Antipsychotic Side Effects — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisAntipsychotic Side EffectsMRCPsych Paper B

A 27-year-old man with schizophrenia has gained 12 kg during 6 months of treatment with olanzapine 20 mg daily. His BMI is now 34 kg/m². His psychotic symptoms are stable, and he has not yet received targeted weight-management support. Which initial approach is explicitly recommended by NICE?

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Correct answer: D — Offer a combined healthy-eating and physical-activity programme and follow NICE obesity guidance

NICE recommends offering people with psychosis or schizophrenia, particularly those taking antipsychotics, a combined healthy-eating and physical-activity programme. Rapid or excessive weight gain should also be managed in line with relevant NICE overweight and obesity guidance. An antipsychotic change may be considered after an individualised, shared review of efficacy, relapse risk, adverse effects and patient preference, but NICE does not mandate an immediate switch to aripiprazole. Metformin has evidence for reducing antipsychotic-induced weight gain, and NICE surveillance identified it as an area for guideline development, but it is not specified in current CG178 as routine first-line treatment solely for this indication. Reassurance alone fails to address substantial weight gain, while reducing olanzapine solely for weight loss may compromise antipsychotic efficacy and is not the recommended initial intervention.

Reference: NICE. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendations 1.1.2.1–1.1.2.2. Published 2014; guideline last reviewed 29 July 2025. https://www.nice.org.uk/guidance/cg178/chapter/recommendations