Lester Adaptation — MRCPsych Paper B MCQ

Correct answer: A — Offer an evidence-based lifestyle intervention, address her cardiometabolic risk with appropriate clinicians, and collaboratively review olanzapine, including the risks and benefits of switching

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

B is correct. An HbA1c of 46 mmol/mol lies in the Lester high-risk range of 42–47 mmol/mol, rather than the diabetes range beginning at 48 mmol/mol. The substantial weight gain and worsening cardiometabolic indices require active intervention: an evidence-based lifestyle-change programme, appropriate assessment and treatment of lipid and diabetes risk, and collaborative review of olanzapine. Switching may be considered, but its potential physical-health benefits must be balanced against psychiatric stability and relapse risk. Monitoring alone (A) is inadequate. Physical healthcare should be coordinated between mental health and primary care rather than simply delegated (C). She does not yet meet the HbA1c criterion for diabetes (D), and immediate unilateral discontinuation of an effective antipsychotic is inappropriate (E). ([rcpsych.ac.uk](https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/lester-tool-june-2023.pdf))

Reference: Perry BI, Holt RIG, Chew-Graham CA, et al. Lester UK Adaptation: Positive Cardiometabolic Health Resource—adult intervention framework, 2023 update. https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/lester-tool-june-2023.pdf