Bipolar I Prophylaxis — MRCPsych Paper B MCQ

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EasyMood DisordersBipolar I ProphylaxisMRCPsych Paper B

Following recovery from a first manic episode, a 29-year-old man is diagnosed with bipolar I disorder. He has no contraindication to lithium and agrees to regular blood monitoring. According to NICE CG185, which medication should be offered as first-line long-term pharmacological treatment to prevent relapse?

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Correct answer: A — Lithium

Lithium is the correct answer. NICE CG185 recommends offering lithium as first-line long-term pharmacological treatment for bipolar disorder and describes it as the most effective long-term treatment. The stem confirms that the patient accepts monitoring and has no contraindication, removing common reasons not to use it. Quetiapine is among the antipsychotics considered if lithium is ineffective, poorly tolerated or unsuitable. Valproate is not the routine next-line monotherapy in current NICE guidance and is subject to strict MHRA restrictions in new patients younger than 55 years, including men. Lamotrigine has a role principally in bipolar depression-related treatment pathways but is not NICE's first-line general prophylactic treatment. Carbamazepine is also not recommended as first-line maintenance treatment.

Reference: National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185), section 1.7, especially recommendations 1.7.5–1.7.10. 2014, amended 2023. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations