Psychopathy Treatment — MRCPsych Paper B MCQ
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Correct answer: C — Evidence remains limited, and a high PCL-R score alone does not establish non-response; adapted, extended cognitive-behavioural interventions targeting offending may be considered.
Explanation lettering: C = shown as A · A = shown as B · B = shown as C · E = shown as D · D = shown as E
B is correct. The evidence base for treating psychopathy is limited and methodologically weak; a high PCL-R score should not be treated as proof that intervention is futile or predictably harmful. NICE recommends considering cognitive and behavioural programmes targeting offending and antisocial behaviour, adapted through increased duration, concurrent individual and group work, booster sessions, follow-up and close monitoring. CBT has not been shown reliably to eliminate the core affective-interpersonal traits, so A overstates efficacy. Pharmacotherapy is not the mainstay and should not routinely be used solely for antisocial personality disorder, aggression or impulsivity, making C incorrect. Although some antisocial behaviour may decline with age, psychopathy does not predictably resolve spontaneously, excluding D. EMDR may be relevant to comorbid PTSD but is not a treatment of choice for psychopathy itself, excluding E.
Reference: National Institute for Health and Care Excellence. Antisocial personality disorder: prevention and management (CG77), recommendations 1.5.1.1 and 1.4.3.1. 2009, updated 2013. https://www.nice.org.uk/guidance/cg77/chapter/Recommendations