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BPSD — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryBPSDMRCPsych Paper B

A 72-year-old man with Alzheimer's disease has persistent agitation and aggression towards care-home staff. A structured assessment has identified and addressed possible clinical and environmental causes, and personalised psychosocial and environmental interventions have been tried and are continuing. According to NICE NG97, under which circumstance should an antipsychotic be offered?

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Reveal the answer and explanation

Correct answer: A — When there is a risk of harm, or agitation, hallucinations or delusions are causing severe distress

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

B is correct. NICE recommends first assessing for and addressing causes such as pain, delirium or inappropriate care and using psychosocial and environmental interventions as initial and ongoing management. Antipsychotics should be offered only if the person is at risk of harming themselves or others, or if agitation, hallucinations or delusions are causing severe distress. Psychosis is therefore neither necessary nor sufficient without severe distress or risk, excluding C. NICE does not specify an arbitrary 2-week threshold or require an SSRI trial, excluding A and D. Antipsychotics are not absolutely contraindicated, excluding E. If prescribed, use the lowest effective dose for the shortest possible time and reassess at least every 6 weeks. Risperidone's licensed dementia indication is narrower: up to 6 weeks for persistent aggression in moderate-to-severe Alzheimer's dementia after ineffective non-pharmacological approaches and where harm is possible.

Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.7.1–1.7.7. Published 2018; last reviewed 24 October 2025. https://www.nice.org.uk/guidance/ng97/resources/dementia-assessment-management-and-support-for-people-living-with-dementia-and-their-carers-pdf-1837760199109