PTSD — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersPTSDMRCPsych Paper B

A 40-year-old military veteran is being treated in a specialist clinic for combat-related post-traumatic stress disorder. He has disabling severe hyperarousal and recurrent flashbacks despite an adequate trial of sertraline and a completed course of trauma-focused CBT. Psychological therapy is continuing. According to NICE NG116, which pharmacological strategy should now be considered?

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Correct answer: D — Add risperidone

The correct answer is D, add risperidone. NICE advises considering an antipsychotic such as risperidone alongside psychological therapy when an adult with PTSD has disabling symptoms or behaviours—severe hyperarousal is the stated example—and symptoms have not responded to other drug or psychological treatments. It must be initiated and regularly reviewed by a specialist. An SSRI or venlafaxine is a reasonable pharmacological option when a person prefers drug treatment, but this patient has already had an adequate SSRI trial and now meets the more specific criteria for adjunctive antipsychotic treatment. Prazosin and propranolol are not recommended treatment strategies in NG116. Benzodiazepines are not an evidence-based treatment for core PTSD and carry dependence and withdrawal risks. Combat-related aetiology does not change these pharmacological criteria.

Reference: National Institute for Health and Care Excellence. Post-traumatic stress disorder: NICE guideline NG116, recommendations 1.6.25–1.6.26. 2018; last reviewed 8 April 2025. https://www.nice.org.uk/guidance/ng116/chapter/recommendations