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Psychiatric Rehabilitation — MRCPsych Paper B MCQ

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ModerateRehabilitationPsychiatric RehabilitationMRCPsych Paper B

A 48-year-old man with schizophrenia has experienced persistent negative symptoms and marked impairment in social and everyday functioning. He has been an inpatient for 5 years and has now been accepted by a specialist inpatient rehabilitation service. His mental state is stable on a tolerated antipsychotic, and there is no immediate risk requiring acute intervention. Which is the most appropriate initial step in developing his rehabilitation plan?

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Correct answer: B — Complete a multidisciplinary biopsychosocial needs assessment and team formulation

The correct answer is B. NICE recommends that people entering rehabilitation for complex psychosis receive a comprehensive multidisciplinary biopsychosocial needs assessment. This covers mental and physical health, treatment history, risk and vulnerability, accommodation, occupation, social networks, cognition and activities of daily living. The findings inform a team formulation and a collaborative care plan incorporating the person’s recovery goals. Medication optimisation may be one component, but dose escalation is not the organising principle of rehabilitation and is not specifically indicated here. Accommodation should match assessed functioning and support needs rather than defaulting immediately to independence. Specialist rehabilitation care should not be transferred solely to primary care. Social-skills interventions may be useful, but they should be individualised and selected after assessment.

Reference: National Institute for Health and Care Excellence. Rehabilitation for adults with complex psychosis (NG181), sections 1.7.1–1.7.7: Person-centred care planning through assessment and formulation. 2020. https://www.nice.org.uk/guidance/NG181/chapter/recommendations