Hyperprolactinaemia — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisHyperprolactinaemiaMRCPsych Paper B

A 30-year-old woman with schizophrenia has remained clinically stable on risperidone 6 mg daily. She develops amenorrhoea and galactorrhoea, and a repeat fasting prolactin concentration is 2500 mU/L. Assessment identifies no alternative cause of hyperprolactinaemia. Following shared decision-making, she prefers to change antipsychotic rather than reduce the dose or add another medicine. A gradual switch to which antipsychotic is most appropriate?

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Correct answer: B — Aripiprazole

The correct answer is **C, aripiprazole**. Amenorrhoea, galactorrhoea and markedly raised prolactin are characteristic of symptomatic risperidone-induced hyperprolactinaemia. Aripiprazole is a dopamine D2 partial agonist with a very low propensity to raise prolactin, and evidence supports a gradual switch to aripiprazole as an effective prolactin-lowering strategy. Olanzapine and quetiapine are relatively prolactin-sparing and could sometimes be considered, but aripiprazole has the clearest prolactin-lowering action and strongest supporting evidence among these options. Clozapine is generally reserved for treatment-resistant schizophrenia rather than selected solely for hyperprolactinaemia. Chlorpromazine blocks D2 receptors and may perpetuate or worsen prolactin elevation. The switch should be planned collaboratively and monitored for relapse, akathisia and emerging impulse-control symptoms.

Reference: Lu Z et al. Pharmacological treatment strategies for antipsychotic-induced hyperprolactinemia: a systematic review and network meta-analysis. Translational Psychiatry. 2022;12:267. https://pubmed.ncbi.nlm.nih.gov/35790713/