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Antipsychotic Discontinuation FEP — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisAntipsychotic Discontinuation FEPMRCPsych Paper B

A 27-year-old man experienced a first episode of non-affective psychosis 18 months ago. He achieved remission with amisulpride 400 mg daily and has remained well. He now wishes to stop antipsychotic treatment. After discussing the benefits, risks and his preferences, which management plan is most consistent with NICE CG178?

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Correct answer: C — Withdraw amisulpride gradually, monitor regularly during withdrawal, and continue relapse monitoring for at least 2 years after stopping

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

B is correct. NICE advises informing the patient that stopping antipsychotic medication within 1–2 years of an acute episode carries a high risk of relapse. If withdrawal is chosen through shared decision-making, the dose should be reduced gradually and the patient monitored regularly for emerging relapse. Monitoring should continue for at least 2 years after withdrawal. Abrupt cessation is inappropriate. NICE does not require lifelong treatment after every first episode, switching to another antipsychotic before withdrawal, or psychotherapy as a prerequisite for stopping. CBT and family intervention may remain helpful but do not replace gradual withdrawal and clinical follow-up.

Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendations 1.4.6.3–1.4.6.5, 2014. https://www.nice.org.uk/guidance/cg178/resources/psychosis-and-schizophrenia-in-adults-prevention-and-management-35109758952133