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Negative Symptoms — MRCPsych Paper B MCQ

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HardRehabilitationNegative SymptomsMRCPsych Paper B

A 60-year-old man undergoing psychiatric rehabilitation has schizophrenia with persistent avolition, social withdrawal and poverty of speech. His positive symptoms are controlled on aripiprazole. Assessment finds no depressive syndrome, active psychosis, substance misuse, extrapyramidal adverse effects or oversedation that would account for secondary negative symptoms. Which psychosocial intervention is singled out by current NICE guidance for particular consideration to promote recovery in people with negative symptoms?

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Correct answer: D — Group arts therapy

The correct answer is D. NICE CG178 specifically advises considering arts therapies to promote recovery, particularly in people with negative symptoms. These are structured psychotherapeutic interventions delivered by an appropriately registered arts therapist, rather than recreational art activities. CBTp is also offered in schizophrenia and may address persistent symptoms and functioning, but it is not the intervention uniquely highlighted by NICE for particular consideration in negative symptoms. Cognitive remediation can improve cognition and sometimes functioning or negative-symptom ratings, but NICE surveillance found the evidence mixed and did not recommend it; combining it with social skills training is therefore not an established UK first-choice answer. Psychodynamic psychotherapy and motivational interviewing are not specifically recommended treatments for enduring negative symptoms.

Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendations 1.4.4.3 and 1.5.4.4. 2014; last reviewed 2025. https://www.nice.org.uk/guidance/cg178/chapter/Recommendations