Synopsis
Compare the metabolic, cardiac and motor burdens of antipsychotics, recognise dangerous reactions, and use baseline measurement and shared review to maintain psychiatric benefit with fewer avoidable harms.
- Establish a baseline for weight, waist, pulse, blood pressure, glucose or HbA1c, lipids, prolactin, movement symptoms, diet and activity before starting.
- Choose the antipsychotic with the person, comparing their previous response and the adverse effects they most want to avoid.
- Clozapine and olanzapine often carry substantial metabolic burden, but lower weight-gain risk does not eliminate the need for screening.
- Akathisia is subjective motor restlessness and may be mistaken for worsening psychosis; increasing the dose can intensify distress.
- QT risk depends on the medicine, dose, interacting drugs, electrolytes and cardiac substrate, rather than the drug name alone.
- Avoid routine antipsychotic polypharmacy except brief periods such as a planned change, unless a documented specialist indication supports it.
- Long-term physical-health review must lead to treatment of abnormalities and clear communication between primary and secondary care.