Objectives. To explore the lived experience of youth, caregivers, and prescribers with antipsychotic medications. Design. We conducted a qualitative interpretive phenomenology study. Youth aged 11 to 25 with recent experience taking antipsychotics, the caregivers of youth taking antipsychotics, and the prescribers of antipsychotics were recruited. Subjects. Eighteen youth, 10 caregivers (parents), and 11 prescribers participated. Results. Eleven of 18 youth, six of ten parents, and all prescribers discussed antipsychotic-related weight gain. Participants were attuned to the numeric weight changes usually measured in pounds. Significant discussions occurred around weight changes in the context of body image, adherence and persistence, managing weight increases, and metabolic effects. These concepts were often inextricably linked but maintained the significance as separate issues. Participants discussed tradeoffs regarding the perceived benefits and risks of weight gain, often with uncertainty and inadequate information regarding the short- and long-term consequences. Conclusion. Antipsychotic-related weight gain in youth influences body image and weight management strategies and impacts treatment courses with respect to adherence and persistence. In our study, the experience of monitoring for weight and metabolic changes was primarily reactive in nature. Participants expressed ambiguity regarding the short- and long-term consequences of weight and metabolic changes. 1. Introduction Second generation antipsychotic prescribing to young people under 25 years of age is increasing internationally [1–12]. The rise in prescription trends has generated controversy given available pediatric evidence for second generation antipsychotic effectiveness and safety data and the unknown long-term consequences with intermittent or continuous exposure [13–16]. Antipsychotic-related weight gain and changes in the metabolic profile (e.g., glucose and lipid homeostasis) that occur following, or in concert with, weight gain are frequently discussed as significant treatment-related issues. The explicit mechanisms of antipsychotic-related weight gain are not fully understood [17–24] nor are the best management approaches (e.g., lifestyle, pharmacologic), but research in these areas continues [17, 25–33]. Predictive or risk factors for antipsychotic-related weight gain are also unknown but some inferences can be made from available syntheses of the literature. These factors include lower pretreatment body mass index (BMI), triglyceride levels, more negative symptoms,
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