• Document: June Results Case study 47: Antipsychotic drugs for schizophrenia
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Results Case study 47: Antipsychotic drugs for schizophrenia June 2007 NPS is an independent, non-profit organisation for Quality Use of Medicines, funded by the Australian Government Department of Health and Ageing. ABN 61 082 034 393 l Level 7/418A Elizabeth Street Surry Hills NSW 2010 l PO Box 1147 Strawberry Hills 2012 Phone: 02 8217 8700 l Fax: 02 9211 7578 l email: info@nps.org.au l web: www.nps.org.au NPSCS0427 Inside Case study 47: Antipsychotic drugs for schizophrenia Scenario and questions page 3 Summary of results page 4 Results in detail Continuing or switching olanzapine page 5 Managing adverse effects of olanzapine page 6 Alternative antipsychotic drugs page 7 Practice points page 9 Commentaries Professor David Castle page 11 Dr Richard J O’Bryan page 12 Appendix Common adverse effects of antipsychotic drugs at usual page 14 therapeutic doses References page 15 The information contained in this material is derived from a critical analysis of a wide range of authoritative evidence. Any treatment decision based on this information should be made in the context of the clinical circumstances of each patient. Declarations of interest have been sought from all commentators. 2 Case study 47 Antipsychotic drugs for schizophrenia Scenario Zac (25 years old) was diagnosed with paranoid schizophrenia several years ago. He has experienced three episodes of psychoses in the past three years, and was commenced on olanzapine 5 mg daily after the first episode. His last episode occurred eight months ago, during which Zac was preoccupied with thoughts that he was being spied on. He lost his job at the local supermarket, and relationships with family members broke down as he feared that they would betray him to the spies. Following this episode, his olanzapine dose was increased from 10 mg to 15 mg daily. Zac has not experienced any delusions since then, and now has a good understanding of his condition. He is currently maintained on 15 mg olanzapine daily to prevent another relapse. He maintains regular contact with his GP and the relationship with his family has improved. He has started working at the local fruit and vegetable shop. Zac presents today and states that he wants to stop his olanzapine because he has been symptom free, he is also very concerned and feeling a bit down about his weight gain (20 kg increase since commencing olanzapine, current body mass index 29 kg/m2). He also states that his mother insisted he tells you about her recent diagnosis of type 2 diabetes. Zac’s last fasting blood glucose concentration, measured 3 months ago, was 6.3 mmol/L (this was normal before he started olanzapine). He has no other medical conditions or allergies. 1. a) Given Zac’s concern, what would you recommend regarding his olanzapine? (please choose one response only) Continue olanzapine  Same dose Higher dose Lower dose Change olanzapine to another antipsychotic drug Stop olanzapine Other (please specify) b) Please give reason(s) for your recommendation. 2. Regardless of your decision in Question 1, if Zac were to continue taking olanzapine, what steps would you recommend to address the: a) weight gain? b) blood glucose concentration? 3. a) Regardless of your decision in Question 1, if Zac were to change from olanzapine to another antipsychotic drug, what would you choose? iDrugi iDosei iFrequencyi iRoutei b) What are the potential advantages of switching to the alternative antipsychotic drug you chose in part (a) compared to continuing with olanzapine as described in the case? c) What are the potential disadvanta

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