A 28-year-old schizophrenic patient on olanzapine 20 mg/day develops polyuria, polydipsia, weight gain of 18 kg over 6 months, and a fasting blood glucose of 240 mg/dL. The antipsychotic most appropriate to switch to, offering minimal metabolic risk while maintaining antipsychotic efficacy, is:
- A Aripiprazole ✓
- B Quetiapine
- C Risperidone
- D Clozapine
Explanation
Among atypical antipsychotics, aripiprazole has the most favourable metabolic profile — it causes minimal or no weight gain, does not significantly affect fasting blood glucose, and has a neutral effect on lipid profiles. This is attributed to its partial D2 agonism and 5-HT2C antagonism (which reduces weight-promoting serotonergic signalling). Olanzapine and clozapine have the highest metabolic risks (weight gain, dyslipidaemia, new-onset diabetes). Quetiapine and risperidone have intermediate metabolic effects. When switching from a high-risk metabolic agent to aripiprazole, a cross-titration over 4–6 weeks is standard practice to avoid psychotic exacerbation.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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