skip to main content

Psychological Intervention Without Medication — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSchizophrenia & PsychosisPsychological Intervention Without MedicationMRCPsych Paper B

A 20-year-old man with first-episode psychosis is assessed by an early intervention in psychosis team. He lives with his parents and agrees to their involvement. After receiving information about the benefits and adverse effects of treatment, he retains decision-making capacity but declines antipsychotic medication and wishes to try psychological treatment alone. According to NICE CG178, what is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: E — Offer individual CBTp and family intervention, review treatment within 1 month, and monitor regularly

NICE recommends explaining that psychological interventions are more effective when combined with antipsychotic medication. However, if a person with first-episode psychosis still chooses psychological treatment alone, they should be offered individual CBTp and family intervention. Treatment options, including antipsychotic medication, should be reviewed within 1 month, with regular monitoring of symptoms, distress, impairment and functioning. Psychological treatment should therefore not be withheld while awaiting medication acceptance. Supportive counselling alone is not the recommended evidence-based intervention, while offering only CBTp or only family intervention omits part of the recommended package. The original keyed answer was directionally correct, but its explanation overstated the evidence by claiming demonstrated benefit independently of medication without qualification.

Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), section 1.3.4, recommendation 1.3.4.2. 2014. https://www.nice.org.uk/guidance/cg178/chapter/recommendations