When choosing an antipsychotic for a patient with schizophrenia and established metabolic syndrome, the agent associated with the LEAST weight gain and lowest diabetes risk among the following is:

• A Olanzapine
• B Clozapine
• C Risperidone
• D Haloperidol ✓

Explanation

Metabolic liability follows a rough hierarchy with clozapine and olanzapine worst, followed by quetiapine and risperidone, while typical agents such as haloperidol carry the least weight-gain and dyslipidaemia risk, though they have far higher extrapyramidal liability. In a patient with pre-existing metabolic disease, a high-potency typical agent or a metabolically neutral agent like aripiprazole or ziprasidone is preferred over olanzapine or clozapine.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.