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DC-LD Diagnostic Framework — MRCPsych Paper B MCQ

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HardIntellectual DisabilityDC-LD Diagnostic FrameworkMRCPsych Paper B

A 40-year-old man with moderate intellectual disability has limited expressive language and cannot reliably describe subjective mood symptoms. Over 4 weeks, staff who know him well have observed a clear change from baseline, including loss of interest in preferred activities, tearfulness, reduced appetite with weight loss, and disturbed sleep. A comprehensive assessment has not identified an acute physical or environmental explanation. The psychiatrist wishes to determine whether he meets criteria for a depressive disorder using a categorical diagnostic framework appropriate to his developmental and communication needs. Which is the most appropriate framework?

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Correct answer: E — Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD)

The correct answer is E. NICE NG54 explicitly identifies DC-LD as a diagnostic classification adapted for adults with intellectual disability. Here, limited expressive language makes unmodified reliance on subjective general-population criteria inappropriate, while change from baseline and collateral information from familiar staff are important. DC-LD should be used within a comprehensive specialist assessment rather than diagnosing depression from behaviour alone. Option D is incorrect because applying ICD-11 without appropriate adaptation may miss atypical or poorly communicated symptoms. The Glasgow Depression Scale carer supplement can quantify depressive symptoms and monitor change but is not a categorical diagnostic framework. The PAS-ADD Checklist is primarily a carer-completed psychiatric screening instrument, not the requested classification system. The MMSE assesses cognition and is not a depression diagnostic framework.

Reference: National Institute for Health and Care Excellence. Mental health problems in people with learning disabilities: prevention, assessment and management (NG54), sections 1.7.1–1.7.11, 2016; last reviewed 30 July 2024. https://www.nice.org.uk/guidance/NG54/chapter/Recommendations