- Design
- Retrospective single-centre review over 10 years
- Population
- 3,700 critical and drug-level alerts from about 6.42 million tests in a psychiatric hospital
- Primary outcome
- Distribution of critical and therapeutic drug monitoring alert values
- Effect
- Drug-level alerts 49.7%; WBC 15.9%, potassium 8.9%, venlafaxine 5.8%; geriatric psychiatry 33%
A retrospective review at a psychiatric hospital in Kunming, China, examined ten years of laboratory critical values and therapeutic drug monitoring alerts from 2016 to 2025, totalling 3,700 alerts among about 6.4 million tests.
Drug-concentration alerts made up 49.7% of the total. The commonest individual items were white cell count (15.9%), potassium (8.9%), myoglobin (7.1%), glucose (6.3%) and venlafaxine with its metabolite (5.8%). A third of alerts came from geriatric psychiatry, and about a fifth from outpatients.
This is a descriptive single-centre study, so it shows where problems cluster rather than why. The pattern is familiar to prescribers: leukopenia with clozapine and other psychotropics, low potassium and high glucose with antipsychotics and comorbid illness, and high antidepressant levels in older patients whose clearance is lower. The take-away is to concentrate monitoring on older inpatients and to interpret a high level in the light of age, interacting drugs and adherence.
- Concentrate psychotropic drug monitoring on older patients, who generated a third of alerts.
- Check white cell count, potassium and glucose in patients on antipsychotics, as these were frequent critical results.
- Consider reduced clearance, interacting drugs and adherence when a venlafaxine level is high.
- Act on a myoglobin alert by assessing for rhabdomyolysis and neuroleptic malignant syndrome.
Why it matters
It shows where psychotropic monitoring catches problems, and older patients carry a large share.
Don't overread it
This is a single-centre descriptive study; it does not show that monitoring improves outcomes.
The statistics, in plain English
The percentages describe the mix of alerts, not how often each problem occurs in patients, so they show where to look rather than individual risk.
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