Evaluation of Baseline Investigations for First-Contact Patients Receiving Psychotropic Treatment at a Tertiary Facility in South-West Nigeria: A Two-Year Clinical Audit

Introduction Baseline investigations are recommended before initiating psychotropic medications to identify pre-existing medical conditions and reduce treatment-related adverse effects. This audit assessed compliance with recommended baseline investigations among first-contact patients receiving psychotropic treatment at a tertiary hospital in South-West Nigeria. Materials and methods A retrospective clinical audit was conducted using electronic medical records (EMRs) of first-contact patients managed between January 2024 and December 2025. Audit standards were derived from the National Institute for Health and Care Excellence (NICE) and the Royal College of Psychiatrists (RCPsych) recommendations. Compliance was categorized as high (≥75%), moderate (50%-74%), or low (<50%). Data were analyzed using descriptive statistics, chi-square tests, independent-samples t-tests, and one-way analysis of variance (ANOVA). Results Of 345 first-contact patients reviewed, 262 (75.9%) received at least one psychotropic medication and were included in the audit. Substance use disorders (61, 23.28%) and depressive episodes (60, 22.90%) were the most common diagnoses. Compliance with weight/body mass index (BMI) assessment, vital signs, and movement disorder screening was 100%. Compliance with laboratory and cardiac investigations was substantially lower: electrolytes/urea/creatinine (E/U/Cr) (25.2%), full blood count (FBC) (22.5%), fasting glucose/glycated hemoglobin (HbA1c) (19.6%), electrocardiography (11.4%), liver function tests (LFTs) (8.8%), and fasting lipid profile (FLP) (7.1%). No patient completed baseline prolactin testing. Overall, 180 patients (68.7%) had low compliance. Inpatients demonstrated significantly higher compliance than outpatients (55.5% versus 34.8%; p < 0.001). Conclusions Compliance with recommended baseline investigations was suboptimal, particularly for laboratory and electrocardiogram (ECG) monitoring. Local monitoring protocols, improved access to investigations, and regular re-audit may improve adherence to recommended standards.