Hyperprolactinaemia — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisHyperprolactinaemiaMRCPsych Paper B

A 26-year-old woman with first-episode psychosis has responded to risperidone 4 mg daily but develops galactorrhoea and amenorrhoea. Repeat serum prolactin is markedly elevated, and other causes of hyperprolactinaemia have been excluded. She requires ongoing antipsychotic treatment. Which antipsychotic would be most appropriate to switch to?

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Correct answer: D — Aripiprazole

Aripiprazole is the best answer. Its partial agonism at dopamine D2 receptors gives it a low propensity to increase prolactin, and switching to aripiprazole can reduce antipsychotic-induced hyperprolactinaemia and associated menstrual symptoms. This is particularly appropriate here because the patient has symptomatic, confirmed hyperprolactinaemia but still requires antipsychotic treatment. Amisulpride and sulpiride are substituted benzamides with a high propensity to elevate prolactin. Haloperidol also commonly raises prolactin through potent D2 antagonism. Paliperidone is the active metabolite of risperidone and is strongly associated with prolactin elevation, so it would not address the adverse effect.

Reference: Electronic Medicines Compendium, ABILIFY 30 mg tablets, Summary of Product Characteristics, sections 4.8 and 5.1, updated 27 April 2026. https://www.medicines.org.uk/emc/product/7972/smpc