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Beware of PHATS in metabolic syndrome

Vol. 5, No. 4 / April 2006

Making time to monitor all five risk factors for metabolic syndrome can be challenging in a busy psychiatric setting. But with higher prevalence in persons with psychiatric disorders and/or taking psychotropics,1 this precursor for type 2 diabetes and cardiovascular disease demands your attention.2 The mnemonic PHATS can help you monitor metabolic syndrome risk factors thoroughly and quickly (Table).

Based on National Cholesterol Education Program (NCEP) criteria,3 patients with three of five PHATS elements have metabolic syndrome. A recent study of patients taking atypical antipsychotics suggests that abdominal obesity and elevated fasting blood glucose might be the most accurate and cost-effective indicators; combining these two factors correctly identified 100% of patients with metabolic syndrome.4 Until additional studies can confirm this finding, use NCEP guidelines—the basis for PHATS.

You can easily monitor for metabolic syndrome with a blood pressure cuff, a tape measure, and periodic blood glucose and lipid profiles. An extra minute or two can help prevent metabolic complications in at-risk patients.


PHATS: 3 of 5 positive criteria indicate metabolic syndrome


>130/85 mm Hg

HDL cholesterol

<40 mg/dL in men

<50 mg/dL in women

Abdominal obesity

Waist circumference

>102 cm in men

>88 cm in women


≥150 mg/dL


Fasting blood glucose

≥110 mg/dL

1. Casey DE. Dyslipidemia and atypical antipsychotic drugs. J Clin Psychiatry 2004;65(suppl 18):27-35.

2. Gracious BL, Meyer AE. Psychotropic-induced weight gain and potential pharmacologic strategies. Psychiatry 2005;2:36-42.

3. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. JAMA 2001;285:2486-97.

4. Straker D, Correll CU, Kramer-Ginsberg E, et al. Cost-effective screening for the metabolic syndrome in patients treated with second-generation antipsychotic medications. Am J Psychiatry 2005;162(6):1217-20.

Dr. Grove, a psychiatrist, practices in Scottsdale, AZ.

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