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Depression — UKMLA MCQ

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HardMental HealthDepressionUKMLAMRCGP AKTMRCP Part 1PSA

A 50-year-old has severe depression with mood-congruent delusions of guilt. He is eating very little but is medically stable, retains decision-making capacity and has no immediate intent to harm himself. What is the most appropriate treatment pathway?

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Correct answer: B — Specialist referral for combined antidepressant and antipsychotic treatment

B is correct. NICE advises referral to specialist mental health services for depression with psychotic symptoms, where care includes risk and needs assessment, coordinated multidisciplinary treatment and later access to psychological treatment. Combination treatment with an antidepressant and an antipsychotic, such as olanzapine or quetiapine, should be considered through shared decision-making. If the person declines an antipsychotic, an antidepressant alone can be used, but primary-care guided self-help is insufficient for this presentation. Antipsychotic treatment also requires baseline physical-health assessment, metabolic monitoring and regular review of whether it remains necessary.

Reference: NICE NG222, recommendations 1.12.1–1.12.4: https://www.nice.org.uk/guidance/ng222/chapter/recommendations