skip to main content

Psychotropics in ID — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateIntellectual DisabilityPsychotropics in IDMRCPsych Paper B

A 32-year-old man with moderate learning disability and schizophrenia is stable on olanzapine 10 mg daily. He has limited ability to describe adverse effects and attends appointments with a support worker who knows him well. In addition to the monitoring recommended for olanzapine in schizophrenia, which approach best reflects NICE NG54 and STOMP principles?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Use structured, person-centred reviews adapted to his communication needs, involving his supporter as appropriate and reassessing benefit, harm, indication and dose

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · B = shown as D · A = shown as E

B is correct. NICE NG54 requires monitoring of treatment benefits and possible harms using agreed outcome measures, with reviews adapted to the person's communication needs and individual circumstances. Responsibilities for investigations should be agreed, and the indication, review schedule and minimum effective dose should remain explicit. A knowledgeable supporter may help identify changes that the patient cannot readily report. STOMP supports appropriate treatment of diagnosed schizophrenia; it does not require automatic antipsychotic withdrawal. Routine olanzapine plasma levels are not required (A), and relying on spontaneous symptom reporting is unsafe (C). Standard monitoring without reasonable adaptation is insufficient (D). Learning disability alone is not a reason to stop clinically indicated treatment (E).

Reference: NICE. Mental health problems in people with learning disabilities: prevention, assessment and management (NG54), recommendations 1.9.3–1.9.6. 2016; last reviewed 2024. https://www.nice.org.uk/guidance/ng54/chapter/recommendations