quetiapine Counselling Notes

History Taking

• Confidentiality: Reassure the patient about confidentiality.
• Empathy: Show empathy towards the patient's concerns.
• Open-ended Questions: Use open-ended questions to gather information.
• Concerns Statement: Acknowledge the patient's concerns about weight gain.
  • "I understand your concern. Let me ask you a few questions. I will make out the best management plan for you."

Weight Gain Assessment

• Weight Gain Details:
  • How much weight have you gained?
  • When did you first notice it?
• Dietary Habits:
  • Describe your diet.
• Exercise:
  • How much exercise do you do?
• Occupation:
  • What is your occupation?
  • Do you lead a sedentary lifestyle?
• Symptoms of Increased Thirst/Urination:
  • Do you have any symptoms of increased thirst?
  • Are you passing more urine than usual?
• Other Symptoms:
  • Have you noticed any other symptoms?
  • Any abdominal pain?
• Menstrual History (for female patients):
  • When was your last menstrual period?
  • Are your periods irregular?
• Acne and Hair Growth (for female patients):
  • Do you have any acne on your face?
  • Do you have any excessive hair growth on your body?
• Weather preference.

Medication Review

• Medication Start Date:
  • When did you start taking this medication (Coetiapine)?
• Compliance:
  • Are you compliant with your medication?
• Other Side Effects:
  • Did you notice any other side effects like dry mouth, constipation, shakiness in your hands?
• Follow-ups:
  • Do you have regular follow-ups with your GP and specialist?

Schizophrenia and Mood Assessment

• Relapse History:
  • Did you have any relapse of this condition?
  • Any uncontrolled schizophrenia symptoms?
• Mood:
  • How's your mood been?
• Appetite:
  • How's your appetite?
• Sleep:
  • How's your sleep?
• Suicidal/Homicidal Ideation:
  • Have you ever thought of harming yourself or anyone else?
• Perceptual Disturbances:
  • Do you see, hear, or feel things that others don't?
• Delusional Thoughts:
  • Paranoia: Do you feel anyone is chasing you or trying to harm you?
  • Broadcasting: Do you feel like the TV is broadcasting about you and talking about you?
  • Thought Insertion: Do you feel like anyone is inserting ideas in your mind?
  • Jealousy: Do you feel like people are jealous of you?
  • Grandiosity: Do you feel that you have superpowers?
  • Insight: Do you think you need medical help?
  • Imaginary Scenario: If there was a fire in this room, what would you have done?
• Thoughts: Do you have any thoughts that other people find strange?

Social and Environmental Factors

• Home Situation:
  • How's the home situation?
  • Who do you live with?
  • Any stress at home?
• Work/Study:
  • Do you work or study?
  • How's university/work going?
  • Any stress at university or work?
• Enjoyment:
  • Are you still enjoying the things you used to enjoy?
• Substance Use:
  • Do you use any drugs, any alcohol, any medications?
• Sexual Activity:
  • Are you sexually active?
  • Do you practice safe sex?
  • Any changes in your sexual life?
  • Weather preference

Management Plan

• Explanation:
  • Most likely the cause of your weight gain is the side effect of your medication.
• Investigations:
  • Full blood count (FBC)
  • Full blood sugar (\text{FBS})
  • Lipid profile
  • Fasting blood sugar levels
  • Liver function test (LFT)
• Lifestyle Modifications:
  • Change your diet to a healthy diet containing fruits, vegetables, avoid sugary drinks, and so on.
    • Referral to a dietitian.
  • Adequate exercise:
    • At least 150 minutes per week.
    • Moderate to high intensity exercise.
  • Decrease alcohol consumption.
  • Cut down on smoking.
• Medication Review:
  • If lifestyle modifications don't help, discuss with psychiatrist about changing medication to one with fewer metabolic side effects.
    • Example: Aripiprazole
• Education:
  • Provide reading materials for a healthy lifestyle.