Lipophilic vs. hydrophilic statins and psychiatric hospitalizations and emergency room visits in US Veterans with schizophrenia and bipolar disorder.

OBJECTIVE ­: Psychiatric hospitalizations and emergency department (ED) visits are costly, stigmatizing, and often ineffective. Given the immune and kynurenine activation in bipolar disorder (BD) and schizophrenia, as well as the immune-modulatory effects of statins, we aimed to compare the relative risk (RRs) of psychiatric hospitalizations and ED visits between individuals prescribed lipophilic vs. hydrophilic statins vs. no statins. We hypothesized (a) reduced rates of hospitalization and ER utilization with statins versus no statins and (b) differences in outcomes between statins, as lipophilia increases the capability to penetrate the blood-brain barrier with potentially beneficial neuroimmune, antioxidant, neuroprotective, neurotrophic, and endothelial stabilizing effects, and, in contrast, potentially detrimental decreases in brain cholesterol concentrations leading to serotoninergic dysfunction, changes in membrane lipid composition, thus affecting ion channels and receptors. METHODS ­: We used VA service utilization data from October 1, 2010 to September 30, 2015. The RRs for psychiatric hospitalization and ED visits, were estimated using robust Poisson regression analyses. The number of individuals analyzed was 683,129. RESULTS ­: Individuals with schizophrenia and BD who received prescriptions for either lipophilic or hydrophilic statins had a lower RR of psychiatric hospitalization or ED visits relative to nonstatin controls. Hydrophilic statins were significantly associated with lower RRs of psychiatric hospitalization but not of ED visits, compared to lipophilic statins. CONCLUSION ­: The reduction in psychiatric hospitalizations in statin users (vs. nonusers) should be interpreted cautiously, as it carries a high risk of confounding by indication. While the lower RR of psychiatric hospitalizations in hydrophilic statins relative to the lipophilic statins is relatively bias free, the finding bears replication in a specifically designed study. If replicated, important clinical implications for personalizing statin treatment in patients with mental illness, investigating add-on statins for improved therapeutic control, and mechanistic exploration for identifying new treatment targets are natural next steps.

A Randomized Controlled Trial of a Patient-Centered Approach to Improve Screening for the Metabolic Side Effects of Antipsychotic Medications.

Adherence to recommendations for monitoring of metabolic side effects of antipsychotic medications has been historically low. This randomized controlled trial tested whether a computerized, patient-centered intervention that educated Veterans with serious mental illness about these side effects and encouraged them to advocate for receipt of monitoring would increase rates of monitoring compared to enhanced treatment as usual. The mean proportion of days adherent to monitoring guidelines over the 1-year study was similarly high and did not differ between the intervention (range 0.81-0.98) and comparison (range 0.76-0.96) groups. Many individuals in both groups had persistent abnormal metabolic parameter values despite high rates of monitoring, contact with medical providers, and receipt of cardiometabolic medications. Participants exposed to the intervention were interested in receiving personalized information about their cardiometabolic status, demonstrating the preliminary feasibility of brief interventions for enhancing involvement of individuals with serious mental illness in health care decision making.

Access to and Use of the Internet by Veterans with Serious Mental Illness.

This study evaluated internet use among 239 veterans with serious mental illness who completed questionnaires assessing demographics and internet use in 2010-2011. The majority of individuals (70 %) reported having accessed the internet and among those, 79 % had accessed it within the previous 30 days. Those who were younger and more educated were more likely to have accessed the internet, as were those with a schizophrenia spectrum disorder, bipolar disorder, or major depressive disorder, compared to individuals with PTSD. Veterans with serious mental illness commonly use the internet, including to obtain health information, though use varies across demographic characteristics and clinical diagnosis.

Evaluation of brief screens for gambling disorder in the substance use treatment setting.

BACKGROUND AND OBJECTIVES: The goal of this study was to determine the diagnostic accuracy of brief screens for Gambling Disorder within a sample of people receiving outpatient treatment for substance use disorders. METHODS: Individuals (n = 300) recruited from intensive outpatient substance use treatment (23.67%) or methadone maintenance programs (76.34%) participated in the study. Four brief screens for Gambling Disorder were administered and compared to DSM-5 criteria. Receiver operator curves were created and an Area Under the Curve (AUC) analysis (an overall summary of the utility of the scale to correctly identify Gambling Disorder) was assessed for each. RESULTS: On average participants were aged 46.4 years (SD = 10.2), African American/Black (70.7%), with an income less than $20,000/year (89.5%). Half the participants were female. Approximately 40% of participants (40.5%; n = 121) met DSM-5 criteria for Gambling Disorder. Accuracy of the brief screens as measured by hit rate were .88 for the BBGS, .77 for the Lie/Bet, .75 for NODS-PERC, and .73 for the NODS-CLiP. AUC analysis revealed that the NODS-PERC (AUC: .93 (95% CI: .91-.96)) and NODS-CLiP (AUC: .90 (95% CI: .86-.93)) had excellent accuracy. DISCUSSION AND CONCLUSIONS: The NODS-PERC and NODS-CLiP had excellent accuracy at all cut-off points. However, the BBGS appeared to have the best accuracy at its specified cut-off point. SCIENTIFIC SIGNIFICANCE: Commonly used brief screens for Gambling Disorder appear to be associated with good diagnostic accuracy when used in substance use treatment settings. The choice of which brief screen to use may best be decided by the needs of the clinical setting.

The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study.

The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their child's recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on "family-centered" care in this study is strongly supported by the active role of consumers in study design and implementation.

Outcomes of a Family Peer Education Program for Families of Youth and Adults with Mental Illness.

Family members of consumers with mental illness often play important roles in initiating and supporting treatment. Self-help programs such as the National Alliance on Mental Illness (NAMI) Family-to-Family Education Program (FTF) have been shown to provide a variety of benefits for family members. Despite recognizing the benefits of FTF, little is known about who may benefit most, and in what ways they might benefit. One group of interest is family members of younger consumers, a group shown to report more negative caregiving experiences and more depression and anxiety than caregivers of older consumers. The current study assesses whether relatives of youth (ages 8-18) differ in their response to FTF as opposed to relatives of adults (19 years and older). Results suggest that all members benefit from FTF. Family members of youth in FTF, however, reported gains more pronounced on their depressive symptoms, and negative perceptions and experiences, relative to family members of adults. The importance of peer support programs is discussed, as well as the specific usefulness of these programs to effectively address concerns of relatives of youth with serious mental health concerns.

Race-related differences in the experiences of family members of persons with mental illness participating in the NAMI Family to Family Education Program.

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families' caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.

A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness.

Inadequate self-management of chronic medical conditions like Type 2 diabetes may play a role in the poor health status of individuals with serious mental illnesses. We compared adherence to hypoglycemic medications and blood glucose control between 44 diabetes patients with a serious mental illness and 30 patients without a psychiatric illness. The two groups did not differ in their ability to manage a complex medication regimen as assessed by a performance-based measure of medication management capacity. However, significantly fewer patients with a mental illness self-reported nonadherence to their hypoglycemic regimens compared to those without a mental illness. Although individuals with mental illnesses also had better control of blood glucose, this metabolic parameter was not correlated with adherence to hypoglycemic medications in either patient group. The experience of managing a chronic mental illness may confer advantages to individuals with serious mental illnesses in the self-care of co-occurring medical conditions like Type 2 diabetes.

Differences in Antipsychotic Treatment Discontinuation Among Veterans With Schizophrenia in the U.S. Department of Veterans Affairs.

OBJECTIVE: Effectiveness of antipsychotic drugs is inferred from relatively small randomized clinical trials conducted with carefully selected and monitored participants. This evidence is not necessarily generalizable to individuals treated in daily clinical practice. The authors compared the clinical effectiveness between all oral and long-acting injectable (LAI) antipsychotic medications used in the treatment of schizophrenia in the U.S. Department of Veterans Affairs (VA) health care system. METHODS: This was an observational study utilizing VA pharmacy data from 37,368 outpatient veterans with schizophrenia. Outcome measures were all-cause antipsychotic discontinuation and psychiatric hospitalizations. Oral olanzapine was used as the reference group. RESULTS: In multivariable analysis, clozapine (hazard ratio=0.43), aripiprazole long-acting injectable (LAI) (hazard ratio=0.71), paliperidone LAI (hazard ratio=0.76), antipsychotic polypharmacy (hazard ratio=0.77), and risperidone LAI (hazard ratio=0.91) were associated with reduced hazard of discontinuation compared with oral olanzapine. Oral first-generation antipsychotics (hazard ratio=1.16), oral risperidone (hazard ratio=1.15), oral aripiprazole (hazard ratio=1.14), oral ziprasidone (hazard ratio=1.13), and oral quetiapine (hazard ratio=1.11) were significantly associated with an increased risk of discontinuation compared with oral olanzapine. No treatment showed reduced risk of psychiatric hospitalization compared with oral olanzapine; quetiapine was associated with a 36% worse outcome in terms of hospitalizations compared with olanzapine. CONCLUSIONS: In a national sample of veterans with schizophrenia, those treated with clozapine, two of the LAI second-generation antipsychotics, and antipsychotic polypharmacy continued the same antipsychotic therapy for a longer period of time compared with the reference drug. This may reflect greater overall acceptability of these medications in clinical practice.

Development and Feasibility Testing of a Smartphone Intervention to Improve Adherence to Antipsychotic Medications.

Approximately 60% of individuals with schizophrenia do not take their antipsychotic medications as prescribed, and nonadherence is associated with exacerbation of psychotic symptoms, increased hospital and emergency room use, and increased healthcare costs. Behavioral-tailoring strategies that incorporate medication taking into the daily routine and use environmental supports have shown promise as adherence-enhancing interventions. Informed by the Information-Motivation-Behavioral (IMB) Skills Model and using the iterative process of user-centered design, we collaborated with individuals with schizophrenia and psychiatrists to develop an interactive smartphone application and web-based clinician interface, MedActive, for improving adherence to oral antipsychotic treatment. MedActive facilitates the active involvement of individuals with schizophrenia in managing their antipsychotic medication regimen by providing automated reminders for medication administration and tailored motivational feedback to encourage adherence, and by displaying user-friendly results of daily ecological momentary assessments (EMAs) of medication adherence, positive psychotic symptoms, and medication side effects for individuals and their psychiatrists. In a 2-week open trial completed by 7 individuals with schizophrenia and their psychiatrists, MedActive was determined to be both feasible and acceptable, with patient participants responding to 80% of all scheduled EMAs and providing positive evaluations of their use of the application. Psychiatrist participants were interested in viewing the information provided on the MedActive clinician interface, but cited practical barriers to regularly accessing it and integrating into their daily practice.

Use of medications to reduce cardiovascular risk among individuals with psychotic disorders and Type 2 diabetes.

OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death in patients with serious mental illness (SMI) and in patients with Type 2 diabetes. Inadequate pharmacologic care for CVD may partially explain poor health outcomes in individuals with both conditions. We sought to identify patients in this group at greatest risk for suboptimal pharmacologic management. METHODS: Among individuals with Type 2 diabetes and SMI identified from Maryland Medicaid data, we evaluated patient and service utilization factors associated with the prescription of HMG-CoA reductase inhibitors ("statins") for hyperlipidemia and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for chronic kidney disease, congestive heart failure, and hypertension. RESULTS: From 2001 to 2003, the annual prevalence of use of statins and ACE-inhibitors/ARBs ranged from 44 to 59%, with rates increasing each year. Being female, having certain cardiovascular conditions, and having a greater number of outpatient visits for diabetes increased the odds of receiving statins and ACE-inhibitors/ARBs. More frequent contact with the mental health system was associated with a lower likelihood of receipt of both medication classes; having a substance use disorder was associated with reduced use of statins. African-Americans were less likely than Caucasians to receive statins, but more likely to receive prescriptions for ACE-inhibitors/ARBs. CONCLUSIONS: Although the use of cardioprotective medications in individuals with Type 2 diabetes and SMI increased over the study period, a considerable proportion of patients remained inadequately managed despite their considerable cardiac risk. Further study should focus on observed racial variations and strategies to increase the capacity of mental health contacts to improve prescribing of these agents.

Physical wellness and employment status among adults with serious mental illness.

This study examined whether concurrent medical status contributes to employment outcomes among those with psychiatric disabilities. Thirty-five percent (n = 70) of the 200 participants reported being currently employed. Sixty-three percent (n = 127) reported one or more co-occurring medical conditions; thirty-six percent (n = 71) reported two or more, and twenty-one percent (n = 41) reported three or more co-occurring medical conditions. Individuals with higher self-ratings of physical health functioning were more likely to be employed. Neither the number of co-occurring medical conditions nor any specific medical condition was related to employment status. Recommendations to enhance existing models of supported employment programs with physical health and wellness promotion components are offered.

Quality of diabetes care among adults with serious mental illness.

OBJECTIVE: The study compared the quality of care for type 2 diabetes delivered to two groups with type 2 diabetes--adults with serious mental illness and those with no serious mental illness--in a range of community-based clinic settings. METHODS: Cross-sectional analyses of medical chart data from 300 patients (201 with serious mental illness and 99 without serious mental illness) were used to examine indicators of the quality of care established by the Diabetes Quality Improvement Project. Recommended services assessed included glycosylated hemoglobin examination, eye and foot examinations, blood pressure check, and urine and lipid profiles. Self-report data were used to compare receipt of provider-delivered diabetes education and receipt of cues regarding self-management of diabetes for the two study groups. RESULTS: Evidence of lower quality of diabetes care was found for persons with serious mental illness as reflected by their receipt of fewer recommended services and less education about diabetes, compared with those without serious mental illness. Although participants with serious mental illness were less likely to receive cues from providers regarding the need for glucose self-monitoring, they were as likely as those without serious mental illness to receive cues regarding diet and medication adherence. CONCLUSIONS: Although participants with serious mental illness received some services that are indicated in quality-of-care standards for diabetes, they were less likely to receive the full complement of recommended services and care support, suggesting that more effort may be required to provide optimal diabetes care to these vulnerable patients.

Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: a systematic review and meta-analysis.

Depressed mood is highly prevalent among HIV-infected individuals. Some but not all studies have found group psychotherapy to be efficacious in this population. We performed a systematic review and meta-analysis of double-blinded, randomized controlled trials to examine efficacy of group psychotherapy treatment among HIV infected with depressive symptoms. We used PubMed, the Cochrane database, and a search of bibliographies to find controlled clinical trials with random assignment to group psychotherapy or control condition among HIV infected patients with depressive symptoms. The principal measure of effect size was the standard difference between means on validated depression inventories. We identified 8 studies that included 665 subjects: 5 used cognitive behavioral therapy (CBT), 2 used supportive therapy, and 1 used coping effectiveness training. Three of the 8 studies reported significant effects. The pooled effect size from the random effects model was 0.38 (95% confidence interval [CI]: 0.23-0.53) representing a moderate effect. Heterogeneity of effect was not found to be significant (p = 0.69; I(2) = 0%). Studies reporting use of group CBT had a pooled effect size from the random effects model of 0.37 (95% CI: 0.18-0.56) and was significant. Studies reporting the use of group supportive psychotherapy had a pooled effect size from the random effects model 0.58 (95% CI: -0.05-1.22) and was nonsignificant. The results of this study suggest that group psychotherapy is efficacious in reducing depressive symptoms among, HIV-infected individuals. Of note, women were nearly absent from all studies. Future studies should be directed at addressing this disparity.

Trends in Prevalence of Diagnosed Ocular Disease and Utilization of Eye Care Services in American Veterans.

PURPOSE: To assess trends in prevalence of diagnosed ocular disease and use of eye care services in the Veterans Affairs (VA) health care system. DESIGN: Prevalence study. METHODS: We performed a retrospective study of all eligible veterans in the VA Capitol Health Care Network from 2007 to 2011. The VA database was used to abstract demographic and socioeconomic variables, including age, race, sex, marital status, service connection, prescription copay, homelessness, and VA facility. Primary outcome measures were the prevalence of diagnosed ocular disease and use of eye care. Ocular diagnoses were determined by International Classification of Diseases, 9th revision codes and use by prescription medication fills, visits to eye care clinics, and cataract surgery frequency. RESULTS: The average age of veterans ranged from 59.8-60.9, most veterans were male (88.1-89.8%), and there was a high proportion of African Americans (29.5-30%). The prevalence of all ocular diagnoses increased from 20.5% in 2007 to 23.3% in 2011 (P < .01), a 13.7% increase. Similarly, the prevalence of diagnosed cataract increased by 35.7% (P = .02) from 7.1% in 2007 to 9.6% in 2011. Diagnosed glaucoma prevalence increased by 9.4% (P = .03) from 6.7 to 7.4%. The percent of patients seen in eye clinics increased 11.6%% in the 5-year study period to 24.0% in fiscal year 2011 (P = .05). The use of ophthalmic medications increased 20% (P < .01). The rate of cataract surgery did not change significantly during the study period. CONCLUSIONS: The prevalence of diagnosed eye conditions among American Veterans is increasing, as is the use of eye care services. Cataract surgery rates did not increase, which may indicate a need to increase availability of these services.

Working memory deficits in adults with ADHD: is there evidence for subtype differences?

BACKGROUND: Working memory performance is important for maintaining functioning in cognitive, academic and social activities. Previous research suggests there are prevalent working memory deficits in children with attention deficit hyperactivity disorder (ADHD). There is now a growing body of literature characterizing working memory functioning according to ADHD subtypes in children. The expression of working memory deficits in adults with ADHD and how they vary according to subtype, however, remains to be more fully documented. METHODS: This study assessed differences in working memory functioning between Normal Control (NC) adults (N = 18); patients with ADHD, Combined (ADHD-CT) Type ADHD (N = 17); and ADHD, Inattentive (ADHD-IA) Type (N = 16) using subtests from the Wechsler Adult Intelligence Scale-III and Wechsler Memory Scale-III and the Paced Auditory Serial Addition Task (PASAT). RESULTS: The ADHD groups displayed significant weaknesses in contrast to the NC group on working memory tests requiring rapid processing and active stimulus manipulation. This included the Letter-Number-Sequencing test of the Wechsler scales, PASAT omission errors and the longest sequence of consecutive correct answers on the PASAT. No overall ADHD group subtype differences emerged; however differences between the ADHD groups and the NC group varied depending on the measure and the gender of the participants. Gender differences in performance were evident on some measures of working memory, regardless of group, with males performing better than females. CONCLUSION: In general, the data support a dimensional interpretation of working memory deficits experienced by the ADHD-CT and ADHD-IA subtypes, rather than an absolute difference between subtypes. Future studies should test the effects of processing speed and load on subtype performance and how those variables interact with gender in adults with ADHD.

Religiosity, psychosocial adjustment, and subjective burden of persons who care for those with mental illness.

OBJECTIVE: The purpose of this study was to characterize the nature of religious and spiritual support received by family caregivers of persons with serious mental illness and to test hypotheses that religiosity would be associated with caregiver adjustment. METHODS: Eighty-three caregivers who participated in a study of the Family to Family Education Program of the National Alliance on Mental Illness were assessed at baseline in terms of their religiosity and receipt of spiritual support in coping. They also completed measures of depression, self-esteem, mastery, self-care, and subjective burden. Hierarchical regression was used to test hypotheses that religiosity would be associated with better adjustment, with confounding variables controlled for. RESULTS: Thirty-seven percent of participants reported that they had received spiritual support in coping with their relative's illness in the previous three months. When age, race, education, and gender were controlled for, religiosity was associated with less depression and better self-esteem and self-care. Personal religiosity was a stronger predictor of adjustment than religious service attendance. CONCLUSIONS: Family caregivers of persons with serious mental illness often turn to spirituality for support, and religiosity may be an important contributor to caregiver adjustment. Collaborative partnerships between mental health professionals and religious and spiritual communities represent a powerful and culturally sensitive resource for meeting the support needs of family members of persons with serious mental illness.

Use of emergency department services for somatic reasons by people with serious mental illness.

OBJECTIVE: This study identified factors associated with use of the emergency department for medical reasons among individuals with serious mental illness. METHODS: A total of 200 randomly selected outpatients who were receiving community-based psychiatric care were recruited for the study and interviewed with items from the National Health Interview Survey and other national health surveys. RESULTS: Emergency department use (37 percent of the sample) was negatively associated with older age and positively associated with the number of co-occurring medical conditions, smoking, recent injury, and recent change in health care provider. CONCLUSIONS: The relatively high rate of emergency department use may be suggestive of inappropriate use or may reflect perceived barriers to care. Future work should identify specific reasons for seeking care in the emergency department and develop interventions to optimize appropriate emergency department use.

Prevalence of diagnosed ocular disease in veterans with serious mental illness.

OBJECTIVE: To compare the prevalence of diagnosed ocular disease and eye disease treatment between Veteran's Administration (VA) patients with and without serious mental illness (SMI). METHODS: Retrospective comparison of diagnosed ocular disease and treatment prevalence among patients with and without diagnosed SMI in fiscal year 2011 in the VA Capitol Health Care System (VISN 5). RESULTS: We identified 6462 VA patients with SMI and 137,933 without SMI. The prevalence of diagnosed ocular disease was 22.7% in SMI patients and 35.4% in non-SMI patients (P<.001). Those with SMI had a higher prevalence of glaucoma (10.2% vs. 7.1%, P<.0001), cataract (12.6% vs. 9.2%, P<.0001) and dry eye (4.0% vs. 2.7%, P<.0001). Less than half (34.3%) of SMI subjects had been seen in ophthalmology or optometry vs. 23.0% of controls (P<.0001). CONCLUSION: VA patients with SMI have a greater prevalence of diagnosed ocular disease, particularly cataract, glaucoma and dry eye. While SMI patients utilize eye care services at a higher rate than the general VA population, the majority of subjects with SMI do not get recommended annual eye examinations. More consistent annual ocular screening among VA patients with SMI may be indicated.

The RAISE Connection Program: Psychopharmacological Treatment of People With a First Episode of Schizophrenia.

OBJECTIVE: This study examined the adherence of psychiatrists to the Schedule of Recommended First and Second Line Antipsychotic Medications ("Antipsychotic Schedule"), which was implemented in two Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program Implementation and Evaluation Study clinics. METHODS: Sixty-five individuals with a first episode of psychosis were enrolled in the RAISE Connection Program clinics. Two psychiatrists received training and ongoing consultation on use of a shared decision-making approach to prescribing antipsychotic medications according to the Antipsychotic Schedule. Information about participants, prescribed antipsychotic medications, and completion of side-effect assessments were obtained from standardized research assessments and chart extractions. Descriptive statistics were used to characterize the extent to which patterns of antipsychotic prescribing and side-effect monitoring were consistent with the Antipsychotic Schedule. RESULTS: Ninety-two percent of participants were prescribed an antipsychotic medication and received the medication on 76%±35% of the days they were in treatment. Seventy-seven percent of participants were prescribed at least one Antipsychotic Schedule first-line antipsychotic, 20% were prescribed olanzapine, and 10% received a trial of clozapine. Regarding monitoring for metabolic side effects, 92% of participants had at least one weight recorded, 72% had at least one blood glucose measure recorded, and 62% had at least one lipid profile recorded. CONCLUSIONS: In the context of a study in which training and ongoing clinical supervision by experts was provided to psychiatrists and shared decision making was encouraged, antipsychotic prescribing patterns closely adhered to recommendations established by the RAISE Connection Program.