LAI Early Use — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisLAI Early UseMRCPsych Paper B

A 26-year-old man has recovered from the acute symptoms of a first episode of psychosis. He wishes to continue antipsychotic treatment but would prefer regular injections because he expects to forget daily tablets. According to NICE CG178, when should a long-acting injectable antipsychotic be considered?

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Correct answer: A — After the acute episode, when he prefers it or avoiding covert non-adherence is a clinical priority

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

B is correct. NICE CG178 recommends considering a depot or long-acting injectable antipsychotic when the person prefers this formulation after an acute episode, or when avoiding covert non-adherence—whether intentional or unintentional—is a clinical priority. His recovery from the acute episode, preference for injections and anticipated difficulty remembering tablets satisfy these criteria. An LAI does not require established treatment resistance; treatment resistance instead prompts assessment for clozapine after two adequate antipsychotic trials. NICE specifies neither a minimum duration of oral treatment nor a forensic or compulsory-treatment requirement. The original wording was repaired because describing an LAI simply as a “first-line” option overstates NICE: for first-episode psychosis, NICE specifically recommends oral antipsychotic medication with psychological interventions, while its LAI recommendation refers to use after the acute episode.

Reference: NICE. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendation 1.5.5.3, 2014. https://www.nice.org.uk/guidance/cg178/chapter/recommendations