Metabolic Risk Hierarchy — MRCPsych Paper B MCQ
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Correct answer: C — Olanzapine and clozapine
Olanzapine and clozapine are most strongly associated with type 2 diabetes and have the greatest overall metabolic burden, particularly for weight gain and disturbances of glucose and lipid metabolism. Quetiapine also carries clinically important metabolic risk, but population-based evidence places it below olanzapine and clozapine. Aripiprazole and lurasidone generally have more favourable metabolic profiles. Haloperidol, flupentixol, amisulpride and sulpiride have other important adverse effects but are not the pair most strongly associated with diabetes. Risk is not equal across antipsychotics, although glucose status should be monitored with every antipsychotic in accordance with NICE guidance. The development of diabetes in this patient does not by itself prove that quetiapine was the sole cause.
Reference: Hirsch L, et al. Second-Generation Antipsychotics and Metabolic Side Effects: A Systematic Review of Population-Based Studies. Drug Safety. 2017;40(9):771–781. https://pubmed.ncbi.nlm.nih.gov/28585153/