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IPS and Cognitive Deficits — MRCPsych Paper B MCQ

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ModerateRehabilitationIPS and Cognitive DeficitsMRCPsych Paper B

A 45-year-old man with schizophrenia is clinically stable in a community rehabilitation service. He wants to obtain competitive paid employment and is able to identify his job preferences and engage with support. Neuropsychological assessment shows significant deficits in attention and verbal memory. Which approach best reflects the Individual Placement and Support model?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Refer to IPS now, adding cognitive remediation alongside vocational support if indicated

Explanation lettering: C = shown as A · A = shown as B · B = shown as C

The correct answer is B. IPS aims to help motivated people obtain mainstream competitive employment without requiring prolonged assessment, pre-vocational training or proof of “work readiness”. His attention and memory deficits may affect job matching and the support required, but they do not mandate postponement or exclusion. NICE recommends IPS for people with complex psychosis who want mainstream employment and advises that cognitive remediation can be provided alongside vocational rehabilitation. Therefore, completing cognitive remediation first (A) is unnecessary. IPS has no IQ threshold (C), and cognitive impairment is not itself a contraindication (D). Sheltered work (E) conflicts with the IPS emphasis on competitive employment, although alternative occupational schemes may be considered when a person does not currently wish or feel ready to pursue paid work.

Reference: National Institute for Health and Care Excellence. Rehabilitation for adults with complex psychosis (NG181), recommendations 1.8.10 and 1.8.13. 2020. https://www.nice.org.uk/guidance/NG181/chapter/recommendations