What monitoring strategies should I implement for a patient with schizophrenia receiving antipsychotic treatment?

For a patient with schizophrenia receiving antipsychotic treatment, the following monitoring strategies should be implemented:

• Baseline assessments before starting treatment: Measure and record weight or BMI, pulse, blood pressure, fasting blood glucose or HbA1c, and blood lipid profile. Offer an electrocardiogram (ECG) if specified in the drug's summary of product characteristics (SPC), if there is cardiovascular risk, or if the patient is an inpatient ¹,⁶.
• Regular monitoring during dose titration and ongoing treatment: Monitor and record response to treatment including symptom changes and behaviour, side effects and their impact on functioning, emergence of movement disorders, and adherence ¹,⁶.
• Physical health monitoring schedule: Weight should be measured weekly for the first 6 weeks, then at 12 weeks, at 1 year, and annually thereafter, with results plotted on a chart. Waist circumference should be measured annually and plotted. Pulse and blood pressure should be checked at 12 weeks, 1 year, and annually. Fasting blood glucose or HbA1c and blood lipid levels should be measured at 12 weeks, 1 year, and annually ¹.
• Responsibility for monitoring: Secondary care teams should maintain responsibility for monitoring physical health and medication effects for at least the first 12 months or until the patient’s condition stabilises. After this, monitoring responsibility may be transferred to primary care under shared care arrangements ¹.
• Additional considerations: Discuss and record side effects the patient is willing to tolerate, and document rationale for medication changes. Monitor for overlapping side effects such as akathisia and agitation. Discuss use of alcohol, tobacco, and other substances as they may interfere with treatment ¹,⁶.