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<h3>Background and Importance</h3> Antipsychotic medication alleviates symptoms of psychosis, support improvements in daily functioning, and reduces mortality risk in patients with psychotic disorders. The use of antipsychotic medication is hampered by side effects, including metabolic syndrome and life-threatening arrhythmias. According to clinical guidelines, physical health assessments including health history, electrocardiogram (ECG), body weight, blood pressure, and blood lipid measurements should be performed prior to start of antipsychotic medications to reveal cardiac and cardiovascular risk factors. While the available literature primarily focuses on laboratory monitoring, little is known about the extent to which review of patient’s medical and family history of diabetes and heart disease are reviewed, and whether ECGs are performed when recommended. <h3>Aim and Objectives</h3> The aim of the study was to investigate to what extent physical health assessements recommended by guidelines for treatment of psychosis were documented in patient records in mental health specialist services. <h3>Material and Methods</h3> In a cross-sectional study in 16 units in community mental health centres and hospitals treating patients with psychosis, adherence (fidelity) to guideline recommendations was assessed using four criteria from The Antipsychotic Medication Management Fidelity Scale. Two fidelity raters reviewed 10 randomly selected patient records in each unit (N=147 valid patient records) using a checklist. All the criteria were answered by dichotomous judgements (yes/no), indicating whether the specific criteria was fulfilled or not. <h3>Results</h3> Information about patients’ medical history and family history regarding diabetes and heart disease was documented in 7 (5%) of the 147 patient records. Recordings of blood pressure, weight and body mass index were documented in 18 (12%) and blood lipids in 36 (25%) patient records. Electrocardiogram (ECG), if recommended for the chosen medication or medical history indicated possible heart disease, was documented in 31 (21%) patient records. <h3>Conclusion and Relevance</h3> Our study showed that physical health assessments before the start of antipsychotic medications were frequently not documented in patient records, implying that the degree of adherence to national and international guideline recommendations is low. Systematic quality improvement efforts to increase the frequency of recommended systematic somatic assessments may reduce the risk of undesired medication side effects such as cardiac arrythmias and metabolic syndrome in patients with psychosis. <h3>Conflict of Interest</h3> No conflict of interest