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STOMP — MRCPsych Paper B MCQ

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ModerateIntellectual DisabilitySTOMPMRCPsych Paper B

A 40-year-old man with severe intellectual disability has received risperidone for aggressive behaviour for 2 years. He has no psychotic or affective disorder, and an initial reduction in the identified target behaviour was documented. According to NICE NG11 and the STOMP initiative, what is the most appropriate ongoing medication-review arrangement?

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Correct answer: B — Review multidisciplinary at least every 6 months, including benefit, adverse effects and the stopping plan

The correct answer is B. For antipsychotic medication prescribed for behaviour that challenges, NICE NG11 requires a full multidisciplinary review after 3 months and then at least every 6 months. The review should document changes in the target behaviour, adverse effects and a plan for stopping; continued prescribing requires proven benefit. STOMP similarly promotes structured, person-centred review, the minimum effective dose and safe reduction or withdrawal when medication is no longer beneficial. An annual review alone is therefore insufficient, although the separate annual learning-disability health check remains important. STOMP does not require abrupt discontinuation, because withdrawal should be individualised and safely planned. Clozapine is not indicated solely because risperidone has been used long term, and prophylactic dose escalation is inconsistent with minimum-effective-dose prescribing.

Reference: National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges (NG11), recommendations 1.8.4–1.8.6. 2015. https://www.nice.org.uk/guidance/ng11/chapter/recommendations