Cardiometabolic Treatment Gap in Routine Psychiatric Care: A Cross-Sectional Study of 1553 Patients

People with severe mental illness (SMI) have elevated cardiometabolic morbidity and mortality, with similar concerns increasingly reported in other psychiatric conditions including anxiety disorders and ADHD. Somatic conditions are often underdiagnosed and pharmacologically undermanaged in this population. We aimed to quantify the alignment between objectively measured cardiometabolic abnormalities and reported pharmacological treatments in a large transdiagnostic psychiatric cohort.

We conducted a monocentric cross-sectional observational study in a specialized psychiatric outpatient setting in France between 2018 and 2023. Adults (18-65 years) with schizophrenia, major depressive disorder, bipolar disorder, anxiety disorders, or attention-deficit and hyperactivity disorder were included. Standardized clinical and laboratory assessments captured blood pressure, fasting plasma glucose, lipid profile, waist circumference, metabolic syndrome, and HbA1c. Somatic medications (antihypertensives, statins, metformin) and self-reported hypertension/diabetes were recorded. The discordance between measured cardiometabolic abnormalities and reported pharmacological treatments was estimated using a bounding approach within the intersection of available data for each pair of variables.

Among 1553 patients (mean age 38.8 ± 14.2 years; 58.5% women), elevated blood pressure was present in 35.2% whereas 5.7% reported antihypertensive treatment. Hypercholesterolemia was observed in 50.5% while 2.5% reported statin use. High FPG (≥ 5.6 mmol/L) occurred in 12.6%, HbA1c ≥ 48 mmol/mol (≥ 6.5%) in 2.3%, and 1.8% reported metformin treatment. Abdominal obesity was observed in 59.8%, and metabolic syndrome in 20.9%. Applying a bounding approach within complete-case subsamples, between 29.5% and 35.3% of patients had elevated blood pressure without reporting antihypertensive treatment, between 47.9% and 50.7% had hypercholesterolemia without statins, and between 10.8% and 12.6% had high FPG without metformin.

In this large monocentric psychiatric cohort, cardiometabolic abnormalities were frequent yet poorly reflected in patient-reported pharmacological treatment. These findings highlight the need to better understand and address the gap between detection and treatment of cardiometabolic conditions in psychiatric care, and to ensure that abnormal findings translate into appropriate clinical follow-up.