Metabolic Side Effects — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisMetabolic Side EffectsMRCPsych Paper B

A 28-year-old man with schizophrenia is to start treatment with an antipsychotic. He has obesity, impaired fasting glycaemia and hypertriglyceridaemia. Which of the following antipsychotics has the greatest propensity to worsen weight and metabolic parameters?

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Correct answer: C — Olanzapine

Olanzapine has the greatest propensity among the listed drugs to cause weight gain and deterioration in glucose and lipid parameters. Its UK SmPC identifies weight gain as very common and records elevated glucose, cholesterol and triglycerides. Comparative evidence places olanzapine, together with clozapine, among the antipsychotics with the worst metabolic profiles. Aripiprazole and lurasidone are relatively metabolically benign. Haloperidol generally carries a lower metabolic burden than olanzapine but is more strongly associated with extrapyramidal adverse effects. Amisulpride can cause weight gain and is particularly associated with hyperprolactinaemia, but its overall metabolic risk is lower than that of olanzapine.

Reference: Pillinger T et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry, 2020. https://pubmed.ncbi.nlm.nih.gov/31860457/