quetiapine Counselling Notes

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 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 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?

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?

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

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.