| name | endo-sdm-antipsychotic |
| description | Recommends using weight‑neutral antipsychotic alternatives when possible and employing shared decision‑making that provides quantitative estimates of expected weight effect to guide drug choice. Triggered when a clinician asks, “How do I involve this patient in choosing an antipsychotic with minimal weight gain?” or “What resources show weight‑change projections for risperidone vs aripiprazole?”. |
Shared decision‑making for antipsychotics with weight‑effect estimates
STEP 1 — Gather Information
Collect psychiatric indication, current weight and BMI, prior weight changes with psychotropics, patient’s weight‑related concerns and preferences, baseline metabolic labs (glucose, lipids), and any contraindications to specific agents.
STEP 2 — Rule In / Rule Out
Is an antipsychotic clinically indicated for the patient’s condition?
- No: Consider non‑pharmacologic therapies or alternative medication classes; revisit if symptoms persist.
- Yes: Proceed to classify available antipsychotic options by weight effect.
STEP 3 — Classify or Stratify
Stratify candidate antipsychotics into weight‑neutral (e.g., aripiprazole, ziprasidone, lurasidone) and weight‑gain (e.g., olanzapine, clozapine, quetiapine, risperidone) groups using published mean weight‑change data over 12 weeks:
- Aripiprazole ≈ +0.5 kg, Ziprasidone ≈ 0 kg, Lurasidone ≈ +0.2 kg
- Risperidone ≈ +2 kg, Quetiapine ≈ +2.5 kg, Olanzapine ≈ +4.5 kg, Clozapine ≈ +3.5 kg
Create a shortlist that matches efficacy needs with the lowest expected weight impact.
STEP 4 — Decide
Engage in shared decision‑making using a decision aid that presents the quantitative weight‑change estimates alongside efficacy, side‑effect profile, and cost; select the agent that best balances therapeutic goals and weight concerns; document the discussion, the patient’s values, and the agreed‑upon prescription.
Clinical Guardrails / Mimics / Pitfalls
Do not default to high‑risk weight‑gain agents (olanzapine, clozapine) in patients with obesity or metabolic syndrome without explicit discussion of weight impact; avoid ignoring the patient’s weight‑related values; do not rely solely on efficacy data when choosing antipsychotics; monitor weight at baseline and regularly (e.g., monthly for the first 3 months, then quarterly) to detect early changes.
Concrete Clinical Example
A 32‑year‑old man with schizophrenia, BMI 29 kg/m², reports worsening psychosis and worries about weight gain. The clinician discusses options: aripiprazole (expected weight change +0.5 kg over 12 weeks) versus olanzapine (+4.5 kg). The patient chooses aripiprazole; treatment starts at 5 mg daily with a weight check scheduled in 4 weeks.
Source: Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2015, DOI:10.1210/jc.2014-3415
