The Lester Positive Cardiometabolic Health Resource
(CMH-resource) - Further information
This clinical resource provides a simple framework for
identifying and treating cardiovascular and type 2 diabetes risks
in patients with psychosis receiving antipsychotic medication,
which supports collaborative practice across professional
disciplines and service settings.
The updated 2014 version was co-produced by NHS England, NHS
Improving Quality, Public Health England and the National Audit of
Schizophrenia team to support the 2014 physical health
CQUIN. This resource has now been endorsed by the
National Institute for Health and Care Excellence (NICE, November
The development was facilitated by the National Audit of
Schizophrenia (NAS) an initiative led by the Royal College of
Psychiatrists’ Centre for Quality Improvement, commissioned by
the Healthcare Quality Improvement Partnership (HQIP) as part of
the National Clinical Audit and Patients Outcomes Programme
(NCAPOP) and involving a close collaboration with the Royal
College of General Practitioners (RCGP) and the Royal College of
The RCGP Clinical Innovation and Research Centre worked the NAS
project team to produce the 2012 version of the clinical resource
for the United Kingdom (UK), adapted from work by Australian
colleagues (Curtis et al, 2012). This resource provides a
simple collaborative framework for identifying and treating
cardiovascular and type 2 diabetes risks in any service setting.
The resource was adapted for UK use initially through a consensus
group led on behalf of the RCGP by Professor Helen Lester and has
now been fully endorsed by the RCGP, Royal College of
Psychiatrists, Royal College of Nursing, Royal College of
Physicians, HQIP (NCAPOP), Rethink Mental Illness and Diabetes
Lead Authors on the UK adaptation (2014
Dr David Shiers: Retired GP
North Staffordshire and Clinical advisor to NAS
Dr Imran Rafi: GP in Surrey; Chair of RCGP
Clinical Innovation & Research Centre; Senior Lecturer in
Primary Care Education, St George’s University of London
Professor Stephen Cooper: Consultant
Psychiatrist and Clinical advisor NAS
Richard Holt: Honorary Consultant Physician
and Professor of Diabetes and Endocrinology, Southampton
Lead Authors on the UK adaptation (2012
Helen Lester, David Shiers, Imran Rafi, Steven
Cooper, Richard Holt.
To cite: Lester H,
Shiers DE, Rafi I, Cooper SJ, Holt RIG. (2012) Positive
Cardiometabolic Health Resource: an intervention framework for
patients with psychosis on antipsychotic medication. Royal
College of Psychiatrists. London.
Expert contributions and review
Particular thanks to: Salima Adatia, Thomas
Barnes, Mike Crawford, Ahmet Fuat, Roger Gadsby, Fiona
Gaughran, Ellie Gordon, Kathryn Griffiths,
Ian Hulatt, Kamlesh Khunti, Ian Maidment, Carol Paton, Maxine
Patel, David Taylor, Jogin Thakore, Andre Tylee, David Yeomans.
This resource was inspired by the HETI
Cardiometabolic Health Algorithm in Sydney, New South
Wales led by Dr Jackie Curtis, Consultant Psychiatrist,
Professor Katherine Samaras, Professor of Endocrinology, and
Dr Hannah Newall, Psychiatrist, to whom we offer very warm thanks
for their ongoing involvement and support in developing this UK
adaptation of their original work.
References and useful resources
Alberti K, Zimmet P, Shaw J. The metabolic syndrome - a new
worldwide definition. Lancet. 2005; 366: 1059-62.
Curtis, J., Newall H.
& Samaras, K. (2012) The heart of the matter: cardiometabolic
care in youth with psychosis. Early Intervention in
De Hert M, Dekker JM, Wood D, et al. Cardiovascular disease and
diabetes in people with severe mental illness position statement
from the European Psychiatric Association (EPA), supported by the
European Association for the Study of Diabetes (EASD) and the
European Society of Cardiology (ESC). European Psychiatry.
2009; 24: 412-24.
Holt RIG. (2012) Cardiovascular disease and diabetes in people with
severe mental illness: causes, consequences and pragmatic
management PCCJ Practice Review.
Maudsley Prescribing Guidelines in Psychiatry, 11th Edition (2012),
Eds Taylor D, Paton C, Kapur S, ISBN: 978-0-470-97948-8
Mitchell AJ, Vancampfort D, De Herdt A, Yu W,
De Hert M. Is the Prevalence of Metabolic Syndrome and Metabolic
Abnormalities Increased in Early Schizophrenia? A Comparative
Meta-Analysis of First Episode, Untreated and Treated Patients.
Schizophrenia Bulletin Advance Access published August 27,
Schizophrenia Guidance CG 82 (Updated) 2009NICE guideline PH 38 ‘Preventing
type 2 diabetes: risk identification and interventions for
individuals at high risk’ (recommendation 19).
JW, Hennekens CH. Severe Mental Illness and Risk of Cardiovascular
Disease. JAMA. 2007; 298: 1794-6. MJA. 2009; 190:
Shiers D & Kendall T. (2012)Tackling
a scandal of premature mortality; time for a ‘hearts & minds’
approach. London School of Economics Health and Social Care