skip to main content

Metabolic Risk Management — MRCPsych Paper B MCQ

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

ModerateSchizophrenia & PsychosisMetabolic Risk ManagementMRCPsych Paper B

A 23-year-old woman with schizophrenia has taken olanzapine 15 mg daily for 6 months, with good symptom control and no previous relapses. She has gained 15 kg. Fasting plasma glucose is 6.8 mmol/L and HbA1c is 44 mmol/mol; renal function and lipids are normal. This is the first time metabolic abnormalities have been detected, she has not yet been offered any structured lifestyle support, and she is distressed by the weight gain and willing to consider changes to treatment. What is the most appropriate next step?

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

Reveal the answer and explanation

Correct answer: A — Discuss switching to an antipsychotic with lower metabolic risk and offer structured lifestyle intervention

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

B is correct. A 15 kg gain plus fasting glucose 6.8 mmol/L and HbA1c 44 mmol/mol places her in the UK high-risk, non-diabetic hyperglycaemia band. The Lester UK Adaptation makes psychiatrist-led antipsychotic review a priority when substantial weight gain or emergent glucose abnormality follows antipsychotic initiation, delivered through shared decision-making alongside behaviour-change/lifestyle intervention; she is stable, informed and willing, so a planned switch discussion is appropriate. A defers action while harm progresses. C risks discontinuation symptoms and relapse and is never justified here. D wrongly makes metformin the sole step: NICE PH38 positions metformin as supporting lifestyle change when glycaemia deteriorates despite, or where the person cannot join, an intensive programme. E is factually wrong—neither result reaches diabetic thresholds.

Reference: Royal College of Psychiatrists / NCAP, Positive Cardiometabolic Health Resource (Lester UK Adaptation), intervention framework — antipsychotic review and behaviour-change interventions, 2023 update. https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/lester-tool-june-2023.pdf