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Self-Harm — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatrySelf-HarmMRCPsych Paper B

A 16-year-old girl presents to the emergency department 4 hours after intentionally taking 40 paracetamol 500 mg tablets as a single ingestion. She is alert, medically stable and able to engage in an assessment. She reports low mood and hopelessness. What is the most appropriate immediate management approach?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Start urgent overdose care while arranging a concurrent specialist psychosocial assessment

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

B is correct. A 20 g paracetamol overdose requires urgent physical assessment, including a paracetamol concentration at 4 hours and treatment according to current toxicology guidance. However, current NICE guidance also states that physical healthcare and psychosocial assessment should be carried out concurrently where the patient can participate; mental health assessment should not routinely wait until all medical treatment is complete. Option A wrongly delays time-critical overdose care. Regret or denial of current intent is insufficient for discharge without a specialist psychosocial assessment. Referral to children's social care depends on identified safeguarding concerns and does not replace either assessment. Mental Health Act detention is not an automatic first step; consent, capacity or competence, immediate safety and the appropriate legal framework must first be assessed.

Reference: NICE. Self-harm: assessment, management and preventing recurrence (NG225), recommendations 1.5.2, 1.7.2–1.7.4 and 1.7.12–1.7.14. 2022. https://www.nice.org.uk/guidance/ng225/chapter/recommendations