A 32-year-old man comes to the office for follow-up a month after being hospitalized for treatment of a manic episode related to schizoaffective disorder. The patient has no other medical history. His mania has resolved and he appears calm. Although he continues to hear a voice narrating his daily activities, the voice has diminished in frequency and intensity. The patient is less anxious and his sleep has improved. Vitals signs are within normal limits. He is 175 cm (5 ft 9 in) tall and weighs 95.2 kg (210 lb); he has gained 4.5 kg (10 lb) since discharge. Physical examination shows no other abnormalities. Laboratory results are as follows: Which of the following medications is most likely to have caused this patient's physical examination and laboratory findings?

Question

A 32-year-old man comes to the office for follow-up a month after being hospitalized for treatment of a manic episode related to schizoaffective disorder.  The patient has no other medical history.  His mania has resolved and he appears calm.  Although he continues to hear a voice narrating his daily activities, the voice has diminished in frequency and intensity.  The patient is less anxious and his sleep has improved.  Vitals signs are within normal limits.  He is 175 cm (5 ft 9 in) tall and weighs 95.2 kg (210 lb); he has gained 4.5 kg (10 lb) since discharge.  Physical examination shows no other abnormalities.  Laboratory results are as follows:  Which of the following medications is most likely to have caused this patient's physical examination and laboratory findings?

Quizplus · Accepted Answer

11ec25c8_d795_36f7_bc81_bb52ae1681b6_MD0003_00 Many psychotropic medications can cause weight gain. However, the second-generation antipsychotic olanzapine is associated with a risk for clinically significant weight gain, dyslipidemia, and hyperglycemia, making it the most likely cause of this patient's physical examination and laboratory findings. Among second-generation antipsychotics, olanzapine and clozapine carry the greatest risk of metabolic adverse effects. Possible mechanisms include appetite stimulation and drug-induced changes in metabolism. Aripiprazole, lurasidone, and ziprasidone are associated with the lowest risk for metabolic side effects (Choices A and H). second-generation antipsychotics (Choices B, D, and G) Carbamazepine, lithium, and valproate are often used as mood stabilizers in the treatment of schizoaffective disorder and may cause weight gain. However, they are less likely to cause hyperglycemia. Patients taking lithium should be monitored periodically for thyroid dysfunction. This patient's TSH is normal. (Choices C and E) The serotonin-norepinephrine reuptake inhibitor duloxetine is not associated with clinically significant weight gain or hyperglycemia. The antidepressant mirtazapine may cause weight gain but is less likely to cause hyperglycemia. Educational objective: Weight gain, dyslipidemia, and hyperglycemia are common complications of treatment with second-generation antipsychotics. Olanzapine and clozapine carry the greatest risk. References: Weight gain and changes in metabolic variables following olanzapine treatment in schizophrenia and bipolar disorder. (http://www.ncbi.nlm.nih.gov/pubmed/21495734) Second-generation antipsychotics and metabolic side effects: a systematic review of population-based studies. (http://www.ncbi.nlm.nih.gov/pubmed/28585153)

A 32-Year-Old Man Comes to the Office for Follow-Up a Month