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Metabolic Syndrome Management — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisMetabolic Syndrome ManagementMRCPsych Paper B

A 55-year-old man with schizophrenia remains under specialist mental health follow-up and has been stable on olanzapine 20 mg daily. Responsibility for routine physical-health monitoring was transferred to primary care 18 months ago. His latest results are BMI 35 kg/m², HbA1c 48 mmol/mol, total cholesterol 7.2 mmol/L and blood pressure 145/92 mmHg. Which plan most closely follows the Lester UK Adaptation of the Positive Cardiometabolic Health Resource?

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

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Correct answer: A — Coordinate active interventions with primary care and collaboratively review his antipsychotic treatment

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

B is correct. This patient is in the Lester intervention or “red” zone across several domains: obesity, blood pressure above 140/90 mmHg and HbA1c at the diabetes-review threshold of 48 mmol/mol. His lipids also require cardiovascular-risk assessment and appropriate management. The specialist mental health and primary care teams should collaborate so that interventions are delivered and communicated; transfer of routine monitoring does not justify disengagement by the mental health team. Olanzapine's metabolic effects should be reviewed through person-centred shared decision-making, balancing psychiatric benefit against harm. An antipsychotic switch may be considered but is not automatically required, so D is incorrect. A fragments care, while C contradicts the principle “Don't just screen—intervene.” E is inadequate because each identified risk factor requires attention.

Reference: Perry BI, Holt RIG, Chew-Graham CA, et al. Lester UK Adaptation: Positive Cardiometabolic Health Resource—an intervention framework for people experiencing psychosis and schizophrenia, 2023 update. Royal College of Psychiatrists. https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/eip-2024/ncap-lester-tool-intervention-framework.pdf?sfvrsn=21e45dbd_17