both common and severe, is between 10-30 years shorter compared to the general population. Approximately 60% of this increased mortality risk is explained by increased risk of somatic comorbidities, which can originate from psychotropic drug-related adverse effects. Therefore, (inter)national clinical practice guidelines (CPGs) provide recommendations on which somatic parameters should be monitored among patients with mental disorders. However, adherence to CPGs’ monitoring recommendations is suboptimal in clinical practice. Next to monitoring of somatic parameters, another approach, based on pharmacogenetics, could focus on minimizing adverse effects. Here, a possible relationship is explored between the rate at which a psychotropic drug is broken down by the liver (drug metabolism rate) and the occurrence of adverse effects.
The aim of this dissertation was to explore somatic monitoring, its outcomes, and the management of psychotropic drug-related adverse effects, as well as to explore a potential relationship between the rate of drug metabolism and the occurrence of adverse effects.
We can conclude that CPGs often lack clarity about the exact roles and responsibilities in treating aberrant parameters values and barely present monitoring recommendations for older patient populations (>65 years). These findings could explain the found suboptimal somatic monitoring and treatment rates in patients with a mental disorder. Furthermore, both collaboration and communication between different healthcare professionals could be improved. Finally, there seem to be no relationship between the drug metabolism rate of psychotropic drugs and the occurrence of adverse effects in patients with a mental disorder.