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Medication Adherence — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisMedication AdherenceMRCPsych Paper B

A 42-year-old man with schizophrenia has had two relapses caused by intentionally missing his oral antipsychotic. His symptoms respond well when he takes it, and he has no intolerable adverse effects. He has capacity to make treatment decisions and says that he would consider regular injections. According to NICE CG178, which is the most appropriate next medication strategy to discuss with him?

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Correct answer: D — Consider a depot or long-acting injectable antipsychotic collaboratively

The correct answer is D. NICE recommends considering a depot or long-acting injectable antipsychotic when avoiding intentional or unintentional non-adherence is a clinical priority. The decision should be collaborative and take account of the person's preferences and attitudes towards regular injections; this patient is willing to consider them. NICE specifically advises against adherence therapy as a discrete intervention, so B is incorrect. Increasing the oral dose does not address missed doses and would increase adverse-effect risk when medication is taken. Covert medication is not a routine adherence strategy and would require exceptional legal and ethical justification, including relevant capacity and best-interests considerations. Punitive discharge would undermine engagement and relapse prevention.

Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendations 1.4.4.7, 1.5.5.3 and 1.5.6.1. Published 2014; amended 2022. https://www.nice.org.uk/guidance/cg178/chapter/recommendations