Challenging Behaviour — MRCPsych Paper B MCQ

Correct answer: A — Arrange prompt physical assessment for abdominal pain or illness

The correct answer is A. A recent change in behaviour in a person with intellectual disability may communicate an unmet need, including pain or physical illness. The grimacing and repeated abdominal holding particularly indicate possible abdominal pain, so prompt physical assessment is required and any identified cause should be treated. Antipsychotics are not first-line treatment for aggression alone; NICE restricts their use to situations such as failure of psychological or other interventions, persistence after treatment of contributing health problems, or very severe risk, and they must accompany other interventions. CBT-based anger management may be considered later following assessment and formulation. Increasing restrictions is inappropriate without necessity and proportionality, while DoLS authorisation addresses legal safeguards for deprivation of liberty rather than treatment of the new behaviour.

Reference: National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges (NG11), sections 1.5, 1.8 and 1.10. 2015. https://www.nice.org.uk/guidance/ng11/chapter/recommendations