Answers: Learning Scenario

      a. Advise lifestyle interventions and that she remains on the same dose of her olanzapine. Encourage Fiona to discuss her concerns with her doctor at the earliest opportunity if lifestyle interventions are not successful 

CORRECT. Lifestyle interventions are recomended as they have a positive effect in most cases. They should almost always be the first thing to try and in most circumstances should be continued in addition to any additional intervention. On average, these interventions can reduce existing weight by approximately 3kg. 

      b. Advise her to ask her prescriber to change her antipsychotic to aripiprazole as this has a lower propensity to cause weight gain 

INCORRECT. Aripiprazole does not have a lower propensity to cause weight gain but requires careful consideration as changing antipsychotic may destabilise Fiona's recovery. 

      c. Advise her to continue taking the olanzapine but ask her prescriber to add in adjunctive aripiprazole 5mg daily 

INCORRECT. Adjunctive aripiprazole is recommended as a possible intervention for weight gain associated with olanzapine (and clozapine) but only if lifestyle changes do not have a sufficient effect. 

      d. Advise her to continue taking the olanzapine but ask her prescriber to add in adjunctive metformin

INCORRECT. Adjunctive metformin should only be offered when lifestyle interventions have been fully explored and other interventions considered.