Review Question - QID 105806

Atypical antipsychotics such as olanzapine may be used to treat schizophrenia. Olanzapine has a lower incidence of extra-pyramidal symptoms (common to typical antipsychotics) but may cause significant weight gain, hyperglycemia, dyslipidemia, and hypertension.

Fasting glucose and lipids ought to be monitored every 12 weeks in patients taking atypical antipsychotics due to the increased risk of weight gain, hyperglycemia, dyslipidemia, and hypertension. Olanzapine may also be used to treat obsessive compulsive disorder, anxiety disorder, depression, mania, and Tourette's syndrome. Other antipsychotics include clozapine, quetiapine, risperidone, aripiprazole, and ziprasidone. Clozapine may also cause significant weight gain, and in contrast to olanzapine it may cause agranulocytosis (requiring weekly CBCs).

Almandil et al. describe weight gain and other metabolic adverse effects associated with atypical antipsychotic treatment of children and adolescents. In this meta-analysis, olanzapine, risperidone, and aripiprazole were all associated with statistically significant weight gain. Olanzapine was associated with the most weight gain and aripiprazole the least.

Schultz et al. review schizophrenia. The incidence of schizophrenia is 1%. It affects equal numbers of men and women, but the onset is often later in women than in men. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, voices that converse with or about the patient, and delusions that are often paranoid. Negative symptoms include flattened affect, loss of a sense of pleasure, loss of will or drive, and social withdrawal.

Illustration A shows a table of antipsychotics and their relationship to metabolic disturbances.

Incorrect Answers:
Answer 1: Haloperidol is an antipsychotic that may cause extrapyramidal side effects, endocrine side effects (such as hyperprolactinemia and galactorrhea), dry mouth, hypotension, and sedation but would be unlikely to cause the symptoms described in this vignette.
Answer 2: Trifluoperazine is a typical antipsychotic like haloperidol and would be expected to cause similar side effects.
Answer 4: The most common toxicities of lithium are tremor, sedation, edema, heart block, hypothyroidism, and polyuria (due to diabetes insipidus).
Answer 5: Fluoxetine, like other SSRIs may cause gastrointestinal distress and sexual dysfunction but would be unlikely to result in a metabolic syndrome.