Treatment of Schizophrenia in a Patient at Risk of Developing Metabolic Syndrome – Interactive Case Study

The difficulties before admission lasted for several weeks. During the hospitalization, where medication with risperidone at a dose of 4 mg daily was initiated, the symptoms subsided relatively quickly, and the patient was discharged for outpatient care with a diagnosis of acute psychotic disorder.

His condition was relatively stable, and he returned to work. However, approximately 3/4 of a year later, he discontinued the medication himself, and within 2 months, there was a recurrence of paranoid symptoms.

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During the second hospitalization, antipsychotic medication with risperidone was re-initiated, but there was a development of sexual dysfunction, and laboratory tests showed high levels of prolactin. The patient further complained of insomnia. The medication was therefore changed to olanzapine 10 mg daily, with which he was discharged. During the next half year, there was a weight gain of 10 kg, and laboratory tests showed elevated cholesterol, triacylglycerols (TAG), and borderline glucose levels.

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Lurasidone is an antipsychotic with minimal risk of developing metabolic complications (weight gain, effects on lipid metabolism, and glucose levels) and hyperprolactinemia. It has also been shown to have a favorable effect on cognitive functions.

The efficacy of most antipsychotics does not differ significantly, but their safety profiles, i.e., the occurrence of side effects, do. Therefore, it is important to choose medication with regard to this since for most patients, this treatment will last for years.

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MUDr. Sylva Racková, Ph.D.
Psychiatric Outpatient Clinic, Pilsen