intermediateshared decision-makingantipsychoticshyperprolactinemiamedication side effectspatient-centered careschizophrenia
A 44-year-old man with schizophrenia, well-controlled on haloperidol 10 mg daily for 2 years, presents for a routine follow-up. He reports he is adherent to medication but is distressed by significant weight gain of 35 pounds, new-onset gynecomastia, and sexual dysfunction including erectile dysfunction and decreased libido. Labs reveal a prolactin level of 89 ng/mL (normal: 2–18 ng/mL). He states he does not want to stop his antipsychotic because he fears relapse but wants these side effects addressed. He asks the PMHNP what his options are. Using a shared decision-making framework, what is the most appropriate next step?