A 26-year-old woman comes to the emergency department to report that her life is in danger. The patient believes that transmitters inserted in her bedroom walls are broadcasting her thoughts to a central government agency that is now plotting to kill her. On mental status examination, she is fearful and paces the examining room. The patient makes poor eye contact with the examiner, and her responses are interrupted by frequent pauses during which she appears to talk back to a person who is not present. She has no medical history. The patient smokes a pack of cigarettes daily and does not use illicit drugs. Physical examination shows a thin, disheveled young woman but no abnormalities. She is hospitalized, improves with medication over the course of 2 weeks, and is discharged on olanzapine. At this patient's 3-month checkup, which of the following studies should be obtained?

Question

A 26-year-old woman comes to the emergency department to report that her life is in danger.  The patient believes that transmitters inserted in her bedroom walls are broadcasting her thoughts to a central government agency that is now plotting to kill her.  On mental status examination, she is fearful and paces the examining room.  The patient makes poor eye contact with the examiner, and her responses are interrupted by frequent pauses during which she appears to talk back to a person who is not present.  She has no medical history.  The patient smokes a pack of cigarettes daily and does not use illicit drugs.  Physical examination shows a thin, disheveled young woman but no abnormalities.  She is hospitalized, improves with medication over the course of 2 weeks, and is discharged on olanzapine.  At this patient's 3-month checkup, which of the following studies should be obtained?

Quizplus · Accepted Answer

11ec160b_3601_9f12_9249_c5fd27a04ec7_MD0001_00 Olanzapine is a second-generation antipsychotic (SGA) medication used to treat psychotic and mood disorders. SGAs are commonly used as first-line agents due to their lower risk of extrapyramidal side effects compared to first-generation antipsychotics. As a class, SGAs are associated with metabolic adverse effects (eg, weight gain, dyslipidemia, hyperglycemia, increased risk of diabetes) to varying degrees. Among the SGAs, olanzapine and clozapine carry the greatest metabolic syndrome risk. Patients taking SGAs require routine monitoring of metabolic parameters, including weight, waist circumference, blood pressure, fasting glucose, and lipid profile. (Choices A and F) Blood urea nitrogen, creatinine, and thyroid function tests should be routinely monitored in patients taking the mood stabilizer lithium due to its potential to cause hypothyroidism and impair renal function. Treatment with olanzapine does not require routine monitoring of thyroid or renal function. (Choice B) Olanzapine rarely causes neutropenia, and routine monitoring of complete blood counts is not required unless the patient has a history of drug-induced or baseline neutropenia. Clozapine is the only antipsychotic that requires regular monitoring of the absolute neutrophil count due to the drug's 1% risk of agranulocytosis. (Choice C) Routine ECG monitoring is not required with antipsychotic treatment unless the patient has known pre-existing cardiovascular risk factors (eg, long QT syndrome). Among SGAs, ziprasidone is most often associated with QT prolongation. (Choice E) Although antipsychotics can cause prolactin elevation due to D2 receptor antagonism in the tuberoinfundibular pathway, prolactin levels are not routinely monitored unless the patient has symptoms of prolactin dysfunction (eg, galactorrhea, sexual impairment). Among SGAs, risperidone has been associated with a greater risk of prolactin elevation. Educational objective: As a class, second-generation antipsychotics are associated with metabolic adverse effects (eg, weight gain, dyslipidemia, hyperglycemia, increased risk of diabetes). Within the class, olanzapine and clozapine carry the greatest risk. __________ References: Clinical monitoring and management of the metabolic syndrome in patients receiving atypical antipsychotic medications. (http://www.ncbi.nlm.nih.gov/pubmed/27147592) Second-generation antipsychotics and metabolic side effects: a systematic review of population-based studies. (http://www.ncbi.nlm.nih.gov/pubmed/28585153)

A 26-Year-Old Woman Comes to the Emergency Department to Report