‘Flattened, fattened, and forgotten’: the ‘dis-integrated’ care of patients prescribed antipsychotics in the UK

Rising antipsychotic burden in primary careThere is a growing problem with antipsychotic prescribing, that if the NHS is not careful, could become a new scandal in the making.Illnesses that require treatment with antipsychotics have increased risks for development of multimorbidity, polypharmacy, and premature mortality.1 These medications -originally reserved for treatment of serious mental illnesses (SMIs), such as schizophrenia and bipolar affective disorder -can be lifesaving or transformative, and we value their appropriate clinical use.This editorial is not 'anti-psychiatry'; nor do we advise patients to stop taking antipsychotics without expert review.However, antipsychotics cause weight gain, glucose dysregulation, and dyslipidaemia; these exacerbate the SMI-patient specific risks for obesity, diabetes, and cardiovascular disease, which contribute towards premature death around 10-20 years earlier than their peers.2 People prescribed antipsychotics require proactive physical health monitoring, coordinated care, and early, sustained interventions to minimise risks.Central to these interventions are rational prescribing, lowering doses, or switching antipsychotics to those with lower cardiometabolic risk when possible.Sadly, the fracturing of NHS services is failing to address this need, often leaving patients 'flattened, fattened, and forgotten', as was poignantly summarised by Carolyn A Chew-Graham and colleagues, including the lived experience of GP David Shiers as the father of a patient. 1 'Flattened, fattened, and forgotten': the 'dis-integrated' care of patients prescribed antipsychotics in the UK