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First Episode Psychosis — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisFirst Episode PsychosisMRCPsych Paper B

A 24-year-old man presents to an Early Intervention in Psychosis service with a 4-week history of auditory hallucinations, thought insertion and social withdrawal. Physical examination and baseline metabolic investigations are unremarkable. He starts oral aripiprazole. According to NICE guidance for adults with psychosis or schizophrenia, which monitoring set should be completed 12 weeks after starting the antipsychotic?

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Correct answer: E — Weight, pulse, blood pressure, fasting glucose or HbA1c, and blood lipids

NICE CG178 recommends measuring weight weekly for the first 6 weeks and again at 12 weeks. Pulse and blood pressure, fasting blood glucose or HbA1c, and blood lipid levels are also due at 12 weeks. Therefore, B is the complete scheduled monitoring set. Waist circumference is recorded at baseline and then annually in adults, so its inclusion as a routine 12-week measurement makes A and C incorrect. Prolactin is included in the baseline assessment but is not specified as routine 12-week monitoring in this adult guideline. Renal, thyroid and liver function tests, serum calcium and ECG are not part of the standard NICE 12-week bundle, although they may be indicated by symptoms, comorbidity or medication-specific requirements.

Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendation 1.3.6.4, 2014, amended 2021. https://www.nice.org.uk/guidance/cg178/chapter/recommendations