PS516 Unit 5 Antipsychotic Case Paper Example

Twenty Pounds in Four Months: A PS516 Unit 5 Paper Weighing Antipsychotic Options and Side Effects for a Young Adult With Schizophrenia

[Student Name]

Purdue University Global

PS516: Psychopharmacology

Unit 5 Antipsychotic Case Paper

[Instructor Name]

[Date]

The client, his family, the clinic and every detail of the case are composite and illustrative; the sources cited are real.

The Client

Marco, 24, works the overnight shift stacking pallets onto trailers at a freight warehouse near Walla Walla. Last spring he became convinced that coworkers were broadcasting his thoughts over the warehouse radio and began hearing a voice that commented on everything he did. After a short hospital stay he was diagnosed with schizophrenia and started on olanzapine. The voice is now quiet most days and he has returned to work. In four months, though, he has gained twenty pounds, sleeps eleven hours on days off and told me, "I'd rather hear the voice than look like this."

Home is a rented house he shares with his mother and his two teenage sisters. His mother called the clinic after finding his pills in the trash.

How Antipsychotics Work

Every antipsychotic on the market occupies dopamine D2 receptors at least partly, Stahl (2021) explains, and doing so in particular brain pathways is what turns down voices and false beliefs. Blocking D2 receptors in other pathways causes some of the side effects, such as movement problems and rises in prolactin. Most newer antipsychotics also act on serotonin and other receptors, and those actions shape their side effect profiles, including weight gain and sedation, which are linked in part to effects on histamine and serotonin receptors.

What the Evidence Says About Choice

Huhn et al. (2019) compared 32 oral antipsychotics in a network meta-analysis of 402 trials in adults with acute schizophrenia. Most drugs differed only modestly in how much they reduced overall symptoms, with clozapine showing the largest effect. Differences in side effects were much larger. Some drugs, including olanzapine, were associated with substantial weight gain, while others caused little; some were more sedating; and others carried higher risks of movement side effects or prolactin increases. The authors argued that because efficacy differences are small, choosing an antipsychotic should depend heavily on side effects and on what matters to the patient.

That conclusion fits Marco's situation exactly. Olanzapine is working on his symptoms, but its weight gain is the very side effect he cannot accept.

What the Evidence Says About Stopping

Leucht et al. (2012) gathered trials that took people whose schizophrenia had settled on medication and assigned some to keep taking it and others to a dummy pill. Over about a year, far fewer people relapsed on medication, roughly a quarter, than on placebo, roughly two-thirds. Those who stayed on medication were also less likely to be readmitted to the hospital.

The evidence says Marco's choice is not between the voice and the weight; it is between olanzapine and another antipsychotic that may cost him less.

What the Care Manager Can Do

I cannot change Marco's medication. I can make sure his concern reaches the prescriber quickly and in a form that leads to a decision, and I can help him stay safe until then.

First, I asked Marco whether he had stopped taking the pills. He had missed four nights. I explained that stopping suddenly raises the risk of relapse and asked him to keep taking them until he saw the nurse practitioner, and he agreed. I scheduled the visit for that week.

Second, I sent the nurse practitioner a note listing his weight gain, his sleep, the missed doses, his statement about the voice and his mother's report. I added that metabolic monitoring, including weight, waist size, blood sugar and lipids, is recommended for people taking antipsychotics, and asked whether his labs were due.

Third, at the visit, the nurse practitioner discussed switching to an antipsychotic with a lower risk of weight gain, explaining that a switch would be gradual and that symptoms would be watched closely. Marco agreed to a cross-taper over several weeks.

Supporting Adherence and Health

Medication is only one part of Marco's recovery. Our plan includes weekly check-ins during the switch to track the voice and sleep, a referral to the clinic's dietitian and a walking plan with his younger sister, who offered to go with him before his shifts. We also discussed what early warning signs of relapse look like for him, such as sleeping less, feeling watched at work or hearing the radio speak to him again, and agreed that he, his mother or I would call the nurse practitioner if any appeared.

His mother joined one session. Finding the pills in the trash had frightened her, and she had begun watching him take every dose. We talked about how to support him without supervising him, and she agreed to let him manage his own pill box while telling me or the nurse practitioner if she saw warning signs.

Measuring the Switch

A switch between antipsychotics carries its own risks, and the team needs a way to see early whether it is working. With the nurse practitioner, I set up a simple weekly record for the first two months: Marco's own rating of the voice from zero to ten, hours of sleep, weight and any new side effects, such as restlessness, stiffness or dizziness on standing. If the voice rises above four for two weeks in a row, or if he misses more than two doses, I contact the nurse practitioner that day. Weight and waist measurements are repeated at three months, along with blood sugar and lipid tests.

Ethical Points

Marco has the right to make decisions about his treatment, including refusing medication. Respecting that right means giving him accurate information about relapse risk and alternatives rather than only urging him to comply. It also means taking his concern about weight seriously, since side effects that feel unbearable are one of the main reasons people stop antipsychotics.

Limits

Network meta-analyses average results across many trials, and individual responses vary widely. Huhn and colleagues studied acute treatment over a few weeks in adults who had had several episodes, while Marco is in his first, and weight gain often develops over months. Leucht and colleagues' relapse figures come from trials that may not match Marco's circumstances.

Conclusion

Marco's case shows why side effects deserve as much attention as efficacy. Stahl explains how antipsychotics act on dopamine and other receptors, Huhn and colleagues show that drugs differ more in side effects than in effectiveness, and Leucht and colleagues show why stopping carries a high risk of relapse. The care manager's work was to keep Marco on medication safely while getting his concern to the prescriber, who offered a switch that might let him keep both his symptom control and his health.

References

Huhn, M., Nikolakopoulou, A., Schneider-Thoma, J., Krause, M., Samara, M., Peter, N., Arndt, T., Bäckers, L., Rothe, P., Cipriani, A., Davis, J., Salanti, G., & Leucht, S. (2019). Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: A systematic review and network meta-analysis. The Lancet, 394(10202), 939-951. https://doi.org/10.1016/S0140-6736(19)31135-3

Leucht, S., Tardy, M., Komossa, K., Heres, S., Kissling, W., Salanti, G., & Davis, J. M. (2012). Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: A systematic review and meta-analysis. The Lancet, 379(9831), 2063-2071. https://doi.org/10.1016/S0140-6736(12)60239-6

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.