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Antipsychotic Review in ID — MRCPsych Paper B MCQ

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ModerateIntellectual DisabilityAntipsychotic Review in IDMRCPsych Paper B

A 17-year-old boy with autism spectrum disorder and moderate intellectual disability has severe aggression but no psychotic disorder. A specialist has started risperidone to target the aggression alongside ongoing psychosocial interventions. At the review 3–4 weeks after initiation, there has been no clear benefit. According to NICE NG11, if there remains no indication of a response, by what latest point after initiation should the antipsychotic be stopped?

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Correct answer: A — 6 weeks after initiation

The correct answer is A: 6 weeks after initiation. NICE NG11 recommends reviewing antipsychotic effectiveness and adverse effects after 3–4 weeks. If there is still no indication of a response at 6 weeks, the medication should be stopped, the behaviour reassessed, and further psychological or environmental interventions considered. Two weeks is earlier than the specified efficacy review. Three months applies to the full multidisciplinary medication review when there has been a positive response, not to an ineffective initial trial. Thereafter, medication should be reviewed at least every 6 months and continued only when benefit has been demonstrated. Twelve months is not a recommended initial review or stopping point.

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