Problem
Naomi. 35 year old patient with schizophrenia Scenario: Naomi (35 years old) was diagnosed with paranoid schizophrenia approximately 10 years ago. She had been treated with haloperidol with reasonable attenuation of hallucinations for some time. Three years ago her doctor began to worry that she was beginning to develop some facial tics and Naomi was changed onto olanzapine. Now Naomi feels her life has improved, the adverse effects from the medication seem to have decreased, her relationship with her family is good and she has even started working part-time. She wants to stop her olanzapine because she says she is getting on with her life and does not want to live with the adverse effects the drugs cause, she feels she is cured. She is also very concerned about her weight gain (20 kg increase since commencing olanzapine, current body mass index 32 kg/m2 ).
• Describe why the doctor would think that Naomi's facial tics are a result of the haloperidol treatment, and why a change to olanzapine may be a better course of treatment. With this ensure you include the pharmacology involved.
• Is Naomi's weight gain due to hertaking olanzapine? What are the risks and possible consequences of continuing on/stopping her present medication?