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ECT — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

HardMood DisordersECTMRCPsych Paper B

A 50-year-old man with severe depression has not responded to three adequate antidepressant trials or augmentation with lithium. He gives informed consent for ECT and asks how the initial electrode placement will be chosen. Which statement most accurately reflects current NICE NG222 guidance?

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

Reveal the answer and explanation

Correct answer: A — Do not mandate a placement; individualise treatment under ECTAS standards

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

B is correct. Current NICE NG222 does not mandate right unilateral, bitemporal or bifrontal ECT as the universal initial placement. It requires discussion of patient-specific risks—particularly cognitive impairment—shared decision-making based on clinical needs and preferences, and administration according to ECTAS standards. Electrode placement is therefore selected by the specialist ECT team as part of an individualised prescription. Right unilateral ECT may be chosen to reduce memory effects, while bilateral ECT may produce a faster response, but neither is designated by NICE as the routine initial placement. Bifrontal placement is not identified as the NICE default. Placement is not irrelevant because it influences both efficacy and cognitive adverse effects.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management, NG222, section 1.13: Electroconvulsive therapy for depression. 2022. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations