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STOMP Review — MRCPsych Paper B MCQ

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EasyIntellectual DisabilitySTOMP ReviewMRCPsych Paper B

An adult with an intellectual disability has taken risperidone for 3 years solely to manage aggression. There is no diagnosed psychotic or affective disorder, and no medication review has been documented since treatment began. The person is currently settled, with no immediate severe risk to self or others. In accordance with STOMP and NICE guidance, what is the most appropriate next step?

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Correct answer: A — Review its indication, benefits and harms, then plan supervised reduction if appropriate

The correct answer is A. NICE requires antipsychotics prescribed for behaviour that challenges to undergo a full multidisciplinary review after 3 months and at least every 6 months. The review should assess the original indication, measurable benefit, adverse effects and whether a supervised reduction or discontinuation is appropriate. STOMP promotes safe optimisation rather than automatic or abrupt withdrawal. Continuing unchanged is inappropriate after 3 years without review. Dose escalation is not justified in a settled person, and NICE recommends the minimum effective dose. Clozapine is not indicated merely for behaviour that challenges, while adding a second antipsychotic conflicts with the recommendation to prescribe a single antipsychotic and would increase adverse-effect burden.

Reference: NICE. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges (NG11), recommendations 1.8.4–1.8.6. 2015. https://www.nice.org.uk/guidance/ng11/chapter/recommendations