Explaining antipsychotic weight gain and a monitoring plan (CASC)

Station instructions (candidate)

You have 7 minutes with the parents (and young person if present). Validate concern about weight and glucose, explain that some antipsychotics — including olanzapine — carry higher metabolic risk especially in young people, outline what monitoring should look like, and negotiate a plan: lifestyle support, possible switch to a lower-metabolic agent, possible metformin, and why abrupt stop of all treatment risks relapse. Avoid jargon without explanation. Do not promise zero risk. Do not dismiss their anger.[1][2][6]

Marking domains

Empathy and agenda setting; accurate plain-language metabolic explanation; youth risk awareness; structured monitoring plan; collaborative options (switch/metformin/lifestyle); relapse-risk balance; shared decision and written follow-up; avoids both minimisation and “stop everything” panic.[1][2][3]

Model communication map

1. Open: thank them for raising this; name shared goals — keep him well for school and protect long-term physical health.[1]
2. Validate: weight and glucose changes are real, expected more with some medicines, and more concerning in adolescents; you should have been tracking this early.[2][6]
3. Plain mechanism: some medicines increase hunger and change how the body handles sugar and fat — not a moral failure of the family.[6]
4. Why medicine helped: reduced psychosis symptoms; sudden full stop risks return of illness that also harms life expectancy and safety.[1]
5. Options now: (a) structured lifestyle support; (b) switch to a medicine with lower average weight effect if symptoms allow; (c) discuss metformin as an add-on studied for antipsychotic weight problems; (d) treat abnormal glucose with medical colleagues.[3][4][5]
6. Monitoring promise: weight/waist/BP and labs on a clear timetable (early weeks then regular reviews) with named responsibility (clinic vs GP).[1]
7. Safety-net: thirst, lots of urine, vomiting, confusion → urgent care for possible dangerous high sugar.[1]
8. Close: summarise plan, written leaflet, follow-up date, invite questions.[1]

Common fails

• “All antipsychotics are the same for weight.”[6]
• Agreeing to stop all medicine today with no relapse plan.[1]
• Blaming parents’ cooking as the sole cause.[2]
• Offering metformin without mentioning monitoring, side effects, or that lifestyle still matters.[3][4]
• Using only acronyms (MetS, SGA, HbA1c) without checking understanding.[1]