Treatment-Resistant Psychosis in an Adolescent at Risk of Metabolic Syndrome: A Case Report.

Management of treatment-resistant psychosis is inherently complex, presenting unique clinical challenges in pediatric populations when metabolic syndrome risk limits pharmacologic options. We report a case of an adolescent with rapid decline and persistent psychotic symptoms despite trials of first-line antipsychotic agents. His refractory clinical course required careful consideration of the relative benefits of other antipsychotic therapies against their potential for significant metabolic adverse effects. Clinical decision-making was further complicated by the need to engage the patient's mother in consent discussions and shared treatment decisions. This case highlights the clinical challenges of treating pediatric treatment-resistant psychosis while balancing psychiatric stabilization, cardiometabolic risks, and family-centered consent.