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Drug-Induced Parkinsonism Management — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisDrug-Induced Parkinsonism ManagementMRCPsych Paper B

A 38-year-old man with schizophrenia develops symmetrical limb stiffness, bradykinesia, cogwheel rigidity and a shuffling gait 2 weeks after his risperidone dose is increased. He is afebrile, alert and cardiovascularly stable, and reports no subjective inner restlessness. Which option best identifies the adverse effect and its appropriate management?

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Correct answer: E — Drug-induced parkinsonism — reduce the dose; if necessary, switch antipsychotic or use short-term procyclidine

This is antipsychotic-induced parkinsonism: bradykinesia, rigidity, cogwheeling and a shuffling gait developed soon after a risperidone dose increase. Management begins with reviewing and reducing the causative antipsychotic dose when clinically feasible. Persistent or troublesome symptoms may require switching to an antipsychotic with lower parkinsonism liability or cautious short-term use of an antimuscarinic such as procyclidine. Tardive dyskinesia predominantly causes involuntary choreoathetoid or orobuccolingual movements, and antimuscarinics can worsen it. Akathisia causes subjective inner restlessness with an urge to move rather than bradykinesia and rigidity. Neuroleptic malignant syndrome would usually include fever, autonomic instability and altered consciousness. Catatonia is characterised by features such as stupor, mutism, posturing or negativism.

Reference: Kent and Medway NHS and Social Care Partnership Trust, Antipsychotic Guidelines, Appendix 10: Commonly Associated Antipsychotic Adverse Effects, 2025. https://www.kmptformulary.nhs.uk/media/1159/antipsychoticguidelineskmptclig25701.pdf