Antipsychotic Side Effects

A 42-year-old woman on olanzapine 15 mg/day for bipolar disorder presents with amenorrhea for 3 months, galactorrhea, and gynecomastia. Her serum prolactin is 85 ng/mL (normal <25 ng/mL). Which investigation is most appropriate to confirm the mechanism of prolactin elevation?

A 42-year-old woman with bipolar I disorder has been on olanzapine 15 mg/day for 6 months. She presents with severe muscle rigidity, fever (39.8°C), altered mental status, and autonomic instability (HR 118/min, BP 160/95 mmHg). Serum creatine kinase is 1850 U/L. What is the most appropriate immediate next step in management?

A 38-year-old man with schizophrenia has been on risperidone 6 mg/day for 8 months. He presents with involuntary orofacial movements, tongue protrusion, and lip smacking that began 2 weeks ago. Vital signs are normal, temperature is 37.2°C, and creatine kinase is 180 U/L. What is the most appropriate next step in management?

Which clinical feature best distinguishes typical antipsychotic-induced tardive dyskinesia from acute dystonia?

A 38-year-old man on risperidone for schizophrenia for 6 months presents with galactorrhea and amenorrhea in his female partner. Which finding best distinguishes risperidone-induced hyperprolactinemia from haloperidol-induced hyperprolactinemia?