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BPD Crisis — MRCPsych Paper B MCQ

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ModeratePersonality DisordersBPD CrisisMRCPsych Paper B

A 33-year-old woman with established borderline personality disorder presents after an argument with her partner and has made superficial cuts requiring simple first aid. Following psychosocial assessment, she denies current suicidal intent or plans, has no psychosis or intoxication, and her immediate risk can be managed with community support. She requests admission because she feels unable to cope at home. According to NICE CG78, what is the most appropriate next step?

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

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Correct answer: A — Consult her crisis plan, identify coping strategies collaboratively, explore community alternatives to admission and arrange prompt follow-up

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

B is correct. NICE recommends consulting the existing crisis plan, understanding and validating the person's distress, encouraging reflection on manageable solutions, exploring alternatives to hospital admission and arranging follow-up at an agreed time. Admission is not indicated solely because it is requested; it is reserved for significant risk to self or others that cannot be managed by other services, or when Mental Health Act detention is required. Discharge without psychosocial assessment and follow-up would be unsafe. Diazepam for 2 weeks is inappropriate: medication should not replace suitable crisis interventions, and any sedative used cautiously in a crisis should have low addictive and misuse potential and normally be stopped within 1 week. Structured psychotherapy may be appropriate for longer-term treatment but is not initiated as the immediate response to this crisis.

Reference: NICE. Borderline personality disorder: recognition and management (CG78), sections 1.3.7 and 1.4.1. 2009. https://www.nice.org.uk/guidance/cg78/chapter/Recommendations